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Trust CEOs decry ‘undeliverable’ and damaging financial plans

NHS trusts have committed to financial plans without properly considering their consequences, with finance directors turning a blind eye to unrealistic forecasts under pressure from NHS England, some of the country’s top NHS chief executives have warned.

Many of the senior trust leaders speaking at HSJ’s Top CEOs roundtable admitted they had gone further than they wanted to in agreeing to higher levels of planned savings.

At the roundtable event, University College London Hospitals Foundation Trust CEO David Probert said there were “definite challenges to the professionalism of some of our fantastic finance leaders”, who were “being asked to put in place plans that [they] may not fully agree are deliverable or are highly risky.”

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Source: HSJ, 7 July 2023

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Trust CEOs could ‘end up in prison’ because of ‘unsafe’ hospitals, warns chief

An acute trust chief executive has criticised the lack of communication during last month’s nursing strike, warning that he and other accountable officers could face manslaughter charges if patients are put in danger by decisions made by senior colleagues elsewhere in the system.

Matthew Hopkins told a board meeting that Worcestershire Royal Hospital’s emergency department was “pushed to the extreme” on 20 December, with 176 people squeezed into a facility originally built for 50.

He said that without warning from regional colleagues, an additional 18 people were brought in to the hospital by the ambulance service and ended up in corridors, at which point the trust declared a critical incident.

The chief executive officer said he wanted to put on record an apology to staff for the incident, adding that he was “not aware” of the situation until it unfolded.

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Source: HSJ, 17 January 2023

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Trust CEOs and chairs to blame for care failings which saw death of over 40 babies

A series of chairs and chief executives at an acute trust were ‘wrong’ to believe the organisation was providing acceptable care over an 11-year period and should be held accountable for one of NHS’s largest maternity care scandals, an inquiry concluded today.

Bill Kirkup’s inquiry into East Kent Hospitals University Foundation Trust found 45 of the 65 deaths of babies examined could have been prevented. It also concluded the overall outcome of 48% of 202 cases investigated could have been different, if care had matched nationally recognised standards. 

It also warned that the unjustified belief that things “would get better” as a result of management changes still continued at the trust.

The report added that problems in the service were visible to senior managers and the board through a succession of reports, dating back to 2009. 

The report stated: “We have concluded that accountability lies with the successive trust boards and the successive chief executives and chairs. They had the information that there were serious failings, and they were in a position to act; but they ignored the warning signs and strenuously challenged repeated attempts to point out problems. This encouraged the belief that all was well, or at least near enough to be acceptable. They were wrong.”

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Trust CEOs accuse police of ‘high stakes game of chicken’

Ambulance chiefs have warned that patients are coming to harm, paramedics are being assaulted and control room staff reporting a “high stakes game of chicken” with police during the implementation of a controversial new national care model.

The Association of Ambulance Chief Executives say in a newly published letter they believe the “spirit” of national agreement on how to implement the Right Care, Right Person model is not being followed by police, raising “significant safety concerns”.

The membership body set out multiple concerns about the rollout of the model, under which the police refuse to attend mental health calls unless there is a risk to life or of serious harm.

In the letter to Commons health and social care committee chair Steve Brine, AACE chair Daren Mochrie says timescales for introducing it were often “set by the police rather than “agreed” following meaningful engagement with partners”, meaning demand was shifting before health systems had built capacity. They also flag a lack of NHS funding to meet the new asks. 

Mr Mochrie, also CEO of North West Ambulance Service Trust, described a “grey area” relating to what he called “concern for welfare” calls, which meet neither the police nor attendance services’ threshold for attendance.

“To date this is the single biggest feedback theme we have heard from ambulance services, with some control room staff describing feeling like they’re in a ‘high-stakes game of chicken’ where the police have refused to attend and told the caller to hang up, redial 999 and ask for an ambulance,” he wrote.

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Source: HSJ, 20 February 2024

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Trust CEO asks for ‘scientific evidence’ on covid vaccine safety to reassure staff

NHS trust chief executives have told HSJ  they need more clarity the Pfizer-BioNTech covid vaccine is safe to reassure their worried staff. 

