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Found 209 results
  1. Content Article
    In June 2023 the Secretary of State for Health and Social Care announced that HSSIB would undertake a series of investigations focused on mental health inpatient settings. This overarching report brings together and explores cross-cutting patient safety risks across five individual investigations. The aim of this report is to examine patient safety risks identified across the following HSSIB investigations: Creating conditions for learning from deaths and near misses in inpatient and community mental health services: Assessment of suicide risk and safety planning (12 September 2024) Creating conditions for the delivery of safe and therapeutic care to adults in mental health inpatient settings (24 October 2024) Mental health inpatient settings: out of area placements (21 November 2024) Mental health inpatient settings: Supporting safe care during transition from inpatient children and young people’s mental health services to adult mental health services (12 December 2024) Mental health inpatient settings: Creating conditions for learning from deaths in mental health inpatient services and when patients die within 30 days of discharge (30 January 2025) Findings Safety, investigation, and learning culture There remains a fear of blame in mental health settings when safety events happen. This contributes to a more defensive culture despite staff actively wanting to learn. Many recommendations to support learning for improvements in mental health care do not lead to implemented actions. Reasons for this include a lack of impact assessment resulting in unintended consequences, no clear recipient involved in the development of recommendations, and duplicated recommendations across organisations. System integration and accountability The integration of health and social care within an integrated care system currently relies on relationships, with an expectation and hope that they will work well. However, where this is not the case, a lack of clear accountability can result in poor outcomes for people with mental illness and severe mental illness. The delivery of care for people with mental illness and severe mental illness is challenging because health and social care services are not always integrated and their goals are not always aligned. Physical health of patients in mental health inpatient settings There are gaps in the provision of physical health care for people with severe mental illness, including inconsistent health checks, poor emergency responses, and misattribution of physical symptoms to mental illness. The misattribution of physical symptoms to patients’ mental health was observed and had the potential to contribute to worsened patient outcomes. National reports, strategies and research have made recommendations to improve the physical health of people with severe mental illness. However, there is evidence that recommendations are delayed in implementation and people continue to die prematurely. Integrated care boards lack the required data and the necessary analytical capability to assess disparities in access, experience and outcomes related to the physical health needs of people with severe mental illness. There is variation in how the physical health checks are carried out on mental health inpatient wards, with limitations in processes for following up on patients’ physical health needs. There is variation in the knowledge, skills and experience of staff who undertake physical health checks and in the environments in which these checks take place. Patients may not always be supported in terms of health education about their physical health risks and modifiable risk factors, for example smoking, dietary advice and physical activity. Caring for people in the community Integrated care boards cannot consistently draw reliable insights from data at national, system or local level, to optimise and improve services, patient care, and outcomes across mental health pathways of care. This results in variability in service provision which does not always meet the needs of individual patients or local populations. Inpatient ‘bed days’ are taken up by people who no longer need them, because people who are clinically fit for discharge are delayed in being transferred to their home or a suitable residence (appropriate placement). Reasons for delayed discharges include issues with housing support and establishing suitable accommodation. This means patients are not always in the right place of care. Barriers to discharge affect patient flow and may result in delays in admission for people with severe mental illness. This means they have to be cared for in a community setting while waiting for an inpatient bed. There is variation across the country in how drug and alcohol services are provided. The variation does not allow for fair and equitable treatment for all patients. Community services are vital to support people to stay as well as possible and to prevent hospital admissions. However, there is variation in community service provision across the country. Staffing and resourcing Staffing and resource constraints in inpatient and community mental health settings impact their ability to provide safe and therapeutic care. In inpatient settings, constraints contribute to mental health wards aiming to staff for ‘safety’ but not always for ‘therapy’. Challenges for staff include the emotionally demanding nature of their work; this can lead to staff burnout and sickness, and further strain on services. There are gaps in mental health workforce planning, particularly in community services where there is no evidence based workforce planning tool to support a standardised staffing establishment setting model. Digital support for safe and therapeutic care A lack of interoperability or integration between digital systems affects the provision of care across mental health, acute and community providers. Challenges in securing appropriate funding impacts on the ability of hospitals to integrate and update their digital services and infrastructure. Electronic patient record functionality is often not available or does not meet staff needs, and so it is not used. Examples include absent functions for food and fluid balance monitoring and risk assessment of venous thromboembolism (blood clots). Challenges in providing and maintaining patient-facing technology, for example televisions and payphones, impacts on the therapeutic environment and the ability of patients to maintain contact with families and loved ones. Where technology for monitoring patients had been introduced, implementation has required considerations to ensure it is used appropriately, is patient-centred, maintains therapeutic engagement, and supports patients to feel safe. Suicide risk and safety assessment ‘Doing’ tasks, like ‘ticking’ checklists, overshadow meaningful, empathetic ‘being’ interactions with patients. Open, compassionate conversations that build trust and therapeutic relationships, enabling patients to own their risk while feeling supported, can help mitigate this. Investigation processes can contribute to a fear of blame, and subsequently contribute to defensive practices such as checklists and a ‘tick box’ culture. This inhibits open and honest conversations and the ability to put the patient, as their authentic self, at the heart of them. Safety recommendations HSSIB recommends that the Department of Health and Social Care continues to work with the ‘recommendations but no action working group’ and other relevant organisations, to ensure that recommendations made by national organisations specific to mental health inpatient settings are reviewed. This work should consider the mechanisms that supported or hindered the implementation of actions from these recommendations. This may help the Department of Health and Social Care understand what has worked when implementing actions from recommendations and enable learning about why some recommendations have not achieved their intention. HSSIB recommends that the Secretary of State for Health and Social Care directs and oversees the identification and development of a patient safety responsibilities and accountabilities strategy related to health and social care integration. This is to support the management of patient safety risks and issues that span integrated care systems. Safety observation National bodies can improve patient safety in mental health inpatient settings in England by supporting provider investment in equipment, digital systems and physical environments to enable conditions within which staff are able to provide, and patients can receive, safe and therapeutic care.
