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There is no significant relationship between the number of managers or the amount spent on management and the quality of NHS hospital services, research has concluded. Researchers at the London School of Economics studied the performance of all 129 non-specialist acute trusts between 2012-13 and 2018-19. They measured hospital performance on five indicators covering financial position, elective and emergency waiting times, level of admissions and mortality. This was then compared to the number of managers each trust employed and the amount spent on management staff. The researchers also attempted to measure the quality of management based on answers given to relevant questions in the annual NHS staff survey. Reviewing the evidence they analysed, the LSE team state: “We find no evidence of an association between our measures of quantity of managerial input and quality of management… Furthermore, we find no associations between our measures of quantity of management input and five measures of hospital performance.” They add: “This holds, irrespective of how we define managerial input, whether by number of managers or expenditure on management. These results are generally robust to how we account for variation between hospitals and within hospitals over time.” This leads the researchers to conclude: “Hospitals hiring more managers do not see an improvement in the quality of management leading to better performance, and increasing the numbers of managers does not appear to improve hospital performance through any other direct or indirect mechanism.” Read full story (paywalled) Source: HSJ, 17 January 2022

A hospital rated inadequate by inspectors two years ago has been praised for making improvements. The Care Quality Commission (CQC) has welcomed changes in urgent and emergency care at Stepping Hill Hospital in Stockport, Greater Manchester. The trust said the report was a "testament" to its staff's hard work. The CQC's unannounced inspection in November was carried out to check improvements had been made since a previous visit in August 2020. Among the concerns highlighted previously were patients left at high risk of harm during periods of heavy demand, staff shortages and staff who were "not competent for their roles". The new report said inspectors found urgent and emergency care had improved from inadequate to good overall and for being safe and well-led. "It has gone from requires improvement to good for being effective and caring. Responsive has gone from inadequate to requires improvement," the report said. Karen Knapton, CQC's head of hospital inspections, said: "We acknowledge the efforts of the emergency care team at Stepping Hill Hospital. We found staff provided good care and treated people with compassion and kindness." "They gave patients, their families and carers help, emotional support and advice when they needed it. Also, the service has been tailored to meet individual needs, including those living with dementia or a learning disability. " Read full story Source: BBC News, 12 January 2022

NHS leaders have been accused of downplaying the impact of the Covid crisis and putting hospitals under scrutiny for declaring critical incidents and postponing surgeries. A leaked email urges hospitals to use the “correct terminology” and make NHS leaders aware when declaring their status. Sources said the message was a “thinly veiled threat” and that there was “subtle pressure” amid rapid spread of Omicron. At least 24 trusts have declared critical incidents this week, including one in Northamptonshire on Friday afternoon, while new figures show a 59% rise in staff absences in just seven days. Trusts in London were told hospitals will be scrutinised for declaring a critical incident if there is “doubt” over the decision, according to an internal email sent from NHS England on Wednesday. In light of media coverage, it would be “valuable” to “raise awareness of the key terminology and encourage you to ensure that you are clear ... when considering a declaration,” it said. “National scrutiny on the declaration on incidents has heightened ... and [senior managers] will need to make additional enquiries where there is doubt as to the status of an organisation’s incident.” Shadow health secretary Wes Streeting said: “We know that the NHS is under enormous pressure and it is important that local trusts are able to be honest and open with parliament and the public about the challenges they’re facing. We are increasingly concerned that ministers are more interested in covering up problems than solving them.” Daisy Cooper, the Lib Dem Health spokesperson, said: “This is an insult to every health worker who has given their all, and every patient with cancelled appointments and delayed surgeries. Read full story Source: The Independent, 9 January 2022