Trusts were told last week they need to be ready to start vaccinating their staff from early next month. On Tuesday, it was confirmed that they would initially be asked to use the covid vaccine produced by Pfizer and BioNTech, assuming it is granted a licence by the Medicines and Healthcare products Regulatory Agency.

Speaking at the HSJ Provider Virtual Summit, St George’s University Hospitals Foundation Trust chief executive Jacqueline Totterdell said there was a lot of “anxiety” around the vaccine among her staff. Leeds Community Healthcare Trust chief Thea Stein added leaders in her city feel “anxious and uncertain”.

Ms Totterdell said: “As a responsible officer for 9,000 staff, I also need to be clear that the vaccination is safe. That bit of narrative just needs to come out from the centre, about the reasons why they think it is safe.

“I think there is a lot of anxiety, and some of the polls we’ve done around south west London show that as little as 50 per cent of people are willing just to have it without any of that [assurance]."

Northumbria Healthcare FT chief executive Sir Jim Mackey, who also spoke at the summit, admitted he was “a bit surprised” by some staff who said they were not going to get the vaccine.

The former NHS Improvement chief added: “I think when it actually comes to it, and we get the messaging right about it, not just the responsibility for you but also your responsibility for the people you work with… then the vast majority of people will get it and take confidence in the fact that it’s been developed really quickly and effectively.

“These things don’t get signed off if they’re dangerous, so we need to embrace it as the thing that’s going to get us back to normal.”

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Source: HSJ, 26 November 2020

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Trust CEO apologises to staff subjected to racist behaviour

A chief executive has apologised after a survey of his trust’s staff from minority ethnic backgrounds found many had been subjected to racist behaviour by colleagues.

The staff at East of England Ambulance Service Trust said peers had made monkey noises and referred to banana boats in front of them, excluded them from social events, and assumed they could speak Middle Eastern and Asian languages just because of their skin colour, they told researchers.

The trust has had substantial cultural problems for several years, and commissioned the survey to “better understand the experience, perceptions and realities of the trust BME staff”, a board paper said.

The report on its findings, published this week in trust board papers, warns: “There are risks that a minority of EEAST employees are demonstrating behaviours or using language which could be perceived as racist. Reports of subsequent inaction by managers further risk this behaviour being normalised.”

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Source: HSJ, 15 March 2023

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Trust CEO ‘behaved poorly’ and chair was ‘complicit’, NHS England review concludes

An NHS England review into the behaviour of high-profile senior leaders who took over a Midlands trust has concluded that the interim CEO “behaved poorly and inappropriately” while its chair was “complicit with” and failed to address problems.

NHS England had commissioned an independent probe into allegations about the behaviour of new executives, who had recently been appointed to the board of Walsall Healthcare Trust.

David Loughton and Professor Steve Field, who hold the same roles at the Royal Wolverhampton Trust, were brought in as interim chief executive and chair respectively in spring 2021.

Walsall has faced care quality concerns for some years and it was hoped the pair from neighbouring Wolverhampton would bring improvements. 

Dr McLean wrote in her review: “Leadership changes can, understandably, represent a period of anxiety for those affected but this can be minimised if changes are made in line with appropriate values and processes. 

“Whilst I conclude that the joint chair and interim CEO were motivated to act in the best interests of patients, I was saddened by much of what I heard.

”In the narratives I heard, there was a consistent lack of compassion or respect for people.”

She concluded: “The interim CEO, while motivated by the safety and care of patients, has behaved poorly and inappropriately … the joint chair has been complicit with and failed to address this behaviour.”

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Source: HSJ, 2 February 2022

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Trust branded ‘inadequate’ for leadership and maternity

One of the trusts worst affected by coronavirus has been issued with two warning notices and rated ‘inadequate’ for leadership, following a Care Quality Commission inspection.

The regulator raised serious concerns about the safety of Countess of Chester Hospital Foundation Trust’s maternity services, as well as the oversight and learning from incidents.