  2. Content Article
    In this blog, Clare Wade, Patient Safety Learning's Director, draws attention to the impact toxic cultures have on staff and how, sadly, most often nothing is done about it. Clare shares her own personal reflections from past experiences in her career. There is a clear link between toxic cultures and patient safety, and while there are no easy answers these behaviours must be acknowledged, challenged and cured if the NHS is to survive. I’ve personally experienced toxic culture and behaviour on many occasions, but I found two examples particularly tough to navigate. The first was more than 20 years ago when I worked clinically in a trust largely staffed by the local population where most colleagues were either related or friends; I lived some distance away and commuted in. I’d witnessed troubling behaviour from one senior time-served nurse several times, but one day I heard a blatant, serious breach of patient confidentiality between her and another patient. I was shocked and initially didn’t know what to do. I raised it with the nurse involved who laughed at me, and then the sister in charge who told me to just forget it. After much deliberation, I went to the matron in charge of the department. Conversations took place behind closed doors and eventually I was hauled into trust HQ for a formal meeting, alone—the nurse was nowhere in sight. I was accused of causing upset and the nurse had denied any wrongdoing. In no uncertain terms it was made clear that I should keep my head down and mouth closed if I wanted to remain in post. From that day on my time was made miserable, colleagues closed ranks, stopped talking to me and I was ostracised until the day I left the trust. Later in my career, at a different trust, a new director was recruited to lead my department. From the start something felt off as several senior leaders quickly left their roles. It became obvious that the director was a bully; we largely worked in open plan offices, and the director thought nothing of shouting at and belittling people in front of everyone, even other directors and the CEO. It was impossible for senior colleagues not to know what was happening, but no action was taken. The situation worsened with many people taking sick leave or leaving the trust completely. I came under fire as the director didn’t agree with how I led my team or how we worked, even though our performance was excellent. An external consultant was brought in to identify issues with my practice and help build a case against me. The consultant admitted this to me and said they couldn’t find anything wrong to report back. At the time I had a mentor relationship with a senior board member, and I chose to confide in them with the hope of gaining some insight into how I might be able to better deal with the situation. I didn’t know until sometime later, but my mentor was informing the director about our conversations. As time passed, the behaviour worsened and, although many colleagues were experiencing it too, it was obvious I was on my own in wanting to speak up. I was encouraged to go to a senior HR colleague who would be empathetic, so I did and eventually the director agreed to mediation. I was so nervous ahead of the meeting, but it went ahead and to my surprise the director admitted to some of the allegations and agreed some actions. If I thought my treatment had been bad to this point, I had no idea what was to come. It felt like open season with the director’s full toxicity focussed on me. Derogatory rude emails would be sent daily, raising my anxiety as they landed in my inbox. Meetings where we were both present made me feel sick; they would think nothing of singling me out in front of everyone for their derision and nastiness. The barrage was constant and debilitating, affecting every part of my life and breaking my confidence. One day I couldn’t take any more so left work early and crawled into bed at home where I felt safe. I decided to call the senior HR colleague who had facilitated the previous mediation to ask for an update about the agreed actions. I was absolutely shocked to my core at their reaction, they shouted down the phone that I’d had my opportunity to air my grievances, nothing more was going to happen, the director wasn’t going to be held accountable for the agreed actions and I just needed to forget it and get on with my job. Was I naive to expect a different response? I hit rock bottom, felt scared to go into work and knew I had to get out of there for my health and sanity. Even when I left, the impact followed me to my next role; my confidence and resilience were shot and took a long time to rebuild. The director stayed in post for another couple of years until there were so many grievances that the CEO had to act. The sickening part is that after a period of ‘gardening leave’ the director secured another senior role in another trust in the area so will be perpetrating the same toxic behaviour onto others. I know there are thousands of experiences throughout the NHS just like mine and, unfortunately, in many organisations culture and behaviours aren’t improving. This problem is endemic and has decades of history behind it. There is a clear and acknowledged link between toxic cultures and patient safety. Within the NHS Patient Safety Strategy, NHS England states that: "positive patient safety and healthy organisational culture are two sides of the same coin. A culture in which staff are valued, well supported and engaged in their work leads to safe, high-quality care." In order to improve the care delivered to our loved ones, friends and ourselves, the NHS must take action to improve its culture. Forget the financial situation and the waiting lists, this is the most pressing and wicked problem facing our health service today; it permeates throughout everything and unless it is acknowledged, challenged and cured no other interventions will work. Money doesn’t solve toxic cultures, neither does restructuring the NHS for the umpteenth time. Sadly, some colleagues have taken their own lives because of the toxicity they have endured, this needs to stop now. There are no easy answers here but if we don’t put this right the NHS won’t survive. Share your story Have you worked in a toxic culture? Have you tried to speak up? Have you examples of a good team culture? Add your comment below (you will need to be a hub member and signed in) or contact us at [email protected] and we can share your story anonymously. Related reading on the hub Speaking up for patient safety: A new interview series about raising concerns and whistleblowing Speaking up as an agency nurse cost me my career My experience of speaking up as a healthcare assistant in a care home
  3. Content Article
    At a recent Public Policy Projects and Patient Safety Learning event, Maggie Pacheco posed a question to a panel that Patient Safety Learning's Helen Hughes was chairing. "Drawing on my own experience of raising safety concerns at different stages of my career, often met with dismissive or even hostile behaviour, I dread the day when the voices of safety, the brave individuals who dare to speak out, fall silent." "We urge them to be courageous, to push back against unsafe practices, yet too often, their reward is not gratitude or action but silence, retaliation, or career-limiting consequences." "And if, one day, exhausted and demoralised, they stop speaking up, what then becomes of our health system?" The topic sparked considerable debate in the room. Maggie reflects on it further in her LinkedIn post.
