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California warns hospitals not to withhold trans youth healthcare

As Donald Trump seeks to block transgender youth healthcare across the country, California’s attorney general has sent a clear message to providers, reminding them of their duty to provide gender-affirming treatment under the state’s nondiscrimination laws.

“The law requires [hospitals] to continue to provide gender-affirming care to our transgender community,” Rob Bonta, a Democrat who heads the California justice department, told the Guardian on Wednesday. “We will have the transgender community’s back. We will fight for their rights, for their protections, for their freedoms.”

His comments come a week after Trump issued an executive order decreeing that medical institutions that receive federal funding and grants do not provide gender-affirming care, including hormone therapy and puberty blockers, to youth under age 19.

In response, some hospitals have paused treatments, which are considered part of the standards of care for gender dysphoria endorsed by all major US medical associations. Trans patients, their families and civil rights groups have said the interruption of care could have dire consequences for patients’ physical and mental health. They’ve also argued that Trump’s order is unlawful, violating patients’ constitutional rights and parental rights, and that hospitals have no legal obligation to preemptively deny care, particularly while the policy is being challenged in court.

On Tuesday, Children’s Hospital Los Angeles (CHLA), a major local provider, said it was pausing the initiation of hormone treatments for trans youth. The hospital told the LA Times it was not starting new patients’ gender-affirming care while it evaluated Trump’s order “to fully understand its implications”, but said treatment for existing patients would continue.

On Wednesday, Bonta wrote a letter to CHLA warning that “withholding services from transgender individuals based on their gender identity or their diagnosis of gender dysphoria” would violate the state’s Unruh Civil Rights Act, a longstanding law that prohibits discrimination against LGBTQ+ people.

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Source: The Guardian, 5 February 2025

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California pharmacies are making millions of mistakes. They’re fighting to keep that secret

Sharri Shaw walked out of the CVS on Vermont Avenue in South Los Angeles in 2019 believing she had a prescription for the pain reliever acetaminophen.

Instead the bottle held a medicine to treat high blood pressure, a problem she did not have.

Shaw began taking the pills, not learning of the mistake until six days later when a CVS employee arrived at her home, according to a lawsuit she filed last year. The employee told her not to take the tablets, the lawsuit said, before leaving the correct prescription at her door. The mistake, she said, left her stunned.

Shaw’s experience is far from an isolated event. California pharmacies make an estimated 5 million errors every year, according to the state’s Board of Pharmacy.

Officials at the regulatory board say they can only estimate the number of errors because pharmacies are not required to report them.

Most of the mistakes that California officials have discovered, according to citations issued by the board and reviewed by The Times, occurred at chain pharmacies such as CVS and Walgreens, where a pharmacist may fill hundreds of prescriptions during a shift, while juggling other tasks such as giving vaccinations, calling doctors’ offices to confirm prescriptions and working the drive-through.

Christopher Adkins, a pharmacist who worked at CVS, and then at Vons pharmacies until March, said that management policies at the big chains have resulted in understaffed stores and overworked staff.

“At this point it’s completely unsafe,” he said.

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Source: Los Angeles Times, 5 September 2023

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California couple sue clinic for alleged IVF swap 'horror'

A California couple gave birth to a stranger's child after being given the wrong embryo by a fertility clinic during in vitro fertilisation (IVF), says a lawsuit.

Daphna and Alexander Cardinale say they gave birth in September 2019 to a girl that looked nothing like them. After a DNA test, they found the couple that carried their daughter to term, and together decided to swap the girls.

This is not the first alleged mix-up during an IVF procedure.

IVF is a procedure during which a woman's eggs are fertilised by man's sperm in a laboratory before the embryos are implanted into a woman's uterus.

The Cardinales are suing the Los Angeles-based fertility centre, the California Center for Reproductive Health (CCRH), as well as In VitroTech Labs, an embryology lab.

The lawsuit alleges medical malpractice, negligence and fraudulent concealment. Neither company responded to a BBC News request for comment.

In an emotional news conference on Monday, Mrs Cardinale said her family's "heartbreak and confusion can't be understated".

"Our memories of childbirth will always be tainted by the sick reality that our biological child was given to someone else, and the baby that I fought to bring into this world was not mine to keep."