It also found staff were experiencing multiple problems with a newly installed electronic patient record, while systems for managing the elective waiting list were said to be unsuitable.

In maternity services, the inspectors flagged severe staff shortages and a failure to properly investigate safety incidents.

They said there were three occasions during the inspections when the antenatal and post-natal ward was served by only one midwife, despite the interim head of midwifery saying this would never happen. 

Inspectors also highlighted five incidents last year where women had suffered a major post-partum haemorrhage, involving the loss of more than two litres of blood and which resulted in an unplanned hysterectomy. The CQC said two were not reported as serious incidents, and where learning had been identified from the others, action plans were not being completed on time.

The CQC said it was only made aware of the incidents by a whistleblower, while internal actions agreed in December 2021 had still not been implemented two months later.

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Source: HSJ, 15 June 2022

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Trust bosses fear fallout of co-ordinated strikes

Trust leaders have raised concerns about other major unions striking on the same dates as the Royal College of Nursing in co-ordinated action, which would make avoiding disruption and harm ‘more hairy’.

The concerns were raised after the Royal College of Nursing confirmed members at various trusts had voted in favour of unprecedented action last week, with Unison and a raft of other unions also balloting members on strike action this month and in December.

Unison told HSJ co-ordinated action between itself, the RCN and the other health unions was “the best way to ensure industrial action is effective”.

One senior trust leader said that while the RCN strike days would prove a major challenge, they predicted their trust would be able to cope with the fallout. But they said the challenge would get even “more hairy” if Unison members also walked out on the same dates – a prospect they feared likely.

HSJ also understands that trust bosses have concerns about what will and won’t be classified as urgent and also about the emergency work to be carried out throughout a strike.

One senior provider figure used the example of insulin injections, which are at present to be part of the urgent and emergency care activities to continue throughout a strike, and wound treatment services, which, at this stage, are not.

They said: “If people don’t get those [insulin] injections twice a day, that person, by the end of 24 hours, will be in hospital [but] we are negotiating on [other areas] for example wound care. If you don’t dress people’s wounds at the right time, the worst situation is that a [deteriorating] wound means your leg has to be chopped off. At the moment, doing wound care is not being considered urgent care.”

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Source: HSJ, 15 November 2022

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Trust boss warns region faces ‘absolute crisis’ with trusts ‘hanging on by their fingernails’

Hospital chiefs in the South West have warned the region will not avoid the extreme pressures felt by other parts of the NHS amid rapidly rising numbers of COVID-19 inpatients.

The region was the least affected area of England during the pandemic’s first wave, but the medical director of two acute trusts yesterday predicted a “tidal wave” of COVID-19 coming to the West Country.

Adrian Harris, medical director at Royal Devon and Exeter Foundation Trust and Northern Devon Healthcare Trust (NDHT), said the region faced an “absolute crisis” and individual trusts would be “hanging on by their fingernails”.

His comments, made at NDHT’s board meeting, came on the same day HSJ revealed the South West region now has the fastest growth in COVID-19 inpatients. Although the region is England’s least densely populated, it also has the lowest hospital capacity per capita in the country.

Dr Harris said: “We hope and we pray that the lockdown has come in time for Devon. My personal view — and of my colleagues around the country — is that there’s a tidal wave of COVID-19 coming to the West Country."

“We are preparing to be hit as hard as the East of England. If we are hit as hard, we will be hanging on by our fingernails and we are planning accordingly.”

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Source: HSJ, 8 January 2021

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Trust boss accuses private provider of ‘overpromising and underdelivering’

The boss of a large acute trust has accused a private provider of ‘overpromising and underdelivering’ after significant problems emerged with a local arrangement which have piled further pressure on its waiting list.

Mid and South Essex Foundation Trust recently discovered at least 1,000 cases were being returned to the trust from independent provider Omnes Healthcare following “complications” with a pathway for ear, nose and throat patients.