  4. News Article
    Panic buttons, security cameras and active-shooter drills: Those are some of the ways doctors who treat transgender children have armed themselves when facing violent threats over the years. Now, they’re warning the president’s actions could make things more dangerous. Even before President Donald Trump attempted to ban gender transition care nationwide for young people, protesters routinely demonstrated outside clinics that treat trans youths. Some carried signs with violent messages and the names of doctors who treat trans children. One entered a Seattle clinic with a weapon, according to court records. Now doctors say threats of violence are rising — along with fears of legal action — in the wake of Trump’s Jan. 28 executive order that labeled gender transition care for minors a “dangerous trend” and “a stain on our Nation’s history.” Dozens of providers gave sworn affidavits as part of a lawsuit four states filed challenging the legality of Trump’s executive order. Providers in those Democratic-led states remain so afraid, many agreed to file affidavits challenging the order only if they could do so anonymously. Washington’s state attorney general led the legal effort. “I am scared, not just for myself, but for my family,” one Seattle-based physician and professor wrote in court documents. “It is a terrifying time to be a doctor providing gender-affirming care.” Read full story (paywalled) Source: Washington Post, 9 March 2025
  5. News Article
    Mental health patients subjected to abuse on wards do not formally complain as they "do not want to expose themselves to any risk of revenge" from staff, academics say. A study by Hertfordshire Partnership University NHS Foundation Trust, and the University of Hertfordshire, involving 21 patients and two carers, uncovered more than 750 incidents of violence and coercion by staff, few of which were reported. The researchers suggested social workers should be present on wards, with staff also required to wear body cameras to protect patients. The Department for Health and Social Care (DHSC) said staff committing acts of violence should be removed and prosecuted. Claims of violence and coercion allegedly committed by staff included patients being physically restrained, verbally abused, being moved with force and being deliberately ignored. Eight patients told researchers that one or two staff were responsible for abuse against them, while 18 said acts were witnessed by other patients or staff. Only four official complaints were made, according to researchers, with just one upheld. Mr Munt said: "The preoccupation for many patients is that they do not want to expose themselves to any risk of revenge." Read full story Source: BBC News, 6 March 2025
  6. News Article
    When Sally Mumford enrolled in a training course to become a psychotherapist in 2020, she was excited to start a new career. She hoped to help people understand how their feelings and behaviour were shaped by their pasts. But she quickly realised that the course might not be what she had expected. “I arrived like a lamb to the slaughter,” she said. “There was a real nastiness that percolated down from the top.” Mumford said her tutors at the training centre in London let bullying between students go unchecked. “It was all part of making you into a therapist. The whole ethos was to break you down and build you back up how they wanted you to be.” Mumford is one of more than a dozen people who have studied for psychotherapy qualifications at UK institutions who told the Observer that some courses cross the line from challenging to toxic, with tutors bullying students. Some said their tutors made humiliating remarks to them in public, and left them feeling too scared to speak up or leave the course. But the industry is largely unregulated; “psychotherapist” is not a protected profession, so anyone can set up a practice with that title. Psychotherapist training is also unregulated, and there is a wide range of qualifications across the UK. Amanda Williamson, a psychotherapist who has been campaigning for regulation in the industry for more than a decade, is concerned about “toxic” training courses. “I’ve heard negative feedback about all manner of courses at prominent universities, including appalling tales of bullying and badly-run ‘group process’,” Williamson said. Since psychotherapy training requires students to be vulnerable, she argues, regulations must be more rigorous than in other industries. Therapists and training institutions should be bound by a consistent code of ethics, and regulated by the same body, she said. “Regulation, or at least an inquiry to shine a light on these toxic hotspots that are allowed to fester … is very much overdue.” Read full story Source: The Guardian, 17 November 2024
  7. Content Article
    Many executives believe that all failure is bad (although it usually provides lessons) and that learning from it is pretty straightforward. Amy C. Edmondson, a professor at Harvard Business School, thinks both beliefs are misguided. In organisational life, she says, some failures are inevitable and some are even good. And successful learning from failure is not simple: It requires context-specific strategies. But first leaders must understand how the blame game gets in the way and work to create an organizational culture in which employees feel safe admitting or reporting on failure.
  8. News Article
    Trainee midwives at a struggling trust have raised serious concerns about bullying and feeling afraid to speak up, an NHS England report has revealed. Experiences of pre-registration midwifery trainees at Birmingham Heartlands Hospital and Good Hope Hospital, part of University Hospitals Birmingham Foundation Trust, are detailed in a recent NHS England workforce, education and training report following a visit in January. The report said learners at BHH reported a “concerning culture of bullying and undermining”, with some midwives displaying hostility and rudeness, and one student constantly feeling like they were in “fight or flight mode”. At GHH, students were aware how to raise concerns but described it as a “waste of time”, telling NHSE qualified midwives had informed them they frequently raised concerns about staffing levels without these being resolved. Meanwhile, at BHH trainees said lack of action taken when they tried to raise concerns had created an environment where learners were reluctant to voice fears about patients or seek guidance on patient care. The NHSE report said students provided multiple instances of trying to raise concerns which were either not acted on or they experienced repercussions for having attempted to speak up. One person expressed concerns about a woman who had experienced severe bleeding following birth but their supervising midwife dismissed their concern. They then escalated the matter to another staff member and was taken more seriously, but as a result, the student said their supervising midwife “made my life hell” for the rest of the shift. NHSE said it heard examples where midwives made derogatory comments about students in public, including about one person’s weight, which caused them to leave the building in tears. Read full story (paywalled) Source: HSJ, 24 May 2024
  9. Community Post
    Is it time to change the way England's healthcare system is funded? Is the English system in need of radical structural change at the top? I've been prompted to think about this by the article about the German public health system on the BBC website: https://www.bbc.co.uk/news/health-62986347.amp There are no quick fixes, however we all need to look at this closely. I believe that really 'modernising' / 'transforming' our health & #socialcare systems could 'save the #NHS'. Both for #patients through improved safety, efficiency & accountability, and by making the #NHS an attractive place to work again, providing the NHS Constitution for England is at the heart of changes and is kept up to date. In my experience, having worked in healthcare for the private sector and the NHS, and lived and worked in other countries, we need to open our eyes. At present it could be argued that we have the worst of both worlds in England. A partially privatised health system and a fully privatised social care system. All strung together by poor commissioning and artificial and toxic barriers, such as the need for continuing care assessments. In my view a change, for example to a German-style system, could improve patient safety through empowering the great managers and leaders we have in the NHS. These key people are held back by the current hierarchical crony-ridden system, and we are at risk of losing them. In England we have a system which all too often punishes those who speak out for patients and hides failings behind a web of denial, obfuscation and secrecy, and in doing this fails to learn. Vast swathes of unnecessary bureaucracy and duplication could be eliminated, gaps more easily identified, and greater focus given to deeply involving patients in the delivery of their own care. This is a contentious subject as people have such reverence for the NHS. I respect the values of the NHS and want to keep them; to do this effectively we need much more open discussion on how it is organised and funded. What are people's views?
  10. Content Article
    In this article for Health Services Insight, NHS consultant David Oliver examines why most comments on articles in the Health Services Journal (HSJ) are posted anonymously. He highlights that this tendency towards anonymity from commenters who are clearly in influential, senior NHS posts, indicates that the culture in the NHS management community, from NHS England down, is one that makes most people fearful of saying anything in their own name in case of reprisal. He also points out that a culture where people are afraid to make comments and criticisms in their own name is in conflict with the Nolan Principles of 'selflessness', 'integrity', 'objectivity', 'accountability', 'openness', 'honesty' and 'leadership' that senior NHS managers and officials are supposed to be guided by.
