This blog post is offered as a small attempt to focus and highlight a positive, at a time when it feels like the world could do with some more positivity, and evidence based fact.

Last week I made 235 Freedom of Information requests. I know, I know, Jack Straw would be having a fit if he saw that, but let me explain my reasons why:

1. I consider that to force/encourage/model a change of culture in relation to patient safety, and deaths in particular, we need to start talking more openly about deaths and things going wrong in healthcare.
2. I think to have an informed conversation, we need information, facts. These facts are not routinely made available by NHS Trusts.
3. All of the available evidence suggests that certain groups of patients die years earlier than others. My own personal interest on this occasion is in relation to patients with a learning disability. Trusts do not routinely make available or report on their care of this group of patients.

The request I made was about the numbers of deaths, the numbers of those classified as unexpected, deaths referred to a Coroner, deaths of patients with a learning disability, reporting onto NRLS and STEIS, and the numbers and types of investigations that have taken place over the past five years.

I phased my request over three days (even a whizz at copy and paste like myself loses concentration after a hundred or so goes) and what became rapidly clear once the requests were all in, and the acknowledgements started, was that what I was asking was unclear.

I had asked about data for the last five years (without specifying whether I meant financial or calendar – I’d assumed financial but hadn’t been clear about that), I had intentionally not provided a definition of unexpected because I’m interested in what happens locally and therefore didn’t want to impress a framework on that (but had not made that clear enough), I had not made it clear whether I meant just inpatients or community patients as well (I’m interested in all) and my questions didn’t make a lot of sense to ambulance trusts.

What I loved was the way in which the FOI Officers who responded, did so. Make no mistake, FOI Officers are under as much pressure as many other parts of the NHS. If you’re in doubt check out these snippets received as auto responders to one of my requests:

May I wish you a Happy New Year and ask for some goodwill toward FOI officers in the year ahead.
Please bear with us as we are very very very busy and struggling.

Then the footer from the same person a day or so later:

Due to the amount of Freedom of Information requests we are receiving
around 150% of what we received in 2015, 325% of what we received in 2013
and reductions in staff to deal with requests across the Trust, please
accept this as confirmation of receipt of your request.
​​
Whilst we are under resourced due to the increase in workloads, we will
endeavour to provide a full response within 20 UK working days, should
there be any problems we will try to keep you updated if you have provided
telephone numbers that you are contactable on.

I’m fairly sure that this is not exceptional to this Trust.

If I’m honest initially I wasn’t sure how I felt about the advertising of how busy they are, it felt a little crass, almost like washing your dirty linen in public (if you’re under resourced and over stretched then surely complaining internally to your managers, not externally to your customers (as I guess that’s what we are) would be more appropriate). With time and a bit of reflection on this situation I decided that I respected the honesty, the making public what is usually hidden within NHS Trusts, the owning the pressure and the managing of expectations (I also assume that complaints internally have fallen on stony ground).

So, I’ve just put in 235 FOIs and I’m now feeling a low level guilt at adding to people’s workloads, and at how unclear my carefully crafted request was. To date I’ve had 195 requests acknowledged, 20 clarified and 5 already answered. I’m not sure how useful the information I receive will be, time will tell, but the care and attention of the FOI Officers is really appreciated.

One or two responses** have changed my gender to Mr Julian because I signed my request Dr Julian (hello its 2017, women can have qualifications too) but that is about my only grumble. Without fail communications have been polite, they have been timely, they have been clear about when a response can be expected. One or two responses have been intimidatingly officious, such as the acknowledgment of my request that contained 1891 words across 44 paragraphs, but at least I know where I stand (if I can read them all).

Overall though I wanted to blog to acknowledge the good qualities of those initial responses – the fact that requests are acknowledged, that timescales are clear, that confusions are clarified and that generally it feels like my request is both reasonable and important to the person responding.

The quality of what I get back is a different matter, but for now I wanted to acknowledge the professionalism, courtesy and care shown by NHS FOI Officers. They could probably share a lot with colleagues elsewhere, reflections on and learning about honesty, transparency and professionalism.

Thank you Team FOI, you’re all appreciated.

** I’ve just counted them, twelve responses have changed my gender so far. It’s not a big thing (to me) but its totally unnecessary too – if I sign off as Dr Julian, why not reply to Dr Julian? Or to George? Or applicant or requester? Or drop the titles altogether and just go with Hello, Hi, Good Morning or Good Afternoon?

ps I should also acknowledge the absolute brilliance of the platform that is What Do They Know and the amazing volunteers who run it. I’ll be making a donation the next time I get an invoice paid, but feel free to splash some cash in their direction if you’re feeling flush this month.