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Source: BBC News, 9 November 2021

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California approves bill to punish doctors who spread false information

Trying to strike a balance between free speech and public health, California’s Legislature on Monday approved a bill that would allow regulators to punish doctors for spreading false information about Covid-19 vaccinations and treatments.

The legislation, if signed by Gov. Gavin Newsom, would make the state the first to try to legislate a remedy to a problem that the American Medical Association, among other medical groups and experts, says has worsened the impact of the pandemic, resulting in thousands of unnecessary hospitalisations and deaths.

The law would designate spreading false or misleading medical information to patients as “unprofessional conduct,” subject to punishment by the agency that licenses doctors, the Medical Board of California. That could include suspending or revoking a doctor’s license to practice medicine in the state.

While the legislation has raised concerns over freedom of speech, the bill’s sponsors said the extensive harm caused by false information required holding incompetent or ill-intentioned doctors accountable.

“In order for a patient to give informed consent, they have to be well informed,” said State Senator Richard Pan, a Democrat from Sacramento and a co-author of the bill. A paediatrician himself and a prominent proponent of stronger vaccination requirements, he said the law was intended to address “the most egregious cases” of deliberately misleading patients.

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Source: New York Times, 29 August 2022

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C2-Ai launches Maternal and Neonatal Observatory

C2.AI has formally launched its Maternity and Neonatal Observatory at the NHS ConfedExpo in Manchester (Government and Public Sector Journal). The observatory is intended to give hospitals and clinicians a detailed picture of the performance of maternity units and the health trajectories of individual women, so areas of concern can be identified and acted on. The system works by calculating and comparing observed outcomes for women and babies with expected outcomes for these individuals. To do this, it uses AI and machine learning to assess clinical factors, case-mix, and the social determinants of health. Early adopters within the NHS, where maternity services are under intense scrutiny, are expected soon.

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C-section delay left baby severely disabled

A baby was left "severely disabled" after a delay during his delivery by Caesarean section, a High Court judge has been told.

Betsi Cadwaladr health board will pay £4m in compensation after a negligence claim was brought by one of the boy's relatives.

He has required 24-hour care since his birth in 2018 at Glan Clwyd Hospital in Denbighshire.

The hospital apologised, saying doctors are "working hard" to learn lessons.

"We are extremely sorry," barrister Alexander Hutton KC, representing the health board, told Mr Justice Soole.

"[Betsi Cadwaladr] is working hard to learn lessons from this case," he added.

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Source: BBC News, 2 November 2022

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Burnt out staff ‘triggered’ by ‘it’s OK’ messaging from ministers

Frontline staff are being ‘triggered’ by ministers playing down the ‘overwhelming’ pressures facing the health service with “a ‘move along, no story here’-type attitude”, a royal college president has warned.

The Royal College of Emergency Medicine’s Katherine Henderson said the intentions of those making such comments may be “well meaning” but that it was important ministers and NHSE leaders were “humble and transparent about the scale of the problem [facing the NHS] at the moment”.

Katherine Henderson said: “The scale of the problem feels quite overwhelming, and the kind of ‘move along, no story here’-type attitude I think is not great for the people working in healthcare. They need to feel heard.”

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Source: HSJ, 24 November 2021

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Burnout: set up watchdog to protect NHS staff, says wellbeing champion

A regulator that sets standards on staff wellbeing and holds the NHS to account should be established to help protect doctors from burnout, a champion of physicians’ wellbeing has said.

The proposal was one of several put forward by Clare Gerada, president of the Royal College of General Practitioners, who recently stepped down as medical director of the confidential mental health support service NHS Practitioner Health.

She was speaking on 22 March to MPs on the House of Commons health and social care committee about how the Covid-19 pandemic had increased the number of doctors struggling with mental health problems, particularly in general practice.

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Source: BMJ, 24 March 2022

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Burnout in healthcare: the case for organisational change

Burnout is an occupational phenomenon and we need to look beyond the individual to find effective solutions, argue Montgomery and colleagues in a recent BMJ article 

Burnout has become a big concern within healthcare and is associated with sleep deprivation, medical errors, poor quality of care and low ratings of patient satisfaction. Yet often initiatives to tackle burnout are focused on individuals rather than taking a systems approach to the problem. Evidence on the association of burnout with objective indicators of performance (as opposed to self report) is scarce in all occupations, including healthcare. But the few examples of studies using objective indicators of patient safety at a system level confirm the association between burnout and suboptimal care.