  11. Content Article
    Surviving in Scrubs have published their first report 'Surviving healthcare: Sexism and sexual violence in the healthcare workforce' is now live. The report is an analysis of 150 survivor stories submitted to their website since they launched in 2022. It details the findings on the incidents, factors and challenges unique to healthcare that permit sexism and sexual violence in the healthcare workforce. The report contains recommendations to healthcare organisations to better support survivors and end these behaviours. Recommended actions: Education on sexism and sexual misconduct for all staff in healthcare including students, with a focus on responding to reports of sexual misconduct for managers, culture change, allyship and preventing sexual misconduct. Research into the impact of sexism and sexual misconduct on the healthcare workforce via an intersectional lens and development of evidence based interventions to prevent sexual misconduct. An independent inquiry into the culture of sexism and sexual misconduct in healthcare. Improved support for survivors, with access to specialist sexual violence support from independent sexual violence advocates provided by healthcare employers. A review of current policy and past cases by healthcare employers to improve internal processes. Introduction of specialist sexism and sexual misconduct policies, separated from other workforce policies, available in every healthcare employer. An independent anonymous reporting system available across the NHS. Reform from healthcare regulators to reduce the number of cases dropped before investigation and improved psychological safety measures for witnesses during the investigation and tribunal processes. A system to improve communication between healthcare employers, regulators, and the police. Mandatory reporting from the employer to healthcare regulator should be introduced for cases of sexual harassment and assault. Related reading on the hub Calling out the sexist and misogynist culture within healthcare: a blog by Dr Chelcie Jewitt, co-founder of the Surviving in Scrubs campaign
  12. Content Article
    A substantial barrier to progress in patient safety is a dysfunctional culture rooted in widespread disrespect. Leape et al. identify a broad range of disrespectful conduct, suggesting six categories for classifying disrespectful behaviour in the health care setting: disruptive behaviour; humiliating, demeaning treatment of nurses, residents, and students; passive-aggressive behaviour; passive disrespect; dismissive treatment of patients; and systemic disrespect. At one end of the spectrum, a single disruptive physician can poison the atmosphere of an entire unit. More common are everyday humiliations of nurses and physicians in training, as well as passive resistance to collaboration and change. Even more common are lesser degrees of disrespectful conduct toward patients that are taken for granted and not recognised by health workers as disrespectful. Disrespect is a threat to patient safety because it inhibits collegiality and cooperation essential to teamwork, cuts off communication, undermines morale, and inhibits compliance with and implementation of new practices. Nurses and students are particularly at risk, but disrespectful treatment is also devastating for patients. Disrespect underlies the tensions and dissatisfactions that diminish joy and fulfilment in work for all health care workers and contributes to turnover of highly qualified staff. Disrespectful behaviour is rooted, in part, in characteristics of the individual, such as insecurity or aggressiveness, but it is also learned, tolerated, and reinforced in the hierarchical hospital culture. A major contributor to disrespectful behaviour is the stressful health care environment, particularly the presence of “production pressure,” such as the requirement to see a high volume of patients.
  13. Content Article
    Professor Jane Somerville, emeritus professor of cardiology at Imperial College, talks about the issues facing doctors who raise concerns about patient safety issues in the NHS. She shares her views on the risks facing doctors who speak up and the ways that healthcare managers treat whistle blowers. She also highlights issues in the employment tribunal system and outlines the need to regulate NHS managers. In the video, Jane mentions the employment tribunal of Dr Martyn Pitman. Since this interview was recorded, Dr Pitman lost the case he brought for retaliatory victimisation. Transcript I'm Jane Somerville. I'm a retired professor of cardiology, having been on the staff of the Royal Brompton Hospital and Heart Hospital. I don't practise medicine anymore. I'm interested in whistleblowing doctors. I became involved because I went to a conference at the Royal Society of Medicine which unfortunately they wouldn't repeat, although they promised to do so, and I was horrified at what is happening to people in my profession who speak up for the safety of patients. Firstly, they're supposed to speak up for the safety of patients, it's called our Duty of Candour, and secondly the treatment by the trusts, mainly managerial, is absolutely appalling, and I decided with my colleague David Ward that we really ought to work and do something. And why should we? Well, because I'm untouchable—they can't take my career from me, they can't prevent me doing anything, they can't do anything and I'm senior enough in the profession to be able to speak with some authority, at least about how medicine works. So I thought, nothing to lose and everything to gain for my profession. Question: How are you supporting the work to protect doctors who speak up? David Ward and I are working with Justice for Doctors and they include us in their meetings. We try not to get involved or allied with them but they know we're on their side and we speak out, and by virtue of our seniority we get to see people, make some sensible suggestions. Working with the excellent David Hencke who is writing Westminster Confidential— the actual facts. And he has brought the facts of the most horrible tribunal that's been going on with this Martyn Pitman, a distinguished and useful obstetrician and a gynaecologist doing good work, and the Royal Hampshire has behaved extraordinarily badly, in my view. Question: Why aren’t existing systems in the NHS protecting doctors who speak up for patient safety? The Freedom to Speak Up Guardians are usually not strong enough to bang and say to the CEO or the chief executives or the chairman or the board. They're just not strong enough to say, “This has to stop,” so who's to stop the trust managers or the trust managing executives (who could be doctors)? Who's to stop them if they want to persecute? It is part of the coverup culture that unfortunately exists since managers came into the health service. When I grew up, which wasn't yesterday, but also my younger colleagues, we didn't have all this until we had managers. Nobody regulates managers, they can just do what they like, they don't have a General Medical Council—they don't have anything! They have no code and lots of them aren't even educated to be a manager. It needs to be properly regulated and they need not to have both the money and the command, and our foolish profession has allowed both. They have control of the money—thousands of pounds are spent on legal fees of very expensive lawyers and it's a very unjust set of arms. The litigant or the complaining doctor has almost nothing unless he happens to be a rich consultant, and the trust has everything, with these managers in control. There's another side to this which is very, very serious, that I don't want really to touch on except to tell you and that is the question of employment tribunals. They manage to get these doctors to employment tribunals and it's not by chance that the respondents, the trusts, win 97%— that can't be justice, 97%! But I think the justice system has to look into the trouble of the employment tribunals, but it's very unjust on the doctors and very unfair ultimately for the patients. Question: How widespread are the issues facing NHS whistleblowers? Do I have any knowledge of how widespread it is? Answer, no. Why? Because they don't keep statistics in the Department of Health, We've asked them at quite a high level—no idea, thought it was a rather strange question. So we don't have statistics, complaints are not registered and you can't get information. And coupled with that is the improper making and signing of NDAs, which they do to the doctor and of course they're (the doctor) not allowed to go to the press, they're not allowed to speak to anybody and bad things happen even, I regret to say, suicides. To end how widespread it is, of course we don't know. It's more widespread than we think and there are more people who have suffered than we know—they're frightened to come forward. It's a culture of fear in a culture of cover up. Question: What needs to be done to protect doctors who speak up for patient safety? Key number one is stop persecuting doctors who speak up for the safety of patients. All that matters to us is the safety of patients and so therefore they must be given respect. They may not always be right, they may be saying silly things or they may be absolutely on the ball, but they must be listened to and they must not be persecuted by managers. Then next comes they (managers) must be regulated in their behaviour and I am hoping, although it is very serious, that something will come of this corporate manslaughter problem that is going to be brought up. That will concentrate the minds of the managers. They'll be a bit more careful automatically. So stopping the persecution should be automatic—ordered by the Government, ordered by the Prime Minister, ordered by whoever—but they have to stop it. Secondly, there's the question of the regulation of the funds used to have unequal arms—very expensive lawyers and leading QC's cost the Earth so the thing gets more and more and it shouldn't get to the employment tribunal. That needs looking into, but I don't think that's our business. Maybe employment tribunals do some good—not as far as the doctors are concerned. It's a very, very bad system. So let the judiciary get on and organise their own as we should organise our own medical aspects and concern ourselves about the safety of patients. It really is urgent to do something about this in the health service. It's the sort of thing that is losing doctors and doctors in training—I mean who wants to go into a health service where the managers can treat you like dirt, and do. Safety within the health service, within the doctor's brief, is vital and absolute and primary. Related reading Jane Somerville interview on staff speaking up: Transcript from Times Radio Breakfast (7 September 2023) The NHS whistleblowing crisis (8 February 2022) Westminster Confidential - Tribunal of the absurd: My verdict on the Dr Chris Day whistleblower case (David Hencke, 19 November 2022)
  14. Content Article
    Nurse bullying has been an issue for decades and continued during the Covid-19 pandemic. Now, in the post-pandemic era, allegations of toxic behaviour are continuing to climb.  Becker's spoke with Jennifer Woods, vice president and chief nursing officer at Baptist Health Hardin in Elizabethtown, Pennsylvania, and Jamie Payne, chief human resources officer at Saint Francis Health System in Tulsa, Oklahoma, to understand the increase in nurse bullying and how their health systems are working to address it. 