CEO Matthew Hopkins told a board meeting last Thursday: “I think other parts of the country, like us, are seeing independent sector providers in some cases overpromising and underdelivering. The consequence of that is what we’ve seen in the ENT example.”

The contract is managed by Mid and South Essex Integrated Care Board, which told HSJ it was “very sorry that some patients may have been waiting longer than they should have been” because of the problems.

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Source: HSJ, 6 October 2023

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Trust boards instructed to ‘scrutinise’ sepsis data by NHSE

Trust boards should start scrutinising performance against new indicators set out by NHS England this month as part of a national push to iron out unwarranted variation in performance on key sepsis blood tests, according to an NHSE report.

Blood cultures are the primary test for detecting blood stream infections, determining what causes them, and directing the best antimicrobial treatment to deal with them. However, it is too often seen as part of a box-ticking exercise, according to a report published by NHSE yesterday.

Improving performance on this important pathway should be integrated into existing trust governance structures for sepsis, antimicrobial stewardship, and infection control “to help secure a ‘board to ward’ focus on improvement,” the report says.

It says there is too much variation in how blood cultures are taken prior to analysis and sets out two targets for trusts to use to standardise their collection.

The first is ensuring clinicians collect two bottles of blood, each containing at least 20ml for culturing. The more blood collected, the higher the rate of detecting bloodstream infections. Blood culture bottles “are frequently underfilled”.

The second is ensuring blood cultures are loaded into an analyser as fast as possible, within a maximum of four hours, because delaying analysis reduces the volume of viable microorganisms that can be detected.

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Source: HSJ, 1 July 2022

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Trust board backs medical director who wrongly dismissed whistleblower

A trust board has backed the medical director who oversaw the dismissal of a whistleblower in a case linked to patient deaths.

Portsmouth Hospitals University Trust told HSJ John Knighton had the full support of the organisation when asked if he faced any censure over the wrongful dismissal of a consultant who raised the alarm about a surgical technique.

Jasna Macanovic last month won her employment tribunal against the trust with the judge calling its conduct “very one-sided, reflecting a determination to remove [her] as the source of the problem”.

The judgment found that the disciplinary process Dr Knighton oversaw was “a foregone conclusion” and as such had broken employment rules. The nephrologist was twice offered the opportunity to resign with a good reference, once during her disciplinary hearing and again on the day the outcome of that hearing was delivered.

The trust told HSJ nothing in the judgment suggested Dr Knighton should face any action about his conduct and none had been taken. It said there were no reasons to doubt his credibility or probity.

The trust did not respond when asked if any apology had been offered to Dr Macanovic.

A spokesperson said: “We are committed to supporting colleagues raising concerns, so they are treated fairly with compassion and respect.”

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Source: HSJ, 13 April 2022

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Trust blames behaviour ‘from top of the NHS’ for bullying

Leadership behaviour from the “very top of the NHS” has led to an increase in bullying, according to an official strategy document produced by an acute trust.

East and North Hertfordshire Trust published its new people and organisation strategy in its January board papers. Within it, the report said: “Leadership behaviour from the very top of the NHS, during this time of pressure has led to an increase in accusations of bullying, harassment and discrimination.”

In a separate section, the paper noted the difficulties of being a healthcare professional, saying “many staff leave before they need to and many more cite bullying, over work and stress, as reasons for absence and mistakes”.

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Source: HSJ, 13 January 2020

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Trust begins ‘most ambitious’ outpatients project in NHS

A large acute trust is carrying out a major expansion of patient-initiated follow-up (PIFU) appointments, which is said to be “the most ambitious” project of its kind in the NHS.

Norfolk and Norwich University Hospitals Foundation Trust has categorised around half of its outpatient follow-up list as “possible or probable opportunities” for patient-initiated pathways.

NNUH wants to make PIFU the “default model” for patients who are not on active pathways, and where it is safe to do this.

Its project is being closely watched by national leaders and has already drawn praise from NHS England’s director of elective recovery, Rob Stones, during a webinar last month. It is understood to be more ambitious than NHSE’s official PIFU pilot projects.

