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News Article
NHS not ‘human’ enough to get greater role in social care, says government review
Patient Safety Learning posted a news article in News
The NHS should not be given greater control of social care because it is ‘hierarchical, centralised and not person-centred’, according to a government-commissioned review which is repeatedly scathing about the health service. The review was ordered by then health and social care secretary Matt Hancock in June 2020. Cross-bench peer, writer and former Number 10 adviser Baroness Camilla Cavendish was asked “to make recommendations for social care reform and integration with health in the wake of the Covid-19 pandemic, which could fit alongside the funding reforms planned by the department in the context of the NHS long-term plan.” In her final report, Baroness Cavendish wrote that “one answer” to the problems facing the sector “would be to let the NHS take over social care. On paper, this would join up the care continuum.” However, she rejected the idea because of the NHS’ “hierarchical” and “centralised” nature. Baroness Cavendish also suggested the NHS’ role should be limited because it is “still struggling to join up primary and secondary care”. In contrast to the NHS, she claimed: “Social care is more innovative, more responsive and human.” She added: “The culture of the NHS is still largely one of ‘doing to’ patients, and the NHS has much to learn from social care about how to be responsive and human facing.” Referencing “recent attempts to import the successful [Buurtzorg] model of self-managing teams into the NHS”, the cross-bench peer said these “have foundered, because the NHS culture cannot seem to cope with giving staff the autonomy required”. Read full story (paywalled) Source: HSJ, 23 February 2022 -
News ArticleA former consultant gynaecologist has told how he raised concerns over bullying, unsafe practices and a "dysfunctional culture" ahead of a report into a maternity scandal. Bernie Bentick, who worked at Shrewsbury and Telford Hospitals Trust (Sath) for almost 30 years, has spoken publicly about maternity care at the trust for the first time. Sath is at the centre of the largest inquiry in the history of the NHS into maternity care, which is expected to report next month. An official investigation is examining the care that 1,862 families received. Mr Bentick says he told senior management several times about a deteriorating culture at Sath. “I was increasingly concerned about the level of bullying, of dysfunctional culture, of the imposition of changes in clinical practice that many clinicians felt was unsafe," Mr Bentick told BBC's Panorama. "If the resources had been made available to employ adequate numbers, to provide safe levels of care in accordance with national guidelines, then the situation may have been profoundly different.” Mr Bentick went on to say that though some “cursory” investigations were launched into his complaints, he believed the trust responded in a way that tried to “preserve the reputation of the organisation.” Read full story Source: Shropshire Star, 23 February 2022
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News Article
Female surgeons sexually assaulted while operating
Patient Safety Learning posted a news article in News
Female surgeons say they are being sexually harassed, assaulted and in some cases raped by colleagues, a major analysis of NHS staff has found. The Royal College of Surgeons said the findings were "truly shocking". Sexual harassment, sexual assault and rape have been referred to as surgery's open secret. There is an untold story of women being fondled inside their scrubs, of male surgeons wiping their brow on their breasts and men rubbing erections against female staff. Some have been offered career opportunities for sex. Nearly two-thirds of women surgeons that responded to the researchers said they had been the target of sexual harassment and a third had been sexually assaulted by colleagues in the past five years. Women say they fear reporting incidents will damage their careers and they lack confidence the NHS will take action. It is widely accepted there is a culture of silence around such behaviour. Surgical training relies on learning from senior colleagues in the operating theatre and women have told us it is risky to speak out about those who have power and influence over their future careers. Read full story Source: BBC News, 12 September 2023 Related reading on the hub: Breaking the silence: Addressing sexual misconduct in healthcare Calling out the sexist and misogynist culture within healthcare: a blog by Dr Chelcie Jewitt, co-founder of the Surviving in Scrubs campaign GMC's Good medical practice 2024 -
News Article
Execs accused of ‘bullying culture and misuse of power’
Patient Safety Learning posted a news article in News