  15. Content Article
    In this opinion piece for the BMJ, Rammya Mathew talks about the limits of a no blame culture in identifying where harm is being caused by a clinician. "The Letby case is an extreme example of the shortcomings of a “no blame” culture. When things go wrong we’re encouraged to always support staff and ensure that no one feels implicated. It’s as though only systems and processes can be criticised, and discussing the possibility of individual accountability is considered “off grounds.”
  16. Content Article
    The Culture Review report was published following an independent external review of the organisational culture at University Hospitals Birmingham Trust. The external review was carried out by consultancy firm The Value Circle following a series of investigations into problems at University Hospitals Birmingham Foundation Trust over the last year. The review found that, despite significant challenges in staff experience at the Trust, many staff remain committed and proud to provide care to the population they serve. Staff experience at the Trust needs dedicated and continued focus to make positive shifts to a working environment where all staff feel safe, heard, and valued. The review team found a challenging staff experience that has manifested itself over a long period of time, has largely continued unchecked, and has created a culture where for many, an adverse working environment has become normalised. There is currently not a single defining culture at the Trust, but there are commonalities of experience. The culture is comprised of many individual views and interpretations which means staff experience the Trust in different ways. For many of the staff who engaged with the review, their experience of working in the Trust is compromised, with a range of concerns. These include not feeling valued and respected, often not feeling safe at work, and not connected to the wider organisation in which they serve. Staff also reported not feeling included and not having a voice that is heard and acted upon. For some staff this has impacted on their wellbeing. Going forward, the Board must acknowledge the culture at UHB needs to significantly improve. The Board, supported by senior management and staff, must create the conditions for change. This should include zero tolerance for poor behaviour so staff feel they can contribute, collaborate, have their voice heard, and feel their work is valued. Staff should be empowered to lift their heads up and enabled to do the right thing. Empowerment should not be simply handing off responsibility to staff, but listening and engaging in co-production, development, and improvement. The four fundamental shifts the review recommend are: A shift to openness and transparency. A shift to valuing people and ensuring equity and inclusion . A shift to ensuring culture directly connects to effective patient care. A shift to ensuring a physically and psychologically safe working environment.
  17. Content Article
    A recent report found that a third of female surgeons have been sexually harassed at work. In this opinion piece, Dr Liz O’Riordan speaks out about the abuse she suffered from male colleagues while working for the NHS. She describes her experiences, highlighting that incidents of sexual harassment are common amongst female surgical trainees who fear speaking out as it may affect their careers. She also draws attention to the fact that it is not just an issue amongst surgeons, but that many other healthcare professionals experience inappropriate sexual comments and behaviour while at work.
  18. News Article
    More than half of staff at a hospital trust that has been under fire for its "toxic culture" have said they felt bullied or harassed. The findings come from an independent review commissioned by University Hospitals Birmingham (UHB) NHS Trust. It has been at the centre of NHS scrutiny after a culture of fear was uncovered in a BBC Newsnight investigation. UHB has apologised for "unacceptable behaviours". It added it was committed to changing the working environment. Of 2,884 respondents to a staff survey, 53% said they had felt bullied or harassed at work, while only 16% believed their concerns would be taken up by their employer. Many said they were fearful to complain "as they believed it could worsen the situation," the review team found. Read full story Source: BBC News, 27 September 2023
  19. Content Article
    The NHS Staff Survey is an essential tool for assessing the experiences and opinions of NHS workers in Trusts in England. It also provides valuable insights to help understand the speaking up culture in the NHS. In this report the National Guardian’s Office analyse the results of the 2022 NHS Staff Survey, focusing on questions relating to speaking up. Key findings from this report include: The Freedom to Speak Up sub-score declined from 6.5 in 2021 to 6.4 in this year’s NHS Staff Survey. This fall equates to a 1.5% change. Given the size of the survey (over 600,000 workers) this equates to a declining perception of over 9,000 workers. There was a marked fall for raising concerns relating to clinical practice (following 2021 when there was a marked improvement). For the first time, bank staff completed a bank staff survey. The results were in line with the core survey results for all four speak up questions. By sector, ambulance trusts continue to score least well (and are continuing to worsen) whereas community trusts continue to perform best. The gap between community and ambulance/acute trust results is widening, potentially indicating the impact of pressures on frontline services. The Freedom to Speak Up sub-score positively correlates with Care Quality Commission ratings. There is a marked disparity between the highest and lowest scoring organisations, and this has increased for three out of the four Freedom to Speak Up questions since the 2021 survey. The North East and Yorkshire, North West and South East regions scored the highest. East of England scored least well for all four Freedom to Speak Up questions. In particular, the results for both questions about workers feeling that their organisations will address concerns were markedly low. Related reading NHS Staff Survey Results 2022 (9 March 2023) Patient Safety Learning: Still not safe to speak up: NHS Staff Survey Results 2022 (23 March 2023)
  20. Content Article
    In this blog, Steve Turner reflects on why genuine patient safety whistleblowers are so frequently ignored, side-lined or victimised. Why staff don't speak out, why measures to change this have not worked and, in some cases, have exacerbated the problems. Steve concludes with optimism that new legislation going through Parliament offers a way forward from which everyone will benefit. The scale of the problem The hidden costs of stigmatisation of healthcare whistleblowers are immense. System-wide problems in this area of healthcare are reinforced by a lack of transparency and the failure of accountability. The consequences of this failure have been investigated many times over the years. A seminal case was that of the Bristol heart surgery scandal in the 1990s. This was brought to light by the anaesthetist Steve Bolsin and led to the implementation of a system of clinical governance.[1] This advance in measures to deliver quality, consistent and safe care remains as relevant today as it ever was. More recently, the investigation into the failings at mid Staffordshire[2] highlighted how a ‘good news’ only culture, where reputation management was placed above patient safety, is failing patients. Critically for me the shocking fact is that where staff who blow the whistle can't, or don't, speak out, are ignored or silenced, the onus to expose wrongdoing falls on patients and their relatives. This involves great personal cost. The onus to expose wrongdoing falls on patients and their relatives. This involves great personal cost. This shameful thread of patient-led whistleblowing goes back a long way and has not stopped. Examples where patients, carers or relatives have had to take the lead and blow the whistle include the death of Robbie Powell,[3] Elizabeth Dixon,[4] Oliver McGowan,[5] Claire Roberts and those who died in the Belfast Hyponatraemia scandal,[6] the Gosport War Memorial Hospital scandal,[7] and the investigation into maternity services in East Kent.[8] These patient safety scandals show no sign of abating despite the report on the failings at mid Staffordshire[2] and Sir Robert Francis’ major review into whistleblowing in the NHS.