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Source: BMJ, 30 July 2019

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Burnout in doctors doubles chances of patient safety problems, study finds

Doctors suffering from burnout are far more likely to be involved in incidents where patients’ safety is compromised, a global study has found.

Burned-out medics are also much more likely to consider quitting, regret choosing medicine as their career, be dissatisfied with their job and receive low satisfaction ratings from patients.

The findings, published in the BMJ, have raised fresh concern over the welfare and pressures on doctors in the NHS, given the extensive evidence that many are experiencing stress and exhaustion due to overwork.

A joint team of British and Greek researchers analysed 170 previous observational studies of the links between burnout among doctors, their career engagement and quality of patient care. Those papers were based on the views and experience of 239,246 doctors in countries including the US, UK and others in Africa, Asia and elsewhere globally.

They found that burned-out medics were twice as likely as their peers to have been involved in patient safety incidents, to show low levels of professionalism and to have been rated poorly by patients for the quality of the care they have provided.

Doctors aged 20 to 30 and those working in A&E or intensive care were most likely to have burnout. It was defined as comprising emotional exhaustion, depersonalisation – a “negative, callous” detachment from their job – and a sense of reduced personal accomplishment.

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Source: The Guardian, 14 September 2022

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Burnout among staff in the NHS and social care at 'emergency levels'

A new report commissioned by the House of Commons finds NHS staff and social care workers are suffering from burnout at 'emergency levels'. The report has said problems with burnout among the NHS and care staff already existed but was increased due to the Covid-19 pandemic. 

Staff shortages have been indicated as one of the causes of burnout as the work days became longer and the pressure on staff grew. It was also found that staff felt overwhelmed after lockdown ended as patients who had not been to see their GP during lockdown were now coming in with an array of health problems. NHS and care staff felt insufficiently equipped to deal with the incoming patients due to a lack of proper staffing support in the workforce. 

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Read the full report here

 

Source: BBC News, 8 June 2021

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Bupa to cut 85 dental practices in staff shortage

Bupa is set to cut 85 dental practices amid a national shortage of dentists, in a move that will affect 1,200 staff across the UK.

The group said patients at some practices were unable to access the NHS dental service they need.

Bupa, which provides NHS and private care, said the 85 practices would be closed, sold or merged later this year.

The healthcare group's boss said the industry faced "systematic challenges" and the decision was a "last resort".

In August the BBC revealed 9 in 10 NHS dental practices across the UK were not accepting new adult patients for treatment under the health service.

Bupa has not been able to recruit enough dentists to deliver NHS care in many practices for months and in some cases years, it said.

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Source: BBC News, 30 March 2023

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Bullying, suicidal thoughts linked to more frequent headaches in teens (AMERICAN ACADEMY OF NEUROLOGY)

Teens who have been bullied by their peers, or who have considered or attempted suicide, may be more likely to have more frequent headaches than teens who have not experienced any of these problems, according to a study published in the August 2, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology. The study does not prove that bullying or thoughts of suicide cause headaches; it only shows an association.

“Headaches are a common problem for teenagers, but our study looked beyond the biological factors to also consider the psychological and social factors that are associated with headaches,” said study author Serena L. Orr, MD, MSc, of the University of Calgary in Canada. “Our findings suggest that bullying and attempting or considering suicide may be linked to frequent headaches in teenagers, independent of mood and anxiety disorders.”

The study involved more than 2.2 million teens with an average age of 14 years. 

Read the full article here: https://www.eurekalert.org/news-releases/997216

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Bullying, sexism and racism ‘prevalent and tolerated’ at national regulator

An external review into the Healthcare Safety Investigations Branch (HSIB), the national safety watchdog, has revealed ‘damaging’ cultural problems, including bullying, sexism and racism which go ‘right to the top of the organisation’.

The King’s Fund was commissioned by NHS England to undertake a review of the HSIB’s leadership and culture, as it prepares to be an independent organisation.

The review, seen by HSJ, concluded: “Bullying, sexism, racism and other forms of discrimination and unprofessional behaviours appear to be prevalent and tolerated – this goes right to the top of the organisation.”

The result of this was found to be “very damaging to the health and wellbeing of staff, diminished the culture and undermines the potential of the organisation”

The review also described a “perceived command-and-control approach to leadership, lack of openness to challenge, hierarchical approaches to management and behaviour that is out of step with the organisation’s values”.