Former commissioning chiefs have been accused of presiding over a ‘culture of bullying’ at the predecessor organisation to Norfolk and Waveney Integrated Care Board, as part of a legal claim from a former employee. The accusations, which have been made in an employment tribunal case, relate to former chief executive Melanie Craig and other former executives at what was then Norfolk and Waveney Clinical Commissioning Group. Ms Craig now leads Suffolk Community Foundation, a local voluntary sector organisation. The claims have been made by a former long-standing assistant director for mental health services, Clive Rennie, who has claimed unfair dismissal. However, the integrated care board said it disputes the claims and is defending the case. In a witness statement to the tribunal, which began this week, Mr Rennie alleges there was an “authoritarian and dictatorial style of management” and described a “culture of bullying and misuse of power that had emerged under the leadership of Melanie Craig and which included the executive team”. Read full story (paywalled) Source: HSJ, 6 September 2023 -
News Article
NHS staff to be asked about sexual harassment for the first time
Patient Safety Learning posted a news article in News
NHS staff will be asked if they have experienced sexual harassment or inappropriate behaviour in the workplace for the first time. In a letter, NHS England chief delivery officer Steve Russell said the upcoming annual staff survey would include the following question: “In the last 12 months, how many times have you been the target of unwanted behaviour of a sexual nature in the workplace? This may include offensive or inappropriate sexualised conversation (including jokes), touching or assault.” Mr Russell said the anonymous answers to the new question would “help us understand the potential prevalence of sexual misconduct in your organisation and inform further action to protect and support staff across the NHS”. It comes as NHSE launches the health service’s first sexual safety charter to help protect staff from harassment and inappropriate behaviour. The charter is an agreement comprising 10 pledges, including commitments to provide staff with clear reporting mechanisms, training, and support from managers. Read full story (paywalled) Source: HSJ, 6 September 2023 -
News Article
Trust told it ‘lacks skills or integrity’ to carry out suicides review
Patient Safety Learning posted a news article in News
A senior clinician has raised fundamental concerns about a trust’s probe into dozens of suicide cases, which was sparked by his allegations that staff had tampered with the notes of a patient. Cambridgeshire and Peterborough Foundation Trust announced in July there would be an internal review of 60 suicide cases dating back to 2017. But a key whistleblower told HSJ he fears it could be a “whitewash” and it should be carried by an external, independent investigator rather than led by the trust. The suicides review was prompted by allegations staff had added a care plan into the patient record of Charles Ndhlovu, a day after the 33-year-old had died by suicide in 2017. The allegations, not contested by the trust, were based on the findings of an internal investigation in 2021 of the trust’s conduct around Mr Ndhlovu’s case. Read full story (paywalled) Source: HSJ, 6 September 2023 -
News Article
NHS ‘a long way’ from being ‘proactive’ on safety, watchdog warns
Patient Safety Learning posted a news article in News
Integrated care systems (ICSs) should factor patient safety into all their operational and financial decisions, the Healthcare Safety Investigations Branch’s chief investigator has urged. Rosie Benneyworth, who was appointed as interim chief investigator last summer, said other safety-critical industries made decisions on the basis of a “triad” of operations, finances and safety. She said the NHS needed to be “more proactive” to take action before things go wrong. Dr Benneyworth said in an interview with HSJ: “I think it’s fundamental that ICSs put safety at the core of everything they do. And I don’t think operational decisions or financial decisions should be made without considering the implications for safety.” Dr Benneyworth – a former GP and commissioner – also spoke about whistleblowing in the wake of the Lucy Letby scandal, saying national organisations should “lead the way” on being proactive over safety and supporting whistleblowers. Major cultural problems were uncovered at HSIB several years ago, while NHSE has been under the spotlight in recent weeks for implementation of the “fit and proper person” test for board members. “I think it’s very difficult as national organisations to tell providers what they should [be] doing, if we’re not doing it ourselves,” Dr Benneyworth said. She added: “What we need is a much more proactive approach to safety, where we actually identify those things that could go wrong and take action before they do go wrong." Read full story (paywalled) Source: HSJ, 5 September 2023 -
News Article
Whistleblowers sacked by NHS fear no change after Lucy Letby case