A trust has written to its registered workforce to reassure them of management support when delivering care in ‘extremely challenging circumstances’. Derbyshire Community Health Services Trust sent out a “statement of support for professionally registered colleagues”, in which it thanked them for their “continued efforts”, and explained how they would support staff from a “professional and regulatory perspective”, when delivering services that require “a high level of clinical knowledge and autonomous decision-making”. This week has seen NHS staff absences hit new highs – over 100,000 – and the military brought in to support care in London hospitals, in combination with very high community covid transmission rates and very busy acute trusts. The DCHST email, signed by executive director of nursing Michelle Bateman, executive medical director Ben Pearson and interim director of Allied Health Professionals Trish Bailey, said: “When services are at this high level of escalation it can mean that we are not always able to deliver care in the way we would like and that can challenge our professional values.” Helen Hughes, chief executive of charity Patient Safety Learning, said Derbyshire Community Healthcare’s message needed to be echoed by every trust in the country. “Without sufficient staffing resources, difficult decisions are required to prioritise care,” Ms Hughes said. “In some cases, delays in treatment as a result of these decisions could lead to avoidable harm.” She stressed it was “imperative” that future investigations into safety incidents “properly reflect the systemic nature of reasons for error or harm, not simply blaming staff for failures to provide safe care”. “Health professionals’ codes mean that they are not allowed to work outside their sphere of competence. But what if staff are being tacitly encouraged or required to work in an unsafe system? Staff need to be able to feel secure in raising any concerns they have, being listened to and being supported,” Ms Hughes added. Read full story (paywalled) Source: HSJ, 10 January 2022

The chair of West Suffolk hospital trust has resigned over a whistleblowing scandal exposed by the Guardian, as fresh questions are asked over why the trust continues to pay at least £270,000 a year to its former chief executive. Sheila Childerhouse was criticised by an independent NHS report for her failure to question senior executives who had hounded Dr Patricia Mills after Mills had raised concerns about a colleague seen injecting himself with drugs while on duty. Childerhouse has announced that she will step down in January after consultants at the Bury St Edmunds hospital told her last week that her position was “untenable”. The NHS report, by Christine Outram, found that Childerhouse failed to take up Mills’ concerns when she was sent a “confidential” email in 2018 expressing alarm that the self-injecting doctor was being allowed to continue to treat patients. Read full story Source: The Guardian, 23 December 2021

Efforts to end health inequalities should be ‘in the mix’ of metrics used to determine the NHS’ progress against key performance targets, say race inequality experts. In an exclusive interview with HSJ, NHS Race and Health Observatory (RHO) director Habib Naqvi said organisations’ performance on the issue should be scrutinised by an external body to ensure they are held accountable and “not marking their own exam answer”. It comes as the RHO publishes a report that warns the appointment of health inequalities leads across the NHS risks becoming “tokenistic” if they are not adequately supported and held accountable. The report by The King’s Fund think tank has recommended several actions to prevent the introduction of board-level leads from becoming a “hollow gesture”. In August 2020, NHS England asked all NHS organisations to have a named executive board member responsible for tackling inequalities by October that year. The RHO estimates there to be more than 450 of these named leads across the country. The report welcomed this but added “frameworks” of support and accountability should exist to “empower individuals and motivate change”. The recommendations include putting inequalities on an “equal footing” with key performance metrics, as well as a long-term policy focus that puts addressing inequalities “at the heart of system development”. Read full story (paywalled) Source: HSJ, 1 December 2021

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.” Read full story (paywalled) Source: HSJ, 24 November 2021

Nursing leaders have highlighted 10 pressures on health and social care services which they say have created “unsustainable, untenable” conditions. A report from the Royal College of Nursing (RCN) said members working across health and social care in England dispute statements that the current situation in health and care is sustainable. NHS hospital waiting times is listed as one of the 10 indicators with the report referring to this issue as “clearly a symptom of an unsustainable system”. The report, 10 Unsustainable Pressures on the Health and Care System in England, refers to “corridor care” – time spent on trolleys in hospital corridors before being admitted to a hospital bed. “We are clear that delivery of care within inadequate environments such as that frequently referred to as ‘corridor care’ or ‘corridor nursing’ is fundamentally unsafe and must not be normalised,” the report says. The 10 pressures also include high COVID-19 infection rates, NHS nursing workforce vacancy rate, social care workforce vacancies and NHS elective/community waiting times. The report says: “Action needs to be taken to retain as many nursing staff as possible in light of serious staffing vacancies, as well as high levels of exhaustion and burnout. Read full story Source: The Guardian, 15 November 2021