The reviewers also identified a “strong voice from staff”, which felt that senior maternity investigation team leaders were “not being held accountable for behaviours that had a very negative impact on staff”.

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Source: HSJ, 21 January 2022

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Bullying, misogyny and sexual culture at Royal College of Nursing, inquiry finds

A damning inquiry into the Royal College of Nursing, the world’s biggest nurses’ union, has exposed bullying, misogyny and a sexual culture where women are at risk of “alcohol and power-related exploitation”.

A 77-page internal report by Bruce Carr KC, leaked to the Guardian, lays bare how the RCN’s senior leadership has been “riddled with division, dysfunction and distrust” and condemns the male-dominated governing body, known as council, as “not fit for purpose”.

Grave concerns are also raised about the RCN’s annual conference, known as congress, where Carr says an “inappropriate sexual culture” warrants further urgent investigation “to identify the extent to which [it] has actually resulted in exploitation of the vulnerable”.

The eminent barrister reports that there is evidence to support the “impression” that senior individuals have been seeking to take sexual advantage of subordinates and “engaging in unwanted sexual behaviours”.

He calls on those whose conduct is cited in the report, whom he does not name, to consider their positions in the light of testimony of groping, humiliation of female staff members and a refusal of those in positions of responsibility to reflect on the letters of resignation from women on the council, who have complained of “gaslighting and microaggressions”.

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Source: The Guardian, 10 October 2022

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Bullying, bad behaviour and broken IT uncovered at worst trusts for junior doctors

Regulators have uncovered multiple examples of patients being put at risk when junior doctors are left with tasks they are not trained for, lacking support, and facing bullying and inappropriate behaviour.

Inspection teams have had to intervene – in some cases contacting senior trust staff – to ensure urgent issues are addressed, after the inspections.

Health Education England oversees training nationally, which includes making the checks at trusts which have been put under “enhanced monitoring” by the professional regulator, the General Medical Council, because of concerns from trainees.

HSJ has obtained and examined 20 reports, all produced since the beginning of 2019. Themes running through the reports included:

  • Lack of support from consultants.
  • Trainees struggled to contact consultants out of hours. 
  • Bullying and inappropriate behaviour was reported at several trusts. 
  • Inspectors found a reluctance to report concerns and/or a lack of knowledge of how to do it. 
  • Teaching was often of poor quality or cancelled – and sometimes trainees struggled to attend sessions because of how their shifts and rotations were scheduled.
  • Trainees in several trusts reported IT problems, such as being locked out of systems so being unable to access clinical notes and blood tests, and IT systems taking up to 30 minutes to start up, sometimes delaying patient care. 

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Source: HSJ, 29 June 2020

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Bullying still on the rise at troubled trust

An ambulance trust with a long history of cultural problems saw the proportion of staff reporting being bullied or harassed increase in 2023.

The survey by East of England Ambulance Service Trust found 35 per cent of staff who responded said they had experienced bullying or harassment over the last 12 months—up from 32 per cent in 2022, and 25 per cent in 2020.

The work commissioned by the trust also found that many staff who had experienced or seen bullying, or racial or sexual harassment, did not report it, with fear of retaliation being a key factor in their decision. Less than 40 per cent said they would speak to a Freedom to Speak Up Guardian about concerns.

The trust—which has made high-profile efforts to address cultural issues in recent years—said it was normal to see a rise in complaints as staff became aware poor behaviour would not be tolerated, and felt safer to speak out.

Hein Scheffer, the trust’s director of strategy, culture and education, said: “Bullying, harassment and poor behaviour have no place in our organisation and we regularly survey our people’s experience of workplace behaviours to help us root this out. We are working hard to improve our culture and we are among the most improved NHS organisations in England for staff feeling confident in speaking out – with 63% describing the trust as supportive."

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Source: HSJ, 12 June 2024

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Bullying probe at Hancock’s local trust due ‘in spring’

A long-delayed review into West Suffolk Foundation Trust board members’ alleged bullying of whistleblowers is now due to be published ‘by the spring’, senior figures familiar with the process have told HSJ.

The news comes amid calls from senior medics and a campaign group for the review — originally due for publication in April 2020 — to be published as soon as possible.

The review was set up to investigate the “handling and circumstances surrounding concerns raised in a letter that was sent in October 2018, to the relative of a patient who had died in the Suffolk hospital”.

