Problems with leadership and culture of bullying detailed in damning Nottingham hospitals report

By Joel Moore

Problems with leadership, a 'culture of bullying' and issues in risk management have all been outlined in a damning report on Nottingham hospitals.

The Care Quality Commission (CQC) report, published on Wednesday, September 15, detailed a number of failings across Nottingham University Hospitals (NUH).

The NHS Trust which runs both the Queen's Medical Centre and City Hospital has been lowered to 'requires improvement' from a ‘good’ rating following an inspection across June and July this year.

One of the main problems highlighted by the CQC was a failure to address a "culture of bullying across the organisation", which included cases of racial discrimination.

NUH bosses were also issued with a warning, ordering them to make improvements around leadership, risk management, governance and culture.

An inspection was carried out into the well-led domain of the trust, as well as the urgent and emergency services and surgery at the Queen’s Medical Centre and surgery at City Hospital.

Inspectors said they were told in two separate forums of bullying incidents across NUH. They added that they were told there was a "lack of ability to address or resolve incidents in a timely fashion and that culture, policies and procedures did not provide staff with adequate support”.

The report also stated that they were told a number of bullying cases were “directly attributable to racial discrimination”, and that according to a staff survey the trust was above average for black, Asian and minority ethnic staff experiencing bullying or harassment.

Problems were also identified with the relationship between the board and the wider organisation, as well as safety and safeguarding incidents.

Inspectors said that there was "not always a culture of high-quality, sustainable care".

"We found the culture to be top-down and directive," said the report.

"It was not one of fairness, openness, transparency, honesty, challenge and candour. There was a disconnect between the board and the wider organisation. We were told there was separation between the board and the divisions and this was the worst it had been in many years."

They said that corporate and clinical governance were not working together to effectively oversee risks and drive health improvements.

The report stated: "Executive leaders did not appear to recognise how the two were linked. As a result, there was a lack of communication and respect between the two systems inside the organisation."

It revealed they were told at the end of June there was a backlog of 3,858 open patient safety incidents and that "there had been no risk stratification of these as yet to understand any risk".

NUH, who have received 201 negligence claims in relation to maternity care over the last decade, resulting in more than £91m being paid out in damages, were also criticised for shortfalls in relation to maternity.

“Oversight of the maternity services and the management of performance issues had not been sufficiently robust to allow known issues to be addressed,” the report continued.

QMC's urgent and emergency services were also told to improve.

Sarah Dunnett, CQC’s head of hospital inspection, said: “There was a high level of anxiety among staff in the emergency department about the overall lack of capacity and space to meet the needs of people using the service."

Inspectors did say however, that they saw examples of good practice across the trust, with both hospital's surgery services receiving a 'good' rating.

"Surgery services at both sites were managed effectively with high quality patient care deemed a priority," said Ms Dunnett.

"Staff were caring, supportive and respectful and worked hard to achieve the best outcomes for patients."

A spokesperson for the Nottingham branch of Keep Our NHS Public (KONP) said that the report shows the NUH have "serious management issues".

"The public experience of the NHS is through the doctors, nurses, porters and other support staff who care for them and it is essential that these people are listened to," they said.

"We hope this report will be a wake-up call to senior officers and the board."

Visitors to the hospital expressed their surprise at the findings of the report.

“I’m shocked to hear that there’s concerns on how it’s run," said one anonymous patient.

"I certainly have never experienced any issues here."

Natalie Davis, 35, from Long Eaton, added: “I think it’s always been run well, I don’t personally think there’s been anything wrong. But then again I'm not here often enough to notice anything."

Rupert Egginton, deputy chief executive and chief financial officer at NUH NHS Trust said: “We would like to assure patients and colleagues that we are working hard to address the serious concerns highlighted in the recent CQC report, focussing on standards of leadership within the Trust.

“It’s important to note that the report does not criticise clinical services and recognises the care, dignity, compassion and kindness that our staff provide for our patients; but it’s our job as the leaders of the Trust to ensure that the foundations of our organisation - our processes, governance, and learning from incidents - improve to allow our teams to provide safe, high quality care within a positive, open and supportive culture.”


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