A management coach and adviser to the Care Quality Commission has been appointed as the new ‘national guardian’ for the ’freedom to speak up’ programme. Jayne Chidgey-Clark will take up her new role on 1 December. The national guardian’s office leads, trains and supports the network of over 700 freedom to speak up guardians in England, as well as providing “challenge and learning to the healthcare system”. Ms Chidgey-Clark, a registered nurse, has served as a specialist adviser to the CQC since 2017. She has run her own coaching, consultancy and interim management business since 2009. She was a clincial adviser to NHS England’s new care models programme for three years until 2018 and the director of the end of life care modernisation project at Guy’s and St Thomas’ Foundation Trust between 2008 and 2011. Her appointment comes after Henrietta Hughes announced in June she was stepping down from the role after five years. Ms Chidgey-Clark, who is the third appointee to the position, said: “I feel excited and privileged to have been appointed as the new National Guardian for the NHS. I am passionate about, and committed to, making a real difference in people’s lives through the planning and delivery of the highest quality, effective care with excellent outcomes for people who use our health services, and their families.” Read full story (paywalled) Source: HSJ, 11 November 2021

A Liverpool NHS trust has been rated as "requires improvement" by the health service watchdog due to concerns over care and safety. The moves comes following inspections at Aintree University Hospital and Royal Liverpool University Hospital. Inspectors said Liverpool University Hospitals NHS Foundation Trust required improvement in safety while it was classed as inadequate for leadership. The trust said "immediate action" had been taken to address the concerns. Ted Baker, chief inspector of hospitals at the Care Quality Commission, said the inspections in June and July highlighted concerns that the trust's leadership team "had a lack of oversight of what was happening on the frontline". Mr Baker said "lengthy delays" and "poor monitoring" were putting patients at serious risk of harm, and the trust was rated as requires improvement overall. He added: "We were particularly concerned about how long people were waiting to be admitted onto medical wards and by the absence of effective processes to prioritise patients for treatment based on their conditions. "There weren't always the right number of staff with the right skills and training to treat people effectively or keep them safe in the trust's emergency departments and on medical wards." Read full story Source: BBC News, 27 October 2021

Senior managers at an NHS trust are facing calls to resign from local councillors after criticism of the trust’s culture and widespread bullying. The chair of Nottinghamshire County Council's health scrutiny panel has called for the chair of Nottingham University Hospitals Trust Eric Morton to step down along with Keith Girling, the trust’s medical director. Councillor Sue Saddington, chair of the council’s scrutiny committee, said she would be writing to health secretary Sajid Javid over concerns about leadership at the trust. An investigation by The Independent and Channel 4 News earlier this year uncovered dozens of cases of negligent baby deaths and injuries costing millions of pounds in compensation. Families have accused the trust of trying to cover-up mistakes and not learning from errors. More than 30 babies have died at the trust in the past decade with 46 children left with brain damage. Read full story Source: The Independent, 13 October 2021

