London, United Kingdom - The highest echelons of Britain's National Health Service are under unprecedented scrutiny after damaging allegations linked the deaths of new-born babies to cover-ups, incompetence and smear campaigns by senior health officials.
The deaths of 16 babies and two mothers, alongside numerous clinical disasters that left babies brain damaged, may have been avoided if clinical failures at Morecambe Bay NHS Trust in northwest England had been properly investigated, it was revealed in parliament.
At the heart of the media storm were senior managers at the Care Quality Commission, the beleaguered health and safety watchdog, who allegedly destroyed a damning internal review that showed its own inspection failures had left patients at risk of seriously poor care.
The police are being urged to investigate allegations of perverting the course of justice and misconduct in public office. Meanwhile, a drip, drip, of damaging headlines has dragged the most senior NHS figures, including health ministers past and present, into the worsening storm.
|Anger at privatisation of British healthcare
This is the latest in a series of NHS scandals over recent years that have been exposed by persistent, grieving relatives of patients who died as a result of substandard care. In many cases, whistle-blowers who tried to do the right thing were bullied, smeared and gagged by senior managers seemingly above censure, who used millions of taxpayer pounds to protect reputations rather than patients.
After each exposé, government ministers have vowed that "lessons have been learned" and "never again". The endurance of certain senior managers has led some to wonder if there exists an "NHS Mafia" of sorts.
This chapter of the story starts with James Titcombe, whose 10-day-old son Joshua tragically died at Furness General Hospital - part of Morecambe Bay NHS Trust - in November 2008 from a simple treatable infection, just as the CQC took over as the new super-regulator.
Internal documents show in 2009 at least one CQC senior official went on to warn his bosses about "future tragedies" unless there were significant improvements in maternity care. The CQC and Health Ombudsman - the highest complaint authority within the NHS - were also aware of safety problems across the trust, documents show.
Nevertheless, the CQC gave Morecambe Bay a clean bill of health in 2010, according to the CQC's own internal review describing botched inspections by inexperienced inspectors. Titcombe was assured the CQC was taking robust action to improve standards.
In fact, the regulator did not launch an investigation until the end of 2011, by which time the trust had registered 600 "excess" or unexpected deaths in four years.
Sensing he was being fobbed off, Titcombe sought the help of Kay Sheldon, a non-executive CQC board member, who was also voicing similar concerns independently. But Sheldon was bullied and ostracised after raising concerns about the CQC inspections to the board. She eventually blew the whistle on incompetence, poor leadership, bullying and lack of accountability within the CQC in 2011.
The CQC chair Dame Jo Williams responded robustly - she launched a campaign to smear Sheldon as mentally unstable in order to get her removed from the board. Williams was forced to resign last September after The Independent newspaper exposed her dirty tactics .
Sheldon avoided the sack by threatening legal action against then Conservative health secretary, Andrew Lansley. Her tenure on the CQC board, which ends in November, is not being renewed.
Watching the watchdogs
David Behan was brought in as new CQC chief executive last summer, as part of an executive clear-out by the Department of Health. Behan ordered Grant Thornton, a management consultancy firm, to investigate the whole Morecombe Bay shambles. By this time, 30 families were suing the trust for clinical negligence.
It was the Grant Thornton report published by the CQC earlier this month that kicked off the media frenzy.
Initially all names were redacted, apparently to comply with data protection laws. Health Minister Jeremy Hunt defended the redaction in parliament, but was quickly forced onto the back foot after Britain's information commissioner said the law did not prevent naming those involved.
The real criminal cover-up is that babies died needlessly because the CQC ignored serous warnings.
The names were released: former deputy CEO Jill Finney, who allegedly ordered the deletion of the critical internal report at a meeting in March 2012; former CEO Cynthia Bower, who allegedly supported the deletion before leaving with a £1.4m ($2m) pension payout, and Anna Jefferson, a media manager who still works at the CQC, also accused of supporting the decision.
Within hours, Finney was sacked from her new private sector job and Bower resigned from her new NHS post. Hunt vowed to dock their pensions - pretty much an impossible task unless they are convicted of a crime.
All three vehemently deny a cover-up, and say the internal report wasn't published because it was not "fit for purpose".
Jefferson published information online that casts doubt over Grant Thornton's conclusions. Bower is reportedly considering legal action, accusing her former organisation of "hanging her out to dry".
In another twist, it turned out the CQC only provided Grant Thornton with emails from one year, claiming the other six years were unavailable because of "a technical difficulty".
Titcombe, without whom none of this would have come to light, told Al Jazeera the cover-up meeting was a "red herring".