[9] This is reinforced by the 2023 Bewick Review,[10] which is the first of three planned reviews into University Hospitals Birmingham NHS Foundation Trust. This review was commissioned following repeated serious concerns relating to patient safety, leadership, culture and governance, which were initially downplayed or ignored. The full story behind these failings and their significance has yet to fully come to light. Patients have to blow the whistle on unsafe care A stream of healthcare scandals (too many to mention all of them here) have been exposed by members of the public. Key examples include the case of Robbie Powell who died of untreated Addison's disease in 1990.[3] Thanks to the tenacity of Robbie’s father (Will Powell) this led to the clarification of the absence of an individual legal Duty of Candour for healthcare professionals.[11] Despite numerous reports and failed investigations, including one of which put forward 35 suggested criminal charges, the Robbie Powell case remains open with the Crown Prosecution Service (CPS). In addition, the former Welsh Ombudsman and the English Ombudsman are both calling for a public inquiry into the case.[12] Another case concerns those who died at Gosport War Memorial Hospital in the 1990s who were prescribed opioid medicines that were not indicated for their condition. This led to an Independent Review Panel,[7] which took four years and cost £14 million. The Panel found that 456 deaths in the 1990s had "followed inappropriate administration of opioid drugs". In 2019, Assistant Chief Constable Nick Downing, head of the Serious Crime Directorate for Kent and Essex Police, announced that a new criminal investigation into the deaths was to take place and the campaign for justice continues. Other serious issues include premature deaths of people with learning disabilities and autism,[13] which led to the implementation of the learning from deaths programme. On average, the life expectancy of women with a learning disability is 18 years shorter than for women in the general population. The life expectancy of men with a learning disability is 14 years shorter than for men in the general population.[14] There are numerous individual cases that support this finding, many of which were first highlighted by parents, informal carers or relatives. In 2014, the Department of Health and Social Care published a report that found that almost two-fifths of people with learning disabilities died from causes "amenable to good quality healthcare."[15] In 2022, a report by Dr Bill Kirkup into deaths in East Kent NHS maternity services[8] confirmed that the "onus was on patients to raise concerns" because the culture of fear prevented whistleblowers from speaking out. “In every case staff were aware of serious mistakes or wrongdoing but they were unaware of how to raise concerns because those who tried were subjected to peer pressure to be silent and everyone was afraid of the [personal] consequences.” These consequences were exemplified by the experience of the nursing director who was told that speaking up would harm her career. Another significant report is that into the life and death of Elizabeth Dixon,[4] which contains recommendations that apply across the board: "…6. Clinical error, openly disclosed, investigated and learned from, must not be subject to blame. Conversely, there should be zero tolerance of cover up, deception and fabrication in any health care setting, not least in the aftermath of error. (NHSE, GMC, NMC, MoJ) 7. There should be a clear mechanism to hold individuals to account for giving false information or concealing information relating to public services, and for failing to assist investigations. The Public Authority (Accountability) Bill drawn up in the aftermath of the Hillsborough Independent Panel and Inquests sets out a commendable framework to put this in legislation… It should be re-examined. (MoJ) 8. The existing haphazard system of generating clinical expert witnesses is not fit for purpose. It should be reviewed, taking onto account the clear need for transparent, formalised systems and clinical governance. (DHSC, MoJ)…" The amount of evidence and the number of reports that were initiated thanks to the tenacity and courage of patients, relatives, carers and parents, is truly shocking. How can we change this? How many more reports do we need? The only thing we can say with confidence is that lessons have not been learned. Why don’t staff speak out? I was recently asked ‘why don't staff speak out?’ There's very little rigorous research on whistleblowing in health and social care, so I can only offer my personal views on this apparent absence of ethical behaviour. I believe this quote from Margaret Heffernan (Professor of Practice at the University of Bath School of Management) goes some way to explaining this: “I have never encountered an organisation as vicious in its treatment of whistleblowers as the NHS".[16] If anyone has any doubts there are a string of high-profile cases to support it, including the cases of Steve Bolsin, Raj Mattu, Kim Holt, Peter Duffy and Chris Day. When I was asked why staff stay silent my first thought was to say that those who would speak out have all left. Of course, this can't be the full story. So, what are the other reasons? One possible reason is that people who are promoted to highly paid jobs attain these positions because they ‘toe the line’. Organisational psychologists talk about the role of enablers and ‘flying monkeys’ in maintaining this culture. A flying monkey is a psychology term that refers to an enabler of a narcissistic person, a henchman so to speak. Many staff keep their heads down and don't look too hard at what's going on around them. Some commentators see this as a behaviour that is supported by the promotion of toxic positivity. What I mean by this is a culture of talking-up successes, however small, completely ignoring failure, and therefore missing the learning that comes from failure. The widely used phrase ‘rock the boat but stay in it'[17] springs to mind here, especially the empty references to ‘radicals’ and ‘change agents’. This forms part of learning materials that are often accompanied by reams of management jargon and pseudo-science. This leads to a morally bankrupt approach where ‘all is well’ (‘nothing to see here’) and toxic positivity prevails. The belief that no matter how bad a situation is, people should maintain a positive mindset, move on and not mention it, is a way of working that is directly contradicted in these wise words by the late Professor Aidan Halligan: "Run toward problems, especially on a bad day." My views may sound very harsh, especially coming from someone like me who left direct employment with the NHS in 2008. It's important to point out that I believe the vast majority of NHS staff, at all levels from clerical staff and porters to senior managers and chief executives, do their best to work around the bullying and toxicity to deliver safe care for patients. Doing their best despite the prevailing culture rather than being supported by it. Sometimes biding their time and subtly subverting directives that are not in patients’ best interests. For clinicians, the threat of being referred inappropriately to a professional body is ever present,[18] and an environment where the pressure of work is extreme, exhausting and unstainable are also major factors. For many, the prevailing culture also means that the careers of highly skilled accountable, ethical and caring staff are held back through denial of learning opportunities and promotion, and informal blacklisting which is commonplace. There's an army of people ready for change, a huge informal network of highly motivated caring people, which is why I'm optimistic about the future. Why have ‘speaking up’ reforms failed? These are my personal views based on my experience and that of my colleagues. Since Sir Robert Francis’ whistleblowing report[9] there have been several changes designed to improve the situation. These include Freedom to Speak up Guardians (FTSU), the introduction of an institutional Duty of Candour, the ‘Fit and Proper Persons Test'[14] for Board members and the NHS Whistleblower Support Scheme. In addition, the Health and Safety Investigation Branch (HSIB) was set up in 2017 and a National Patient Safety Commissioner was appointed in 2022. Given all the above, why has there not been a reduction in high-profile healthcare failings? In my view there are several reasons. Many believe, as I do, that the approach of the Care Quality Commission (CQC) to whistleblowing is part of the problem. We often learn from investigation reports that the CQC (and other regulators) had been listing problems in their reports for years and yet no meaningful action has been taken. ‘Regulatory capture’ is a serious problem, which is when regulators are adversely influenced by the people they are inspecting. This is often linked to the revolving door of staff who move from health and care employment to the regulators, and informal links which amount to cronyism. This behaviour is something that commentators have noted and which I have experienced myself.