Patient Safety Learning Press Release 10th December 2020 Today the Independent review of maternity services at Shrewsbury and Telford Hospital NHS Trust published its first report on its findings.[1] The report made recommendations for actions to be implemented by the Trust and “immediate and essential actions” for both the Trust and the wider NHS. The Review was formally commissioned in 2017 to assess “the quality of investigations relating to new-born, infant and maternal harm at The Shrewsbury and Telford Hospital NHS Trust”.[2] Initially it was focused on 23 cases but has been significantly expanded as families have subsequently contacted the review team with their concerns about maternity care and treatment at the Trust. The total number of families to be included in the final report is 1,862. These initial findings are drawn from 250 cases reviewed to date. This is another shocking report into avoidable harm. We welcome the publication of these interim findings and the sharing of early actions that have been identified to make improvements to patient safety in NHS maternity services. We commend the ambition for immediate responses and action. Reflecting on the report, there are a number of broad patient safety themes, many of which have been made time and time again in other reports and inquiries. A failure to listen to patients The report outlines serious concerns about how the Trust engaged and involved women both in their care and after harm had occurred. This was particularly notable in the example of the option of having a caesarean section, where there was an impression that the Trust had a culture of wanting to keep the numbers of these low, regardless of patients’ wishes. They commented: “The Review Team observed that women who accessed the Trust’s maternity service appeared to have little or no freedom to express a preference for caesarean section or exercise any choice on their mode of deliver.” It also noted a theme in common with both Paterson Inquiry and Cumberlege Review relating to the Trusts’ poor response to patients raising concerns.[3] The report noted that “there have also been cases where women and their families raised concerns about their care and were dismissed or not listened to at all”. The need for better investigations Concerns about the quality of investigations into patient safety incidents at the Trust is another theme that emerges. The review reflected that in some cases no investigation happened at all, while in others these did take place but “no learning appears to have been identified and the cases were subsequently closed with it deemed that no further action was required”. One of the most valuable sources for learning is the investigation of serious incidents and near misses. If these processes are absent or inadequate, then organisations will be unable to learn lessons and prevent future harm reoccurring. Patient Safety Learning believes it is vital that Trusts have the commitment, resources, and frameworks in place to support investigations and that the investigators themselves have the right skills and training so that these are done well and to a consistently high standard. This has not formed part of the Report’s recommendations and we hope that this is included in their final report. Lack of leadership for patient safety Another key issue highlighted by the report is the failure at a leadership level to identify and tackle the patient safety issues. Related to this one issue it notes is high levels of turnover in the roles of Chief Executive, executive directors and non-executive directors. As part of its wider recommendations, the Report suggests trust boards should identify a non-executive director who has oversight of maternity services. Good leadership plays a key role in shaping an organisations culture. Patient Safety Leadership believes that leaders need to drive patient safety performance, support learning from unsafe care and put in place clear governance processes to enable this. Leaders need to be accountable for patient safety. There are questions we hope will be answered in the final report that relate to whether leaders knew about patients’ safety concerns and the avoidable harm to women and their babies. If they did not know, why not? If they did know but did not act, why not? Informed Consent and shared decision-making The NHS defines informed consent as “the person must be given all of the information about what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments, and what will happen if treatment does not go ahead”.[4] The report highlights concerns around the absence of this, particularly on the issue of where women choose as a place of birth, noting: “In many cases reviewed there appears to have been little or no discussion and limited evidence of joint decision making and informed consent concerning place of birth. There is evidence from interviews with women and their families, that it was not explained to them in case of a complication during childbirth, what the anticipated transfer time to the obstetric-led unit might be.” Again this is another area of common ground with other recent patient safety reports such as the Cumberlege Review.[5] Patient Safety Learning believes it is important that patients are not simply treated as passive participants in the process of their care. Informed consent and shared decision making are vital to respecting the rights of patients, maintaining trust in the patient-clinician relationship, and ensuring safe care. Implementation for action and improved patient safety In its introduction, the report states: “Having listened to families we state that there must be an end to investigations, reviews and reports that do not lead to lasting meaningful change. This is our call to action.” Responding with an official statement in the House of Commons today, Nadine Dorries MP, Minister for Mental Health, Suicide Prevention and Patient Safety, did not outline a timetable for the implementation of this report’s recommendations. In 2020 we have seen significant patient safety reports whose findings have been welcomed by the Department of Health and Social Care but where there has subsequently been no formal response nor clear timetable for the implementation of recommendations, most notably the Paterson Inquiry and Cumberlege Review. Patient Safety Learning believes there is an urgent need to set out a plan for implementing the recommendations of the Ockenden Report and these other patient safety reports. Patients must be listened to and action taken to ensure patient safety. [1] Independent review of maternity services at Shrewsbury and Telford Hospital NHS Trust, Ockenden Report: Emerging findings and recommendations form the independent review of maternity services at Shrewsbury and Telford Hospital NHS Trust, 10 December 2020. https://www.ockendenmaternityreview.org.uk/wp-content/uploads/2020/12/ockenden-report.pdf [2] Ibid. [3] The Right Reverend Graham Jones, Report of the Independent Inquiry into the Issues raised by Paterson, 2020. https://assets.publishing.serv...; The Independent Medicines and Medical Devices Safety Review, First Do No Harm, 8 July 2020. https://www.immdsreview.org.uk/downloads/IMMDSReview_Web.pdf [4] NHS England, Consent to treatment, Last Accessed 16 July 2020. https://www.nhs.uk/conditions/consent-to-treatment/ [5] Patient Safety Learning, Findings of the Cumberlege Review: informed consent, Patient Safety Learning’s the hub, 24 July 2020. https://www.pslhub.org/learn/patient-engagement/consent-and-privacy/consent-issues/findings-of-the-cumberlege-review-informed-consent-july-2020-r2683/

