Eating some NHS FOI Dog Food*

TL;DR: Summary of how to FOI all NHS Trusts in England and what terrible experience that follows.

Background

At the start of 2021, I published some research that I started in about November 2020. This research attempted to look at how many Trusts had a CDIO (or equivalent on the Board). The research methodology is explained in that article, but involved me viewing each Trust website in turn and then doing some google/twitter/LinkedIn searching. I think it took me about 3 months in total. At the start of 2023, as part of my annual goal setting I committed to refreshing the research. However, given the length of time it took to view 226 Trusts, I thought it may be easier and quicker to just FOI each Trust, with a set of questions using a standard template, particularly given a) I was going to ask for information generally not available on Trust websites and b) Working for a Trust, I know this data will exist. HOW WRONG I WAS.

Methodology

1. I obtained a list of all FOI email addresses from the FOI Directory maintained by Matt Burgess and copied this spreadsheet locally.
2. I then created a list of questions. I decided that whilst I was asking the question about Board representation, I’d collect some other useful information too. I tested out this list of questions with a friendly FOI person I knew from a different Trust to my current one. They suggested formulating the questions into a spreadsheet to make collation of all the results simple.
3. I created the spreadsheet for Trusts to complete for me (see example below).
4. I researched how I’d be able to do a mail merge that emailed each Trust on the FOI Directory list and could also attach a spreadsheet to each. It turns out that MS-Word’s default mail merge can’t attach a document to the mail merged documents. I did more research on how this could be done via macros but many of those solutions involved buying a bespoke application for Windows or running a macro or extension, which always makes me nervous. What I ended up doing instead was deciding to do it using the Google suite of tools open to me.
5. I created a dedicated gmail email address for the correspondence associated with this project. I figured that they’d be some backwards and forwards and wanted to separate it from my normal inbox. I also used this gmail account to create a separate profile in my chrome browser.
6. I found an extension for Google Sheets called Mail Merge for Gmail. The free version permits the user to send up to 25 emails per day. Given I was only sending out c.150 emails from the original list, and being very tight, I thought I could live with this. The instructions to use the extension were simple enough I set up a spreadsheet using the fields required. The extension sent out the 25 emails each day, and logged the date and time they were sent (see second image below).
7. I then tracked the questions/queries from each Trust by adding in comments on the single row for each Trust.
8. What I wasn’t anticipating was the amount of data correction work needed. Loads of Trusts had changed to nhs.net accounts or merged organisations since the FOI Directory list was created, so there was a lot of monitoring the inbox I’d set up, finding out the correct email address and adding the new email to the bottom of the mail merge source. In the end there was 32 out of the original 151 that required some modification. As part of this work I’ve emailed Matt from the NHS Directory with the updated list.
9. What I also wasn’t expecting was the handful of Trust who didn’t respond to emails direct, but directed you to their online FOI webpage, some of which included — Dartford and Gravesham, Isle of Wight, North Bristol, Shrewsbury and Telford, St George’s, Newcastle Upon Tyne, University Hospitals of Coventry and Warwick, Western Sussex, Wirral University Teaching Hospital, Cambridge University Hospitals. Of those who used these forms, they then followed it up, asking me for the copy of the spreadsheet that wasn’t able to be uploaded to their site. The worst one of these was Isle of Wight, which required you to set up an account before you could submit and FOI, which seemed an unnecessary speed bump.
10. I then monitored the inbox every few days. Little was I to know how many months I’d be monitoring the inbox for.

3. Spreadsheet for all Trusts to complete

6. Tracking delivery using Mail Merge for GMail

The Results

The analysis of the results will be the subject of a separate blog, but it is illuminating to see the response rate.

Of the 138 Trusts I sent an FOI to in November 2023, 28 have yet to respond at the time of writing. Of those:

• 3 have had the clock reset due to my original request being send to an old email address (e.g. change to NHS.net)
• 25 have yet to send a response, despite a delay ranging from 388 days to 148 days). Embarrassingly, this includes my own Trust, and the team for whom I’m responsible for. This is obviously well outside the statutory deadline of 20 days.

Of the 109 who have responded at the time of writing:

• Very few (c.30) responded within the statutory deadline, although this is quite hard to calculate as a few Trusts sought clarification e.g. “Are you making the request using your real name” and some asked for clarification about my questions e.g. “what does PA mean”. So for the purposes of this calculation, I’ve
• Many others took some chasing. I sent follow up emails at least three times to the longest delaying Trusts. The mean response time is 90 days.

Days taken to respond

One of the most frustrating scenarios was when, after hearing nothing but an initial acknowledgement email from the Trust, I sent a chase email after about 100 days and several Trusts responded with a message along the lines of “Since we’ve not heard from you in the last 20 days, we assumed you no longer wanted this information” which I felt was very poor customer interaction.

Tips for Future FOIs to NHS Trusts

1. Declare that you are using your real name in the original request. It will save quite a bit of confirmation and get the clock running sooner.
2. If you are not a journalist, declare that you are not. This was a question 5 Trusts asked. One said it would “help our statistics for internal reporting if you could confirm if you are a freelance journalist or from a commercial company?”, whereas several others used the phrase: “In accordance with ICO (Information Commissioner’s Office) FOI (Freedom of Information) guidance, the Trust reserves the right to:…Enquire [sic] whether the information being sought is with a view to being released into the public domain (e.g. MP, Media Outlet, Journalist) especially in any instances where there is reason to believe that disclosure may be likely to cause prejudice and/or harm”
3. Make sure you update Matt Burgess at the FOI Directory with any changes to email address you find.

Would I use FOI again?

Having to wait over 300 days is a bit ridiculous, and there is no wonder members of the public feel so frustrated, they feel compelled to report Trusts to the ICO, although doing this requires the requester to have asked the Trust to completed an “internal review” before reporting to the ICO. Despite my frustration, I didn’t feel this was appropriate for me to do.

Unfortunately, the amount of useful information included in Trust publication schemes is very limited, and therefore to obtain useful information, the FOI scheme seems to be the only route. However, if I’d known how long it would have taken, I may have decided to restrict my research to publicly published information on Trust websites and social media as in 2021. There is some question now as to the validity of the data I’ve obtained, since many things will have changed in the past 300 days. I’ll have to make sure I declare that and take it into account when I publish the analysis.

* The term Eating Your Own Dog Food was a phrase used in my days of writing software for a living. It is the practice of using one’s own products or services. This can be a way for an organization to test its products in real-world usage using product management techniques. Given that my team are responsible for fielding FOI’s in my Trust, this is a good example of me attempting to eat my own dog food.