Patient Safety Learning posted a news article in News
NHS clinicians who were sacked after blowing the whistle about avoidable patient deaths say they fear lessons from the Lucy Letby murder trial have not been learned and the case will make no difference to their own claims for unfair dismissal. They say hospital bosses are still more concerned about reputation than patient safety, despite what emerged in the Letby case about the tragic consequences of ignoring consultants who first raised suspicions about her killing babies. Mansoor Foroughi is appealing against his dismissal by University Hospital Sussex NHS trust in December 2021 after raising concerns about patient deaths. Mansoor Foroughi, a consultant neurosurgeon, was sacked by University Hospital Sussex NHS trust (UHST) in December 2021 for allegedly acting in bad faith when he raised the alarm about 19 deaths and 23 cases of serious patient harm that he said had been covered up in the previous six years. Those deaths and at least 20 others are now being investigated by Sussex police after allegations of medical negligence. Foroughi, whose appeal against his dismissal is due to be held in the coming months, told the Guardian: “I don’t think mine or anyone’s chances of success has increased [after Letby], and only a change in the law will do that.” Read full story Source: The Guardian, 1 September 2023 -
News ArticleWhistleblowers who first revealed a toxic environment at one of England's largest NHS trusts say they do not believe crucial changes will be made. In a letter, they said families who suffered due to management failings at University Hospitals Birmingham (UHB) "have every reason to feel let down". Investigations have been examining UHB after staff told the BBC a climate of fear put patients at risk. The letter was written by three doctors to the Labour MP For Birmingham Edgbaston, Preet Gill, who is heading a cross-party reference group on the trust. In their letter, the consultants raise concerns about the appointment from within the trust of new chief executive Jonathan Brotherton and feel the management team remains largely unchanged. "More than six months have elapsed since we spoke to you of the need to repay the debt owed to those UHB staff, patients and their families who have suffered as a result of the board's serious failings," they wrote. "They now have every reason to feel let down." Read full story Source: BBC News, 29 August 2023
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News ArticleMore than half of NHS staff believe bosses would ignore whistleblowers amid fresh concerns hospitals could be covering up potential scandals following the Lucy Letby case. New national figures seen by the The Independent reveal that in the majority of hospitals, most doctors and nurses do not believe their concerns would be acted upon if they were raised with senior managers. It comes after The Independent revealed that NHS bosses accused of ignoring complaints about Letby were the very same people later appointed to act on whistleblower concerns at the hospital where she murdered seven babies and tried to kill six more. Several doctors who worked alongside her during the killing spree say they attempted to raise the alarm with hospital managers – only to have their pleas ignored. They believe the lack of action by bosses resulted in more babies being killed, stating managers who failed to act were “grossly negligent” and “facilitated a mass murderer”. In nearly three-quarters of general hospitals – such as the Countess of Chester where Letby worked – fewer than half of staff believed their trust would act on a concern, according to results from the latest NHS staff survey. Read full story Source: The Independent, 27 August 2023
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News Article
‘Insecure’ junior medics ‘crying every day’ in ‘chaotic’ department
Patient-Safety-Learning posted a news article in News
Delays in patient care and a lack of consultant support have left junior medics fearing for their mental health, an NHS England investigation has discovered. Junior doctors described haematology services delivered from University Hospitals Birmingham’s Heartlands Hospital as “chaotic”. Their concerns are raised in a report by NHS England Workforce, Training and Education (formerly Health Education England). UHB’s haematology service has been under scrutiny since 2021, when HSJ revealed whistleblower concerns over patient safety, including a series of blood transfusion’ never’ events. The WTE team visited UHB in April. As a result, the haematology service is now subject to the General Medical Council’s enhanced monitoring regime. This means intensive support is given to trainees and the trust to improve medical training. UHB’s obstetrics and gynaecology department is also under enhanced monitoring. The WTE report warns that consultants working across multiple sites left trainee medics at Heartlands without sufficient support and supervision. Most conversations with consultants were via telephone, leaving juniors feeling “unsupported and insecure”. The report stated: “Trainees described the workload … as chaotic and some reported the stress … was affecting their mental health… Some reported they do not feel valued, and the panel heard examples of people crying every day. Most described their roles as 100 per cent service provision… [they] reported very limited learning opportunities overall.” Read full story (paywalled) Source: HSJ, 24 August 2023 -