NHSE’s elective chief, Sir Jim Mackey, has said he wants to expand PIFU pathways on an “industrial” scale.

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Source: HSJ, 29 July 2022

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Trust appoints chair to lead independent suicides review

A trust has appointed a chair to lead an independent review into dozens of suicides that was sparked by allegations of record tampering.

Following questions from HSJ about the review’s chair and terms of reference, Cambridgeshire and Peterborough Foundation Trust said Ellen Wilkinson, a former medical director at Cornwall Partnership FT and its current chief clinical information officer, would chair the review. 

The trust, which is looking for a substantive CEO following Anna Hills’ departure earlier this year, said the review “will not examine individual patient deaths but will take a thematic approach and look at the learnings we can take from these tragic incidents”.

The trust told HSJ the terms of reference for the review of more than 60 cases of patients who died by suicide since 2017 were still being finalised.

The decision not to investigate individual cases has been criticised by the whistleblower whose concerns prompted the review in the first place, as HSJ reported in October.

While an employee of the trust, Des McVey, a consultant nurse and psychotherapist, carried out an investigation in July 2021 into the case of 33-year-old Charles Ndhlovu, who died by suicide in 2017.

Mr McVey told HSJ his review found Mr Ndhlovu’s patient record had been tampered with and “his care plans were created on the day after his death” – a conclusion he stands by.

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Source: HSJ, 3 April 2024

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Trust apologises to dozens of families after harm to children

A hospital trust has apologised to families after dozens of children suffered hearing loss following failures in their care.

Croydon Health Services Trust had already revealed three children “may have been at risk of serious hearing loss or a delay to their speech development”, but it has now confirmed to HSJ that a further 49 “incurred mild to moderate hearing loss or impairment”.

The south London trust would not disclose the results of its internal review that begun after it declared a serious incident in March 2021, saying it was “ongoing”, but said it had acted on all the “immediate recommendations”.

The incident was declared after more than 1,400 children were found not to have been followed up by the trust. 

There was also an external review carried out by an audiologist from Guy’s and St Thomas’ Foundation Trust. It is unclear which review uncovered the incidents of harm. 

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Source: HSJ 1 August 2023

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Trust apologises for saying patient’s sexual assault ‘didn’t happen’

A hospital trust has apologised to a mental health patient who reported being sexually assaulted in its A&E department – after it emerged in a safety review that staff wrote ‘this has not happened’ and dismissed her claims of the attack.

The victim was admitted to West Suffolk Hospital’s emergency department following an overdose in January last year. While waiting in A&E for a mental health assessment from a specialist team employed by Norfolk and Suffolk Foundation Trust, she reported being sexually assaulted by a male patient who had also been admitted to A&E.

Yet a review into the incident, published several months later and shared with HSJ, reveals that after the victim reported the attack to a nurse, the staff member recorded “this has not happened”.

They stated that the male suspect in the cubicle next to her had not left his bed and was under constant observation. However, the patient safety review, drawn up after a serious incident probe was launched, adds that this statement was “incorrect, as the [male] patient was not under constant observation”.

“There were witnesses to this incident, and CCTV, and yet it was not escalated until I contacted the trust myself to complain,” the victim said. 

She added that she pursued the complaint, which resulted in a serious incident probe that took several months to conclude, “to prevent others from being failed” in the same way.

She said she was left “shocked, confused and furious” to discover staff had dismissed her assault and claimed the male suspect had not been admitted for an assessment on the day of the attack.

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Source: HSJ, 7 February 2022

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Trust and manager charged with manslaughter

North East London Foundation Trust has been charged with corporate manslaughter – making it only the second NHS provider to be prosecuted for the crime.

The Crown Prosecution Service has authorised the Metropolitan Police to bring a charge of corporate manslaughter against the mental health provider in regard to the death of Alice Figueiredo at the trust’s Goodmayes Hospital on 7 July 2015.

Goodmayes ward manager Benjamin Aninakwa has also been charged with gross negligence manslaughter, and an offence under the Health and Safety at Work Act.