The letter was sent to the family of Susan Warby, 57, who died at West Suffolk Hospital in August 2018 after suffering multi-organ failure and other complications. The letter’s anonymous author raised serious concerns about her treatment by the trust.

The trust launched an investigation, involving fingerprinting and handwriting experts, to find the letter’s author. The process, led by the trust’s senior management, prompted staff to report they felt harassed and bullied, and unions to label the process a “witch hunt” (See box below: Timeline of West Suffolk bullying allegations).

NHS England and Improvement is overseeing the probe, which was ordered by ministers in January 2020. The coronavirus pandemic caused publication to be pushed back until December, but no official reasons have been given for the further delay.

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Source: 9 March 2021

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Bullying on NHS maternity units and poor training a risk to safety, MPs told

Doctors and midwives working in maternity services face higher levels of bullying than any other part of the NHS, MPs have been told.

According to the General Medical Council, trainee doctors in maternity services report more than twice the level of bullying seen in the rest of the NHS while the Nursing and Midwifery Council said midwives were also more likely to be bullied.

MPs on the Commons health select committee heard that the culture in some maternity units was a major barrier to improving safety and tackling poor care.

In an evidence session as part of an ongoing inquiry into maternity care, MPs were also warned the lack of properly funded training was forcing some midwives to pay out of their own pocket.

The inquiry by the committee was launched last year after repeated maternity scandals at the Shrewsbury and Telford Hospitals Trust and East Kent Hospitals University Trust.

Giving evidence to the committee, Charlie Massey, chief executive of the General Medical Council said: “We do see in our data some quite troubling data around bullying."

“If you are an obstetrics or gynaecology trainee, we see in our national training survey each year that some 14% report that they have experienced bullying – and that’s against an average for all trainees of 6%. You see more than double the rate of bullying in obstetrics and gynaecology than you do elsewhere.”

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Source: The Independent, 20 January 2021

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Bullying claims probe at University Hospitals Birmingham uncovers 'substantial issues'

A review into the culture at Birmingham's biggest hospitals trust amid allegations of bullying and undue pressure on staff has found 'substantial issues' of concern, a brief report has revealed. A short briefing for councillors by NHS Birmingham and Solihull chief executive David Melborne offers the first insight into the findings of Professor Mike Bewick and his review team who were tasked with investigating damning allegations made by current and former staff at University Hospitals Birmingham.

More than 50 medics, including some with decades of experience, came forward to criticise a 'toxic' working culture at the trust, many sharing their experiences with MP Preet Kaur Gill (Birmingham Edgbaston). Among the most serious claims that emerged were that whistleblowers concerned about patient safety were silenced with threats of disciplinary action.

In a written report to Birmingham and Solihull councils' joint health overview and scrutiny committee, meeting Monday, Mr Melborne says the rapid review into the Newsnight allegations and subsequent complaints has found 'no fundamental safety issues at the Trust'.

However, he goes on: "That said, there are substantial issues around culture, behaviour, leadership and governance that will need to be addressed". 

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Source: Birmingham Live, 10 March 2023

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Bullying and toxic culture at one of England's largest NHS trusts

Repeated cases of bullying and a toxic environment at one of England's largest NHS trusts have been found in a review.

The Bewick report was ordered after a BBC Newsnight investigation heard from staff at University Hospitals Birmingham (UHB) saying a climate of fear had put patients at risk.

A first phase of the rapid review, headed by independent consultants IQ4U and led by Prof Mike Bewick, was published Tuesday.

It is one of three major reviews into the trust, commissioned following a series of reports by Newsnight and BBC West Midlands in which current and former staff raised concerns.

Summarising the findings, Prof Bewick, a former NHS England deputy medical director, said: "Our overall view is that the trust is a safe place to receive care.

"But any continuance of a culture that is corrosively affecting morale and in particular threatens long-term staff recruitment and retention will put at risk the care of patients across the organisation - particularly in the current nationwide NHS staffing crisis.

"Because these concerns cover such a wide range of issues, from management organisation through to leadership and confidence, we believe there is much more work to be done in the next phases of review to assist the trust on its journey to recovery."

The West Midlands trust said it fully accepted the report's recommendations.

