Patient safety ‘Nepotistic culture’ left poor behaviour unchecked, says review

Staff at a major acute trust described a “nepotistic culture” in which poor behaviour went unpunished, a review into how it handled staff concerns has found.

The review at East Kent Hospitals University Foundation Trust found its organisational culture did not encourage staff to raise concerns, and that they lacked confidence these would be addressed. It reported “fragile” confidence in speaking up, and a lack of triangulation when concerns were raised.

It was carried out by Helen Buckingham, chair of patient and user charity National Voices, and a former director in local NHS organisations and NHS Improvement.

Several interviewees told her of a “nepotistic culture”, where those who fitted in or had the support of important individuals progressed. Board members were frustrated by a lack of consequences for poor behaviour, the review found.

In some cases, consultants who raised concerns had been placed under investigation. And the Freedom to Speak Up service “effectively collapsed in early 2024”, with no FTSU reports recorded for the entire year.

The trust’s board said they found it difficult to triangulate staff concerns with other information.

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Source: HSJ, 31 July 2026