News ArticleA paediatric nurse who called in to LBC news during a discussion on Lucy Letby, says she can see how Letby was able to get away with her crimes as she herself was 'blacklisted' when she reported a colleague. Watch the video Source: LBC News, 19 August 2023
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News Article
Workplace sexual-harassment clampdown for doctors
Patient Safety Learning posted a news article in News
Conduct guidelines for UK doctors are being updated to spell out what constitutes workplace sexual harassment, amid concerns abuse is going unchallenged. The General Medical Council, which regulates doctors to ensure they are safe and fit to care for patients, says it is adopting a zero-tolerance policy. The new advice explains it is not just physical acts that can be a breach. Verbal and written comments or sharing images with a colleague count too. The new guidance will not come into effect until the end of January, after a five-month familiarisation period for staff. And some say there is still a long way to go. Dr Chelcie Jewitt, an emergency-medicine doctor who is part of the Surviving in Scrubs campaign group, which aims to raise awareness of sexism, harassment and sexual assault in the healthcare workforce, said: "We have spoken with the GMC about the guidelines and we do think that they are a step in the right direction - but there is still a long way to go on this journey to eradicating the culture of sexual misconduct within healthcare. "The GMC has the potential to make a real difference and we need to see them supporting victims when they report perpetrators. "We need their reporting processes to be transparent and clearly explained to victims. "We need cases to be thoroughly investigated rather than dismissed. "And we need appropriate, proportionate sanctioning of perpetrators." Read full story Source: BBC News, 22 August 2023 Read a blog Dr Chelcie Jewitt wrote for the hub: Calling out the sexist and misogynist culture within healthcare -
News Article
Directors to be judged on their ability to create ‘compassionate’ cultures
Patient Safety Learning posted a news article in News
NHS England has announced the first details of its ‘Leadership Competency Framework’, and revealed it will be launched this September. The LCF will underpin the annual appraisal of NHS board directors and, in turn, adherence to the revamped Fit and Proper Person Test. NHSE also revealed that leaders, including senior clinicians, who hold “significant roles” but are not board members may be subject to the FPPT in the near future. The new FPPT framework said the LCF would contain “six competency domains which should be incorporated into all senior leader job descriptions and recruitment processes”. Read full story Source: HSJ, 3 August 2023 -
News Article
‘Great’ trust seen as ‘insular and dismissive of integration’
Patient Safety Learning posted a news article in News
A “great” ambulance trust’s “uncompromising” focus on outcomes and its own performance has been a barrier to system working and affected relationships with partners, an external review has advised it. The report from the Good Governance Institute on West Midlands Ambulance Service University Foundation Trust found partners felt it was “increasingly out of sync with new ways of working under integrated care” and even “somewhat dismissive of the integrated care agenda”. It praised the trust overall, saying: “WMAS is seen by all those we spoke to as being a great organisation: well run, with strong leadership and a clear focus on operational delivery. But it said communications, especially through the press, were seen as “bullish and at times damaging to the reputation of partners and harmful to patients”. Its reputation and performance can create a culture of engagement with external partners that “seems defensive at best and arrogant/dismissive at worst”, with the trust being “prickly towards external challenge”, the consultants’ report added. Read full story (paywalled) Source: HSJ, 27 July -