[20]. Patients suffer as a result. The introduction of the National Guardian Office and Freedom to Speak Up Guardians in each NHS trust is also problematic. This initiative has an inbuilt conflict of interest, as the Guardians are employed by the trusts themselves. The All-Party Parliamentary Group on Whistleblowing (APPG) has heard from whistleblowers who have been failed by local Guardians, sharing their experiences that have included the disclosure of their identity to hospital management and boards, which resulted in retaliation. The APPG has also heard from local Guardians who were not supported and themselves the target of retaliation after supporting whistleblowers.[21] In addition, something which I find shocking is that the National Guardian Office appears to studiously avoid the word ‘whistleblowing’ in its material and outputs wherever possible. This adds to the stigma around healthcare whistleblowers and is inexcusable. Another lesser-known initiative is the NHS Speaking Up Support Scheme[22] (originally titled the Whistleblower Support Scheme). There is not much information available on this scheme in the public domain. I became aware of the scheme when I was asked if I wanted to apply. Later I signposted several people to the scheme. I learned that although the scheme has benefited some people, for others it appears to have made their situation worse. Through a freedom of information request, and thanks to the intervention of my MP, I have managed to obtain a redacted copy of the evaluation of the pilot scheme which supports the view of mixed results.[23] Having read this report, it is unclear to me why it hasn’t been published and why it was redacted. Particularly as I think (I can’t be sure of course) that one of the redactions is a comment I made. A comment I wanted to be shared. As for the other post-Francis review initiatives, the Kark Review in 2018 on the Fit and Proper Person Test (FPPT) is unequivocal in its findings: "Essentially it [FPPT] does not ensure directors are fit and proper for the post they hold, and it does not stop the unfit or misbehaved from moving around the system."[24] In addition, the statutory current Duty of Candour[25] seems, at times, to be little more than a tick box, with the responsibility for talking to patients often left to the most junior staff. A Duty of Candour is about simply telling the truth and is everyone’s responsibility, not a task to be delegated. The need for a legal duty of candour on individuals has been highlighted by Robbie Powell’s father Will Powell and links to proposals for a Hillsborough Law. The HSIB and the National Patient Safety Commissioner initiatives have some built in limitations to what can be achieved. The HSIB’s remit does not include investigation of systemic problems. This limits the areas that they can cover. As for the National Patient Safety Commissioner, this is a new role which is very promising. Unfortunately, the scope of this role is limited, with the remit covering only medicines and medical devices. This means that these two initiatives are not able to tackle the systemic organisational cultural issues that are at the root of major patient safety failings. One thing that stands out here is that none of the above measures specifically tackle the stigma around whistleblowing in healthcare. In fact, some reinforce the stigma. A way forward Much has been written about healthcare whistleblowing and measures that have been implemented to promote positive change. Despite these, the victimisation of healthcare whistleblowers and the stigmatisation around whistleblowing in health and in social care has not abated. The measures introduced have so far achieved very little. In some instances, I believe, they have made the problem worse. The Protection for Whistleblowing Bill,[26] which passed its second reading in December 2022, proposes the repeal of the current Public Interest Disclosure Act,[27] replacing it with an Office of the Whistleblower. This would prevent concerns of genuine healthcare whistleblowers becoming buried under an employment issue, and their original patient safety concerns being side-lined. The Public Interest Disclosure Act is expensive, limited in scope and beyond the reach of most whistleblowers. It is also overly complex, with cases currently waiting for over 2 years to be heard. Employers game the system to run whistleblowers out of funds. Fewer than 12% of cases that go to the Employment Tribunal win. It does not protect patients and is not accessible to members of the public who blow the whistle. Currently there is no statutory provision to investigate or address the wrongdoing highlighted by whistleblowers. Many whistleblowers have been denied any protection because they are not workers. An Office of the Whistleblower would change this and help us identify the root causes of systemic patient safety failings.[26] I urge everyone with an interest in this subject to read the bill and watch the video of Baroness Kramer introducing the second reading of the Bill.[28] For the first time in years, I am optimistic. References Department of Health. The report of the public inquiry into children's heart surgery at the Bristol Royal Infirmary 1984-1995: learning from Bristol (Cm5207(II)); 2001. Department of Health. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry; 2013. Hartles S. Robbie Powell: Time for Truth, Justice and Accountability. Open University Harm & Evidence Research Collaborative; 2021. Kirkup B. Independent report. The life and death of Elizabeth Dixon: a catalyst for change; 2020. Ritchie F. Independent Review into Thomas Oliver McGowan’s LeDeR Process Phase two; 2020. Department of Health, Northern Ireland. Report of the inquiry into hyponatraemia related deaths; 2018. Gosport Independent Review Panel Report. The Panel Report - 20th June 2018. Dr Kirkup B. Reading the signals: maternity and neonatal services in East Kent – the report of the independent investigation; 2022. Francis R. Report on the Freedom to Speak Up review; 2015. Bewick M, et al. University Hospitals Birmingham NHS FT (UHB) Phase 1 Review by I4QU. Clinical Safety. iQ4U Consultants; 2023. Action against Medical Accidents. Robbie’s Law. The European Court Ruling in full: https://hudoc.echr.coe.int/fre#{%22itemid%22:[%22002-6998%22]}. Parliamentary and Health Service Ombudsman. Radio Ombudsman: Will Powell’s 32-year quest for justice for son Robbie; 2022. NHS England. About LeDeR; 2023. NHS Digital. Health and Care of People with Learning Disabilities, Experimental Statistics: 2018 to 2019 [PAS]; 2020. Department of Health and Social care. Premature Deaths of People with Learning Disabilities: Progress Update; 2014. Heffernan M. I have never encountered an organisation as vicious in its treatment of whistleblowers as the NHS. BMJ Talk Medicine Podcast; 2020. Bevan H. Rocking the boat and staying in it: how to be a great change agent. Slide set; 2016. Grossman D, Clare S. Birmingham hospital culture worrying - health secretary. BBC Newsnight; 2023. Care Quality Commission. Fit and proper persons: directors; 2022.   Clegg A. How cronyism corrodes workplace relations and trust. Financial Times; 2022. WhistleblowersUK, Meeting with Dr Bill Kirkup CBE and the APPG for Whistleblowing: blog; 2022. NHS England. Speaking up support scheme; 2022. Greenop D. NHSI Whistleblowers Support Scheme pilot. Final Evaluation (redacted); 2019. Obtained in 2022 following a Freedom of Information Request. Kark K, Russel J. A review of the Fit and Proper Person Test. Commissioned by the Minister of State for Health; 2018. Care Quality Commission. Regulation 20. Duty of Candour; 2023. UK Parliament. Protection for Whistleblowing Bill [HL]; 2023. UK Government. The Public Interest Disclosure Act 1998 [PIDA]. Baroness Kramer. Protection for Whistleblowing Bill, 2nd Reading, Baroness Kramer 2022. Video recording of the House of Lords introduction.