The Care Quality Commission (CQC) has raised serious concerns about a major teaching trust’s maternity services and taken action to prevent patients coming to harm. The watchdog has imposed conditions on the registration of Nottingham University Hospitals Trust’s maternity and midwifery services at Nottingham City Hospital and Queen’s Medical Centre and rated them “inadequate”. Following an inspection in October, the CQC identified several serious concerns, including leaders lacking the skills to effectively head up the service, a lack of an open culture where staff could raise concerns, and staff failing to complete patient risk assessments or identify women at risk of deterioration. In its findings, the CQC reported how “fragile” staff wanted to escalate their concerns directly to the regulator, particularly around the leadership’s response to the “verbal outcome of the inspection”. The regulator called this “further evidence of the deep-rooted cultural problems” and escalated these concerns directly to trust CEO Tracy Taylor, who would be “personally overseeing the improvement process required”. Inspectors also found the service did not have enough staff with the right skills, qualifications and experience to “keep women safe from avoidable harm”. The CQC also issued the trust a warning notice over concerns around documenting risk assessments and IT systems. The trust has three months to make improvements. Read full story (paywalled) Source: HSJ, 2 December 2020

Regulators have apologised to a health manager who went through “five years of hell” while being investigated for misconduct, before being told there was no case to answer. Debbie Moore was a senior manager at the former Liverpool Community Health Trust, where there was a major care scandal in the early 2010s. As head of healthcare at HMP Liverpool, where many of the most serious failings were identified, Ms Moore was suspended in 2014 and referred to the Nursing and Midwifery Council. She was accused of multiple failures to take action or escalate concerns, of failing to investigate deaths, and discouraging staff from reporting incidents. However, in a first public interview about her experience, she told HSJ she was “scapegoated” for the problems at the prison, where she says she worked tirelessly to address the issues and had repeatedly flagged concerns to the LCH management team. External inquiries have found the trust would routinely downgrade risks escalated by divisional managers, as it sought to make drastic cost savings in pursuit of foundation trust status. Read full story (paywalled) Source: HSJ, 30 November 2020

Nearly 100 trusts have no ‘very senior managers’ (VSM) who are declared to be from a black, Asian or minority ethnic background, HSJ analysis has revealed. According to data obtained from every NHS provider in England, 96 out of 214 (45%) did not have any VSMs declared as being from a BAME background. This includes several large providers, such as The Newcastle upon Tyne Hospitals Foundation Trust — where around 9 per cent of the workforce and 15 per cent of the city’s population are BAME — and Liverpool University Hospitals FT. Jon Restell, chief executive of the Managers in Partnership trade union, said the underrepresentation of BAME staff in leadership positions has “dangerously damaged” the NHS’ response to coronavirus, labelling it the “ultimate wake-up call”. Read full story (paywalled) Source: HSJ, 30 November 2020

The Care Quality Commission (CQC) has criticised a new trust’s leadership after issuing it with a warning notice to improve care in its two emergency departments. The watchdog warned North Cumbria Integrated Care Foundation Trust that patients were not always receiving timely and appropriate care, while delayed transfers of care had “resulted in significant delays in admitting patients on to wards”. The CQC — which carried out focused inspections at the trust in August and September after concerns were raised about risks to patient and staff safety — added there was evidence of “insufficient numbers of suitably qualified, skilled, competent and experienced clinical staff”. The CQC also said there was a lack of an effective system to mitigate risks, including infection control in the emergency department escalation areas and on some medical wards. Of the trust’s Cumberland Infirmary and West Cumberland hospitals, the CQC said: “People could not access the urgent and emergency care and medicine service when they needed them and often had long waits for treatment.” The CQC’s inspection report, published today, also said the trust had an “inexperienced leadership team” which “did not always have the necessary skills and abilities to lead effectively”. It added there were “few examples of leaders making a demonstrable impact on the quality or sustainability of services”. Read full story (paywalled) Source: HSJ, 30 November 2020