"The critical internal review was hidden from both me and Kay Sheldon, so there was some sort of cover-up, but all this attention on that one meeting takes the focus away from much deeper corruption. For me, the real criminal cover-up is that babies died needlessly because the CQC ignored serous warnings about future tragedies for more than two years. I have grave concerns about the Grant Thornton report and certainly don't accept its conclusion that the CQC and Ombudsman acted in good faith."
Not an isolated case
Baby Joshua died just months after the NHS' biggest ever scandal came to light at Stafford Hospital - run by the Mid-Staffordshire NHS Trust - which saw reports of patients left lying in their urine and others resorting to drinking from flower pots. That trust had also been certified as safe by regulators, while hundreds of people died from substandard care as managers pursued financial targets . Bower at the time was chief executive of NHS West Midlands, which was in charge of Mid Staffs. Relatives of the dead exposed the failings; the government promised "never again".
The Morecambe Bay mess unfolded as two public inquiries into Mid Staffs took place. These cleared the government of wrongdoing, but former Labour health minister Andy Burnham was last week again forced to publicly deny pressuring the CQC to "bury" other bad news.
It is becoming increasingly difficult to dismiss NHS scandals as isolated tragedies after so many high-prolife cases bearing similar hallmarks.
Gary Walker was sacked as chief executive of United Lincolnshire Hospitals NHS Trust in 2010 for allegedly swearing during a board meeting. It turned out Walker had refused to meet non-urgent waiting time targets, a key Labour government priority at the time, because his hospitals were "dangerously full" with emergency cases and he feared for patient safety.
There is a small section of the senior NHS leadership running a 'protection racket' in which people bearing bad news are threatened, gagged, their careers finished, all done using millions of pounds of public money in order to protect themselves and their friends.
His manager at the time, Dr Barbara Hakin, now number two in the NHS hierarchy, told him to meet the targets "whatever the demand" or else make up an excuse and leave quietly.
An "independent review" commissioned by NHS top-dog Sir David Nicholson cleared Hakin and found nothing amiss.
Just over a year later, the trust paid Walker three years' salary to settle the employment tribunal case, insisting he sign a 17-page gagging order, or compromise agreement, banning him from discussing the case. He broke the gag in February 2013, despite threats of legal action from the trust. The sacking cost taxpayers close to a million pounds.
Mortality rates increased significantly in Lincolnshire after Walker's departure. His NHS career was left in tatters, while Hakin got promoted. She is, however, currently under investigation by the General Medical Council for her actions in this case.
"There is a small section of the senior NHS leadership running a 'protection racket' in which people bearing bad news are threatened, gagged, their careers finished, all done using millions of pounds of public money in order to protect themselves and their friends," Walker told Al Jazeera. "This is why the term 'NHS mafia' is doing the rounds."
Walker is among hundreds of NHS workers who have signed compromise agreements costing the taxpayer millions in the past four years, according to the National Audit Office.
"We need a commission to review every single one, to find out whether any patients have been harmed as a result of these buy-offs," said Walker.
He added: "It is clear from my case and others that the NHS has no concept of what an independent review looks like. Recruiting people you know to investigate people you know is not independent."
Regulation per se fits uncomfortably with the ideology of some parts of the current government, but it would be a disaster to use this as an excuse to give up on it altogether.
Health Secretary Hunt said recently he could not guarantee patients that hospitals were safe.
Peter Walsh, chief executive of the charity Action Against Medical Accidents, told Al Jazeera that regulation must be strengthened.
"The recent scandals are the result of a long-term culture within the NHS and Department of Health which has tolerated a lack of transparency and even downright dishonesty, and a 'tick box' attitude to regulation," he said.
"Regulation per se fits uncomfortably with the ideology of some parts of the current government, but it would be a disaster to use this as an excuse to give up on it altogether."
Hunt promised the CQC an extra £40m ($61m) and ordered a new specialist inspection regime. However, many of the key recommendations from the Mid Staffs inquiry, which address systemic cultural and leadership problems have not yet been accepted by the government.
The NHS is the biggest employer in Europe, with more than a million staff. Frontline workers are understandably angry and frustrated at the current media and political onslaught, when the vast majority of staff work incredibly hard for patients - despite dealing with savage funding cuts and unwanted structural re-organisations.
But with more revelations promised for the coming week, one of Britain's most loved institutions is in danger of damaging its reputation for excellence. This would play right into the hands of those in parliament and industry who favour further privatisation of the nation's universal healthcare system.
Follow Nina Lakhani on Twitter: @ninalakhani