News ArticleThe government has admitted that many ‘vulnerable’ hospitals ‘suffer with a lack of permanence of leadership’, but said that chiefs are only sacked by NHS England ‘in extreme and exceptional circumstances’. The comments were included in the government’s response to the independent investigation into major maternity care failures at East Kent Hospitals University Foundation Trust, which highlighted how the practice of repeatedly hiring and firing leaders had contributed to its problems. The investigation said successive chairs and CEOs at the FT were “wrong” to believe it provided adequate care, and urged that they be held accountable. But it said senior management churn had been “wholly counterproductive”, and that it had “found at chief executive, chair and other levels a pattern of hiring and firing, initiated by NHS England” which would “never have been an explicit policy, but [had] become institutionalised”. Read full story (paywalled) Source: HSJ, 21 July 2023
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News Article
‘Culture battle’ over NHS England’s emergency recovery plans
Patient Safety Learning posted a news article in News
Senior sources have described a ‘culture battle’ in NHS England’s approach to urgent care recovery after systems were told to carry out “maturity” self-assessments, and appoint “champions” to drive improvements. Systems were last week told by NHSE to ”self assess” their compliance against key asks in the UEC recovery plan, and asked to nominate urgent care “recovery champions” to “create a community, close to the front line, who can help drive improvement” in emergency care. The “champions” and self-assessments are part of a new “universal offer” of support being drawn up by NHSE under its scheme for urgent care recovery, in which Integrated Care Boards are also being placed in “tiers” of intervention. It is the first project carried out under NHSE’s new service improvement banner, called “NHS Impact” or “improving patient care together”, which was established after an internal review recommended it should focus on a “small number of shared national priorities”. Read full story (paywalled) Source: HSJ, 18 July 2023 -
News ArticleAn 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”. Read full story (paywalled) Source: HSJ, 11 July 2023
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News Article
‘Beginnings of safety culture’ emerging at ‘cover-up’ trust
Patient Safety Learning posted a news article in News
An ambulance trust at the centre of an inquiry into alleged cover-ups has shown signs of improvement, according to the Care Quality Commission (CQC). North East Ambulance Service Foundation Trust has been accused of withholding information from coroners. An ongoing inquiry chaired by former acute trust chief executive Dame Marianne Griffiths is looking at how it deals with serious incidents, whistleblowers’ concerns and whether the trust complies with the “duty of candour” as well as its processes around inquests. The CQC report suggests it has made progress on many of these areas since inspections last year – which triggered a warning notice – and has raised the rating for its emergency and urgent care division from “inadequate” to “requires improvement”. The inspectors said it was a “mixed picture” but they had seen “the beginnings of a safety culture emerging within the trust”. Read full story Source: HSJ, 7 July 2023 -
News Article
‘Misogyny’ and ‘medical patriarchy’ widespread at major trust, reports find
Patient Safety Learning posted a news article in News
A major teaching trust is dominated by a “medical patriarchy”, while “misogynistic behaviour” is a regular occurrence, two investigations have discovered. Two reports into University Hospitals Birmingham Foundation Trust have been published. They are the outcome of an investigation into the trust’s leadership carried out by NHS England, and an oversight review by former NHSE deputy medical director Mike Bewick. They follow major concerns being raised over recent months about safety, culture, and leadership at the trust. The NHSE review said the trust “could do more to balance the medical patriarchy that dominates” the organisation. It noted consultants are invited to observe a chief executive’s advisory group meeting, but nursing, midwifery and allied health professional leaders are not.” On culture, NHSE said the trust should take steps to ensure staff can work in psychologically safe environments where “poor behaviours are consistently addressed” and to “eradicate bullying and cronyism at all levels of the organisation”. Staff had described “inequity and cronyism” being a feature of recruitment processes at all levels. Read full story (paywalled) -
