RUH Bath report pushes reputation aside

'Well-established' reputations must not stand in the way of robust performance management, a second external report on the troubled Royal United Hospital Bath trust says.

The performance management report, obtained by HSJ, was written by former North West regional director Professor Robert Tinston.

It follows his original damning investigation of the trust's corporate governance arrangements (''RUH Bath was deluded', claims probe', news, 30 January).

The problems at RUH first emerged in a critical Commission for Health Improvement report.

Subsequent investigations at the zero-star trust indicated 'deliberate manipulation' of waiting lists and serious financial difficulties.

Former trust chief executive Barbara Harris was seconded to the NHS Leadership Centre as director in April 2001, but she stepped down eight months later after the publication of the CHI report which condemned the management style at Bath when she was at the helm. She was sacked by the trust in August last year.

Professor Tinston's new report does not name any individuals.

But it says: 'The NHS is a large organisation where both organisations and individuals may have well-established and welldeserved reputations. It is important these do not stand in the way of robust performance management where it is needed.'

It adds: 'Explicit account needs to be made of the difficulties that this may present for junior or less experienced staff that are involved in performance management.'

Professor Tinston told HSJ: 'I think there is no doubt the very positive image that the NHS generally had about the trust contributed to a lack of stringency in terms of some of the monitoring.'

And the report says that 'the existence of personal relationships between senior staff in different NHS organisations' must be recognised if there is any possibility of a conflict of interest, along with 'the impact personal relationships may have on the behaviour of other people - especially less senior staff - who have to work with these people'.

The former South West region's director of finance and performance management, Paul Nicholls, is married to Ms Harris. A spokesperson at the region told HSJ in December 2001 that during Ms Harris' time at the trust, its 'day to day' performance management was carried out by a team reporting straight to the regional director, not to Mr Nicholls.

Asked by HSJ whether he had considered the relationship between Ms Harris and Mr Nicholls, Professor Tinston confirmed that he had. He said: 'I think the issue here is a range of different issues that contributed to a lack of stringency in performance management arrangements, and that was one of them.'

But he emphasised: 'We found no evidence whatsoever of any particular favouritism shown towards this trust.'Of the relationship between Ms Harris and Mr Nicholls, he said: 'It is an issue that can't be avoided and was one of a number of things we looked into.'

Mr Nicholls is now finance director at Avon, Gloucestershire and Wiltshire SHA, which commissioned Professor Tinston's performance management report.

Professor Tinston emphasises that 'soft' information on performance, which might be 'more impressionistic and circumstantial' than 'hard' data, 'should not be disregarded'. Hard and soft information should be compared 'to see if there is any marry-up between the two'.