Former health secretary and chair of the Commons health committee Jeremy Hunt has criticised Great Ormond Street Hospital after it was accused of covering up errors that may have led to the death of a toddler. Writing for The Independent, Mr Hunt, who has set up a patient safety charity since leaving government, said it was “depressing” to see how the hospital had responded to the case of Jasmine Hughes, which has now been taken to the Parliamentary Health Service Ombudsman for a new investigation. Mr Hunt said the hospital had chosen to issue a “classic non-apology apology of which any politician would be proud” and added he was left angry over the hospital’s “ridiculous decision” to stop talking to Jasmine’s family and the refusal to apologise for what went wrong. The MP for South West Surrey said the case was symbolic of a wider problem in the health service of a blame culture that prevents openness and transparency around mistakes. Read full story Source: The Independent, 24 November 2020

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." Read full story (paywalled) Source: HSJ, 22 October 2020

Following a damning report by the Care Quality Commission (CQC), the East of England Ambulance Service NHS Trust (EEAST) has been placed into special measures. It comes after inspectors uncovered a culture of bullying and sexual harassment at the trust. As a result of the decision, EEAST will receive enhanced support to improve its services. A statement from NHS England and NHS Improvement outlined that the Trust would be supported with the appointment of an improvement director, the facilitation of a tailored ‘Freedom to Speak Up’ support package, the arrangement of an external ‘buddying’ with fellow ambulance services and Board development sessions. This follows a CQC recommendation to place the trust in special measures due to challenges around patient and staff safety concerns, workforce processes, complaints and learning, private ambulance service (PAS) oversight and monitoring, and the need for improvement in the trust’s overarching culture to tackle inappropriate behaviours and encourage people to speak up. Ann Radmore, East of England Regional Director said, “While the East of England Ambulance Service NHS Trust has been working through its many challenges, there are long-standing concerns around culture, leadership and governance, and it is important that the trust supports its staff to deliver the high-quality care that patients deserve." “We know that the trust welcomes this decision and shares our commitment to reshape its culture and address quality concerns for the benefit of staff, patients and the wider community.” Read full story Source: Bedford Independent, 19 October 2020

Nearly half of trust chairs fail to “effectively deal with non-performing board members” according to a major study of the role of NHS non-executive directors seen by HSJ. The Henley Business School conducted in-depth research over a two-year period for its report 'The Independent Director in Society: Our Current Crisis of Governance & What to Do About It' which is published later this month. The research included a survey of NHS non-executive directors, which reveals that they have a broadly positive view about their contribution but also reveals significant areas of concern. Only 55% of respondents agreed with the statement that NHS trust chairs “effectively deal with/remove non-performing and/or disruptive board members”. Just 47% said chairs had “positive relations with the media.” The survey was undertaken before the onset of the pandemic, but nearly a third of the respondents disagreed with the statement that NHS chairs were “effective in a crisis”. However, almost every survey respondent claimed trust chairs had “high moral values” which were “aligned with those of the organisation.” All but 2% of respondents backed the idea that non-executive directors “have a sense of duty to see things are done both ethically and morally”, while 94% claimed they were “truly independent”. However, a fifth claimed it was impossible for non-executive directors to be effective “given the mandate of the NHS”. Read full story (paywalled) Source: HSJ, 1 October 2020

An ambulance service could be put in special measures after a damning report criticised poor leadership for fostering bullying and not acting decisively on allegations of predatory sexual behaviour towards patients. East of England Ambulance Service Trust failed to protect patients and staff from sexual abuse, inappropriate behaviour and harassment, the Care Quality Commission said. It failed to support the mental health and wellbeing of staff, with high levels of bullying and harassment. Staff who raised concerns were not treated with respect and some senior leaders adopted a “combative and defensive approach” which stopped staff speaking out. “The leadership, governance and culture still did not support delivery of high-quality care,” the CQC said. Read full story (paywalled) Source: HSJ, 30 September 2020

