This site is intended for UK healthcare professionals
Medscape UK Univadis Logo
Medscape UK Univadis Logo

'Corrosive' Culture at NHS Trust Could Put Patient Safety at Risk, Report Finds

Patient safety could be at risk due to a "corrosive" culture in which staff at one of the largest NHS trusts in the country had "a fear of retribution if concerns were raised", a report has said.

Staff at the University Hospitals Birmingham NHS Foundation Trust (UHB) told a review the Trust's senior leaders were "overzealous and coercive", also describing them as "callous" and raising concerns over staff reviews being used to "silence dissent".

The Trust has been under review by the Birmingham and Solihull Integrated Care Board (ICB) for 6 weeks, following a junior doctor at the trust, Dr Vaishnavi Kumar, taking her own life in June 2022. Her father told an inquest that the Queen Elizabeth Hospital – one of four sites run by UHB – was a "hypercritical environment to work in".

The first of three reports, released today, concluded that while, overall, patients could still safe patient care at the trust, a number of issues required attention, with 17 recommendations made for further action.

'Cultural Problems' at Trust are 'Entrenched' and 'Require Serious Attention'

Summarising the findings, Professor Mike Bewick, a former NHS England Deputy Medical Director, said: "Our overall view is that the Trust is a safe place to receive care, but 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 across the organisation – particularly in the current nationwide NHS staffing crisis.

"The cultural problems at the Trust most likely persist, apparently remain entrenched and require serious attention.

"Because these concerns cover such a wide range of issues, from management organisation through to leadership and confidence, we believe there is much more work to be done in the next phases of review to assist the Trust on its journey to recovery.

"During our short review, we have received significant cooperation from the Trust in terms of access to individuals and documentation.

"However, as our work has progressed, we have found that this goodwill has dissipated, and have seen an organisation that is culturally very reluctant to accept criticism or to acknowledge the adverse views expressed by us and other significant external bodies.

"We do not direct this at the Trust's interim leadership team, but others seem to be, or have been, far less open to any suggestion that there are problems at UHB."

Prof Bewick added: "We heard many examples of concerning comments covering a range of topics, including issues over promotion processes, bullying of staff (including junior doctors), and a fear of retribution if concerns were raised. All of these issues will be the subject of further investigation in the Phase 2 Culture Review."

He added: "Preet Gill MP and the Chair of Healthwatch Birmingham, Richard Burden, told us that both had received extensive complaints about the organisation's conduct. Many were concerned about the 'toxic atmosphere and bullying at all levels of management'."

MP: Staff Concerns 'Deeply Troubling'

After the inquest of Dr Kumar, a BBC "Newsnight" programme aired last December highlighting what staff alleged was a "mafia-like" culture which saw staff fear reprisal for raising concerns. UHB denied the claims.

Discussing UHB's response to Dr Kumar’s suicide, the report said it took 2 months for the trust to formally write to her family, with no physical meeting being offered, and a senior member of staff sent Dr Kumar an email 26 days after her death to see if she was still being paid. However, the report acknowledged that steps had been taken to improve relations with Dr Kumar's family.

Preet Kaur Gill, MP for Edgbaston, led a cross-party reference group which supported the review and said that staff concerns were "deeply troubling and plainly unacceptable", with more than 50 whistleblowers highlighting the "put up or shut up" atmosphere.

David Melbourne, chief executive at NHS Birmingham and Solihull ICB, said the review made for "difficult reading".

Other issues mentioned in the report included 26 "never events" – events that are seen as wholly preventable due to safety guidance being in place nationally – that took place across the trust in 3 years, including eight incidents of objects being left inside patients and seven of the incorrect operation being performed.

The report said that while there was "good quality root cause analysis" of these incidents, it called for clarity on how events were reported and said it was not possible to ascertain whether action plans had been implemented.

Jonathan Brotherton, chief executive at UHB, said the trust fully accepted the recommendations and said that steps were already being taken to address and learn from the "significant concerns" raised.

He said: "We want to develop a positive, inclusive work environment where people want to come to work, in a place that they are proud to work in, to do their very best for our patients.

"While we will not be able to fix things as quickly as I would like, we do need to do it as quickly as possible, for the benefit of patients and staff; I am committed to ensuring this happens.

"We must now focus on continuing to provide the best possible patient care, building a values-led culture and supporting our incredible colleagues.”

The second and third reviews, examining governance and culture at UHB, are expected to be published by June 31.

This article contains information from PA Media