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Source: BBC News, 28 March 2023

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Bullying and safety concerns raised by ‘outstanding’ hospital’s juniors

An inspection of an ‘outstanding’ hospital has revealed concerns about unsafe staffing, as well as bullying and undermining behaviour. 

The then Health Education England issued Frimley Health Foundation Trust 14 mandatory requirements after visiting its Frimley Park Hospital in March to look at training in medical specialties. The risk-based review followed concerns in the 2022 national training survey and previous quality interventions by HEE.

Among the problems HEE was told about were:

  • Junior doctors feeling staffing on some shifts was unsafe. Foundation year one doctors were sometimes the only doctors on a ward, while one foundation doctor spent their first weekend on call looking after two wards by themselves.
  • Concerns about bullying and undermining behaviour in an unnamed department, and consultant behaviour during weekend handover which left some staff feeling “uncomfortable”.

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Source: HSJ, 11 July 2023

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Bullying and harassment ‘normalised’ at trust put back in special measures

An ambulance trust has been placed in special measures after the Care Quality Commission (CQC) rated its leadership ‘inadequate’ and said staff felt unable to raise concerns without fear of reprisal

The CQC inspected South East Coast Ambulance Service Foundation Trust after being contacted by staff with concerns about bullying and harassment, inappropriate sexualised behaviour and a leadership team which failed to address concerns.

Many of the concerns echo those raised in 2017 in an independent review into a “culture of fear” at the trust, shortly after it was first placed in regulatory special measures. It was taken out in 2019 but has now been placed back in the equivalent “recovery support programme” on the CQC’s recommendation.

CQC director of integrated care Amanda Williams praised staff who had contacted the regulator. She said: “While staff were doing their very best to provide safe care to patients, leaders often appeared out of touch with what was happening on the front line and weren’t always aware of the challenges staff faced. Staff described feeling unable to raise concerns without fear of reprisal – and when concerns were raised, these were not acted on.

“This meant that some negative aspects of the organisational culture, including bullying and harassment and inappropriate sexualised behaviour, were not addressed and became normalised behaviours."

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Source: HSJ, 22 June 2022

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Bullying and discrimination threaten to shape another NHS restructure

NHS restructures are exposing deep-rooted inequalities, as valued staff face exclusion, intimidation, and unfair treatment under the name of change says Roger Kline and Joy Warmington in an HSJ article.

“The need to do things in a hurry”, we are told, is the system’s way of getting around normal recruitment processes, such as senior appointments in NHS England, trusts and elsewhere – especially the “temporary” ones that become permanent.

Across the NHS, we have heard of a significant number of perfectly competent and high-performing staff (especially senior staff) suddenly finding themselves criticised just ahead of the announcement of a restructure. Suspicious? Extremely, especially ahead of restructures where a favoured candidate is earmarked for the role.

A significant number of these staff are threatened with being performance managed and subjected to investigations whose only purpose seems to be to demoralise and make voluntary redundancy seem attractive. Nepotism is hardly a stranger to senior NHS appointments, but the scale of planned redundancies and restructure appears to have acted to normalise this poor practice.

For example, Alice is a very senior manager with impeccable credentials and appraisals, but finds herself in a restructure in which a close friend of her manager is in direct competition when two jobs become one.

Suddenly, she found herself accused of poor performance and is micromanaged and marginalised. She collapsed at work and is off sick.

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Source: HSJ, 16 June 2025

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Bullying among top surgeons sparks two national investigations

‘Horrifying and upsetting’ reports of bullying in prestigious heart units are being probed by national officials and professional leaders, HSJ can reveal.

Health Education England told HSJ it was “undertaking a national thematic review of training in cardiothoracic surgery”, while the Society for Cardiothoracic Surgery separately revealed it was investigating concerns about “bullying, harassment and undermining behaviour” in the specialty following high-profile recent cases in Newcastle and Wales.

Society president consultant surgeon Simon Kendall, who is based at James Cook University Hospital in Middlesbrough, told HSJ he has been made aware of wider problems beyond those identified in the North East and Wales.

Mr Kendall revealed allegations reported to the society have included people being shouted at in public, problems resulting from a “legacy culture of sarcasm and public humiliation”, and more personal disputes between individuals.

The consultant surgeon told HSJ: “The job is hard enough for all of us, without picking on each other and making it worse."

He added: “It’s the extended team that is affected by these behaviours and it will have an impact on patient safety and patient care.

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Source: HSJ, 1 April 2022

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