News ArticleNHS whistleblowers need stronger legal protection to prevent hospitals using unfair disciplinary procedures to force out doctors who flag problems, the British Medical Association has said. Doctors are being “actively vilified” for speaking out, which has resulted in threats to patient safety, including unnecessary deaths, according to the council chair of the doctors’ union, Phil Banfield. Despite a series of scandals in recent years, it is becoming more common for hospitals to use legal tactics and “phoney investigations” to undermine or force out whistleblowers rather than address their concerns, he warned. Banfield said: “Someone who raises concerns is automatically labelled a troublemaker. We have an NHS that operates in a culture of fear and blame. That has to stop because we should be welcoming concerns, we should be investigating when things are not right. “Whistleblowers are pilloried because some NHS organisations believe the reputational hit is more dangerous than unsafe care,” he added. “Whereas the safety culture in aviation took off after some high-profile airplane crashes in the 70s, the difference is that the aviation industry embraced the need to put things right and understand the systems that led to the disaster – the NHS has not invested in solving the system, it’s been bogged down in blaming the individual instead of the mistake.” Read full story Source: The Guardian, 2 July 2023
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News Article
Trust leadership rated ‘inadequate’ as CQC accuses staff of ‘ignoring’ problems
Patient Safety Learning posted a news article in News
An acute trust’s leadership has been downgraded to ‘inadequate’ after some staff ignored concerns raised directly by CQC inspectors, while others said bullying was ‘rife’. The Care Quality Commission (CQC) found multiple reports of staff raising concerns at York and Scarborough Foundation Trust, but that staff felt they were “ignored”, dismissed or “swept under the carpet”. The trust’s leadership has been rated as “inadequate”, down from “requires improvement”, although its overall rating remains “requires improvement”. The CQC said “poor leadership was having an impact across all of the services” and there were occasions “where leaders displayed defensiveness or appeared to tolerate poor behaviours from staff.” The trust said it had been under “sustained pressure” but had already begun to make improvements, including a new information system in maternity services and a review of nursing establishment numbers. Read full story (paywalled) Source: HSJ, 30 June 2023 -
News Article
Burnout in doctors doubles chances of patient safety problems, study finds
Patient Safety Learning posted a news article in News
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. Read full story Source: The Guardian, 14 September 2022 -
News Article
Trust 'hiding serious harm and death' report
Patient Safety Learning posted a news article in News
There was a fair bit of press coverage last week about an employment tribunal case against the Care Quality Commission – in which the regulator was found to have sacked an inspector for making a series of whistleblowing disclosures. However, many of the key details were either skirted over, or missed altogether, in the coverage. The disclosures made by Shyam Kumar related not just to his role as a special adviser for the CQC, but also to his full-time employer, University Hospitals of Morecambe Bay FT, and to understand the case fully, they need to be separated out. The important context (also skirted over) was that Dr Kumar had raised a series of legitimate concerns about another orthopaedic surgeon at UHMB, both internally within the trust, and externally with the CQC, in 2018. This caused major tensions within UHMB, to the extent that Dr Kumar started to be targeted for criticism by a different surgeon, being labelled a ‘traitor’ to Indian doctors in a group email. When challenged by Dr Kumar, the colleague complained to the CQC that Dr Kumar had sought to threaten and intimidate him, along with other accusations. Read full story (paywalled) Source: HSJ, 12 September 2022 -
News Article
It is crucial that doctors listen to patients – and their families
Patient Safety Learning posted a news article in News
Merope Mills’s recent article in the Guardian should be mandatory reading for all medical and nursing students. All of us who are senior doctors or nurses will recognise only too well the dangerous conditions that Merope describes: the senior doctors with overinflated egos; the internecine warfare between departments; the nursing staff and junior doctors who are rendered impotent by repeated attempts to galvanise action from off-site but know-it-all seniors; the lack of integrated thinking that results when there is no consistent lead clinician; and, most dangerous, not listening to the patient or their relatives, and not directly examining the patient. Candour and co-production are terms much used in healthcare, but for some staff these aspects of care are a million miles away from the ego-driven practice in which they engage. This is why Merope’s advice is so important. Do not have blind faith in your clinician. Do not leave all the thinking to them. Do equip yourself with knowledge and, most of all, do demand to be treated as an equal partner in the care of your body or your loved one. Current and former healthcare professionals respond to Merope Mills’s account of losing her daughter after a series of catastrophic medical errors. Read full story Source: The Guardian, 11 September 2022