A hospital boss championed by Matt Hancock has been told to end “a toxic management culture” after doctors were asked to provide fingerprint samples to identify a whistleblower. The Royal College of Anaesthetists (RCoA) has urged the chief executive of West Suffolk hospital, Steve Dunn, who Hancock described as an “outstanding leader”, to take urgent action to improve the wellbeing of senior clinicians and “thereby the safety of patients”. In a strongly worded letter sent to Dunn in July, seen by the Guardian, the RCoA president, Prof Ravi Mahajan, reminded him that “undermining and bullying behaviour is unacceptable”. Following a three-day review of the hospital, Prof Mahajan’s letter said senior anaesthetists had complained about a “toxic management culture that risks impairing their ability to care safely for patients”. The incident, and other failings in patient safety, contributed to the hospital becoming the first ever to be relegated by Care Quality Commission (CQC) inspectors from “outstanding” to “requires improvement” in January. A spokesman for the trust said: “Ensuring our colleagues work in a supportive, safe environment is good for our staff and means better patient care, which is why we have done extensive work this year to act on feedback about our working culture, including taking action to address the concerns raised by the Royal College of Anaesthetists.” Read full story Source: The Guardian, 11 September 2020

A trust which was heavily criticised for poor infection prevention and control last summer has been praised for making improvements. East Kent Hospitals University Foundation Trust was served with an enforcement notice by the Care Quality Commission in August last year, citing “serious concerns” about patient safety. The trust had twice the national rate of patients infected with COVID-19 after admission to hospital. But a new report, issued today, found significant improvements, with several areas of outstanding practice. The conditions imposed on the trust after last year’s inspection of the William Harvey Hospital in Ashford were also lifted, following the visit by the CQC in early March. Cath Campbell, CQC’s head of hospital inspections in the South East, said the improvements were particularly commendable as the trust had been under extreme pressure as a result of the pandemic. She said: “Leaders adopted learnings from other trusts, and from NHS Improvement which led to the development of a detailed infection prevention and control improvement plan. The trust then set up an improvement group to focus on implementing the actions in the plan and put a committee in place to review internal audit data and led improvements based on this information. “Although there were still one or two areas for improvement which we have advised the trust to look at now, overall this is a very positive report.” Read full story (paywalled) Source: HSJ, 23 April 2021

Former staff at a Midlands acute trust have raised concerns over a ‘toxic management culture’ and ‘unsafe’ staffing levels within its maternity services, HSJ has learned. Two clinicians who recently worked within Sandwell and West Birmingham Hospital Trust’s maternity department have sent a letter to the Care Quality Commission outlining a series of concerns. The letter, seen by HSJ, claimed there was a “toxic management culture alongside poor leadership” within the trust’s senior midwifery team. It added: “This had led to 100 per cent turnover in staff within the middle management line… There is no confidence in the current leadership structure and no confidence that staff will be listened to and heard.” HSJ also understands there are also concerns around the service within the trust’s management. Although they do not raise direct patient safety concerns, the clinicians said the problems were “mostly long-standing” and had “deteriorated to the point where there is now a risk to patient safety”. They added: “We are raising these concerns now with the CQC as we feel we have not been listened to and changed effected in a timely manner.” Read full story (paywalled) Source: HSJ, 10 March 2021

The NHS’ response to the third wave of the coronavirus pandemic saw the number of whistleblowing concerns raised with the Care Quality Commission (CQC) almost double in December, with the strength of local leadership among the most frequent complaints. Many parts of the NHS, particularly in the South East, were suffering major covid pressures in December, and the regulator received 204 whistleblowing concerns, compared to 105 in the same month in 2019. The most common complaints were around staffing levels, infection control and leadership. The rise in complaints was revealed by CQC chief inspector of hospitals Ted Baker in an interview with HSJ. Professor Baker also said the pandemic had proved that the NHS’ emergency care system lacked “resilience”. Trusts which the regulator has received concerns about in recent months have included Liverpool University Hospitals Foundation Trust, over poor staffing levels and infection controls, University Hospitals Birmingham FT, around staffing levels and leadership concerns, and Mid and South Essex FT, over concerns around the provision of oxygen. Professor Baker told HSJ: “One of the really positive things that has happened during the pandemic is an increase in the number of people raising concerns with us. It’s been really helpful for us in assessing the risk in the system." Read full story (paywalled) Source: HSJ, 8 February 2021