  21. Content Article
    A number of serious concerns have been raised about the University Hospitals Birmingham NHS Foundation Trust, relating to patient safety, governance processes and organisational culture. The Trust has been under review by the Birmingham and Solihull Integrated Care Board (ICB), following a junior doctor at the trust, Dr Vaishnavi Kumar, taking her own life in June 2022. In response to these concerns, a series of rapid independently-led reviews have been commissioned at the Trust. This report outlines the outcomes of the first of these reviews, which is focused on clinical safety. It identified a number of issues which require attention, setting out 17 recommendations for further action. The review were assured that services at the Trust remain safe and patients and service users should continue to access care as needed with confidence. However, the review found a number of areas of concern, particularly with regards to governance and leadership, culture and staff welfare and has made a series of recommendations for further action. The review was commissioned following concerns raised in December 2022 relating to patient safety, leadership, culture and governance. As part of this response, NHS Birmingham and Solihull (ICB) announced three independent reviews focusing on: Patient safety and governance (Bewick Review) - commissioned by the ICB, overseen by experienced senior independent clinician, Professor Mike Bewick, former NHS England Deputy Medical Director. Well-Led review of leadership and governance – in conjunction with NHS England, using established methodology. Culture - commissioned externally by UHB’s Interim Chair, incorporating findings from above. In order to bring the conclusions and recommendations of these two pieces of work together and provide additional independent assurance, Professor Mike Bewick has been commissioned to support both remaining reviews and also return at a later date to update on progress on implementing the recommendations following this report. In the patient safety review, the independent review team set out two concerns and four groups of recommendations. As part of this, they also make clear that their ‘overall view is that the Trust is a safe place to receive care’. The review team have highlighted the need for better understanding of raised Hospital Standard Mortality Rates, concerns regarding levels of staffing, particularly nursing at Good Hope Hospital. The review also finds that ‘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’. This was supported by feedback from the Trust’s Medical Staff Committee. The review team make 17 recommendations (available in the full report) across clinical safety, governance and leadership, staff welfare and culture, including: Haemato-oncology: A specific review of mortality should be conducted by an external specialist in this field with support from a governance lead. The terms of reference should include: An independent retrospective review of all the deaths first analysed by Dr Nikolousis to establish any lessons learned Consideration as to whether there an outstanding DoC responsibility relating to this patient cohort All deaths in the year 2021/22 An assessment of how integrated the department is following the merger in 2018 with a focus on how leadership and accountability of the service currently functions. That prospective appointments of senior medical, nursing, and managerial leadership are reviewed with a focus on developing core skills, including those required for leadership, collaborative working methods, professional interaction, and disciplinary processes. In light of the tragic death by suicide of Dr Kumar - Together with HEE, a review of the processes to support doctors in training who are concerned about their mental health, ability to speak up freely about concerns with colleagues and a clear message that they will be listened to. That the concerns of senior clinicians, expressed by the Medical Staff Committee in January 2023, are addressed specifically as part of the Phase 2 cultural review. That the Trust commissions a partner to deliver awareness training on how to identify issues of bullying, coercion, intimidation and misogyny.
  22. News Article
    Nearly a dozen junior doctors have been relocated from a London hospital’s general surgery department by NHS England, after concerns about a culture of fear, poor support, and reports of bullying. NHSE has withdrawn 11 surgical foundation year trainees from Barnet Hospital, in north London, after a review uncovered concerns regarding staff behaviour and safety. The General Medical Council has opened a case into the hospital’s department, which is run by the Royal Free London Foundation Trust, and the trainees have been placed elsewhere in the trust. Colin Melville, the GMC’s medical director and director of education and standards, told HSJ: “Doctors in training in the department reported a culture of fear, worry, and feeling unsupported and unable to raise concerns in the appropriate manner. “There are also concerns over their supervision, bullying, and undermining behaviours in the department, as well as doctors’ physical and mental wellbeing. “Because of the [trust’s] failure to meet the high standards we require, we stand firmly with NHSE workforce, training, and education London’s decision to relocate the 11 trainees, [to] where they can work and learn in a supportive environment. “This action is necessary not only to ensure their safety, but to protect the public as well.” Read full story (paywalled) Source: HSJ, 18 April 2024
  23. News Article
    Bosses at hospitals where police are investigating dozens of deaths have been criticised for “bullying” and fostering a “culture of fear” among staff in a damning review by the Royal College of Surgeons in England. The review focused on concerns about patient safety and dysfunctional working practices in the general surgery departments at the Royal Sussex County hospital in Brighton and the Princess Royal hospital in nearby Haywards Heath. But the reviewers were so alarmed by reports of harassment, intimidation and mistreatment of whistleblowers that they suggested executives at the University Hospitals Sussex trust may have to be replaced. They concluded: “Consideration should be given to the suitability, professionalism and effectiveness of the current executive leadership team, given the concerning reports of bullying.” The report comes as Sussex police continue to investigate allegations of medical negligence and cover-up in the general surgery department and neurosurgery department, involving more than 100 patients, including at least 40 deaths, from 2015 to 2021. The investigation was prompted by concerns from a general surgeon, Krishna Singh, and a neurosurgeon, Mansoor Foroughi, who lost their jobs at the trust after blowing the whistle over patient safety. Read full story Source: The Guardian, 6 February 2024
  24. Event
    Dr Leslie Hamilton, assistant coroner and retired cardiac surgeon, will speak about the importance of creating and maintaining a no-blame culture within NHS and independent healthcare organisations. This should help to ensure that people feel able to share and reflect honestly whenever things go wrong in care, so that lessons can be learnt and changes made to improve patient safety. Register
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