The trust and Mr Aninakwa will appear at Barkingside Magistrates’ Court on Wednesday, 4 October. The prosecution follows a five year investigation by Met detectives.

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Source: HSJ, 7 September 2023

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Trust admits staff shortages causing inappropriate discharges

A trust has admitted it is having to discharge patients inappropriately into care homes or community hospital beds because of a shortage of home care workers.

A report to East Kent Hospitals University Foundation Trust’s board last week revealed that 160 extra beds had been commissioned to maintain flow across the local health economy “due to insufficient domiciliary/care package capacity.”

It went on: “The clinical commissioning group have tried via Kent County Council to commission additional domiciliary care without success. It is acknowledged by the local health economy that it is important to withdraw from these additional beds as quickly as possible as they are not a cost-effective resource and more importantly, in many cases, they are not the ideal discharge destination for those patients who could have been discharged home with a care package.

“Patients are being transferred into community hospital beds or residential home beds due to a lack of domiciliary care packages. Although this is a national issue, it will not be resolved locally until appropriate pathway capacity is commissioned.”

Professor Adam Gordon, president elect of the British Geriatrics Society, said: “If people have been sent to a care home when they don’t want or need to be there that can affect their motivation and result in a form of deconditioning. One of the principles of effective rehabilitation in older people is that if you don’t use it, you lose it.”

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Source: HSJ, 17 March 2022

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Trust admits patients harmed due to huge follow-ups backlog

At least 20 patients have suffered harm due to their follow-up appointments not being booked at a hospital department where people ‘continue to come to harm’, according to an internal review.

Torbay and South Devon Foundation Trust is reviewing its ophthalmology service after 22 people were harmed following “system failures” with their follow-up appointments.  

The trust’s initial investigation, obtained by HSJ with the Freedom of Information Act, warned there were “potentially” other patients affected by the failures who had not yet been identified.

In response, the trust said its ophthalmology department had already “undertaken a significant amount of work to address a large proportion of the actions arising from the review”, including building another operating theatre and recruiting more staff.

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Source: HSJ, 21 August 2023

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Trust acts after BAME staff report ‘systematic bullying’

NHS leaders are being encouraged to have ‘difficult discussions’ about inequalities, after a trust found its BAME staff reported being ‘systematically… bullied and harassed’, along with other signs of discrimination.

A report published by Newcastle Hospitals Foundation Trust found the trust’s black, Asian and minority ethnic staff are more likely than white staff to be bullied or harassed by colleagues, less likely to reach top jobs, and experience higher rates of discrimination from managers.

It claims to be the first in-depth review into pay gaps and career progression among BAME workforce at a single trust.

The new report revealed that, in a trust survey carried out last year, some BAME staff described being subjected to verbal abuse and racial slurs by colleagues; had left departments after being given no chance of progression; and been “systematically… bullied and harassed”.

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Source: HSJ, 22 September 2020

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Trust accused of ‘racism, discrimination and bullying’ as staff partnership halted

The staff-side committee of a major hospital trust has stopped working with its leadership, with its chair alleging an ‘endemic’ culture of ‘racism, discrimination and bullying’.

Irene Pilia, staff-side committee chair at King’s College Hospital Foundation Trust, told colleagues that the decision was taken “in the interests of staff”, especially black, Asian and minority ethnic workers, and expressed concerns about the organisation’s disciplinary procedures. She said the decision had the backing of staff committee officers and delegates.

Ms Pilia, who is also the senior KCHFT Unite representative, said she was open to resuming partnership working again, but told trust executives: “I have lost trust and confidence in the ability of [KCHFT] to conduct fair, impartial and no-blame investigations.

“Until there is tangible and credible evidence that racist behaviour at all levels is proactively eliminated, such that perpetrators face real consequences (including to the detriment of their careers) for their actions and are no longer allowed to behave in racist ways with impunity, I take a stand for the hundreds, possibly thousands of KCHFT staff whose voices are not being heard."

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Source: HSJ, 22 October 2020

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