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Health Watchdog 'Extremely Concerned' About Culture at University Hospitals Birmingham

Investigations coordinated by NHS England (NHSE) into University Hospitals Birmingham (UHB) NHS Trust were in danger of lacking transparency, a health watchdog has warned.

The parliamentary health service ombudsman (PHSO) said that despite identifying "significant concerns" regarding the culture and leadership at the trust, it was being excluded from key parts of the investigation.

An emerging concerns protocol was issued by the PHSO in August last year to flag safety and staffing issues at the trust to NHSE. In a statement on Tuesday, the PHSO said it had become further concerned by UHB's "defensive approach" when discussing patient safety, its failure to fully accept the impact of findings, including an avoidable death, and its approach to the duty of care owed to staff.

'Toxic Culture' Likened to 'the Mafia'

Three reviews into UHB were triggered by NHS Birmingham and Solihull Integrated Care Board in December 2022 following allegations made by BBC "Newsnight" of a "toxic culture" at the trust, alongside evidence that clinicians faced punishment for raising safety concerns. One 'insider' was quoted in the programme saying that UHB, which was rated as requiring improvement during its most recent Care Quality Commission inspection in 2021, was "a bit like the mafia".

The three reviews commissioned were:

  • A rapid response review, led by Mike Bewick, deputy medical director at NHSE
  • A well-led review, commissioned by NHSE
  • A review into UHB’s culture, commissioned by the Trust's new interim chair, Dame Yve Buckland, and conducted by an external provider

In its statement, the PHSO said it had been led to understand that it could participate in the second and third reviews but had since been advised that it would not be able to contribute to NHSE's well-led review. Rob Behrens, the parliamentary and health service ombudsman, said: "It's hard to see how the review can be evidence based if it doesn't consider all the evidence. It raises real concerns around the completeness and transparency of these reviews."

In a letter on 7 March to Dame Ruth May, chief nursing officer and executive director at NHSE, Amanda Amroliwala, chief executive officer at the PHSO, said it "not seen evidence of a culture of accountability, nor a willingness to learn from past failings" at the Trust, and that the Ombudsman's insights would be "directly relevant" to the review process.

In a second letter, also dated 7 March and sent to Jonathan Brotherton, UHB's chief executive, Ms Amroliwala complained of "the defensiveness of some senior leaders at the Trust in relation to recent and ongoing investigations, eroding confidence that there is a willingness to accept accountability or learn from failings".

Mr Behrens said: "We all share the same goal in wanting to see improvements at UHB so that people living in the West Midlands and using its services can access the best possible care with confidence. Working together and feeding our evidence and expertise into those reviews is by far the best way to achieve that goal."

Medscape News UK has approached NHSE for comment.

University Hospitals Birmingham NHS Trust has previously said that patient safety was its first priority.