The chair of a large teaching hospital has resigned in protest after claiming the NHS Trust Development Authority had pre-judged the results of a Care Quality Commission inspection, HSJ can reveal.
A high level row over the fate of Barking, Havering and Redbridge University Hospitals Trust is revealed in a series of leaked emails between CQC chief inspector of hospitals Sir Mike Richards and the trust’s former chair, Sir Peter Dixon.
Sir Peter complained to Sir Mike that the TDA wanted to place the organisation into special measures because of financial problems but to “hide behind” a CQC report criticising quality.
In one letter seen by HSJ Sir Peter says: “My relationship with the TDA is now such that I cannot be effective in securing for the trust the support it needs going forward. I have therefore had to ask them to find another chair for the trust.”
The emails obtained by HSJ reveal Sir Peter wrote to Sir Mike ahead of his resignation to complain the TDA had pre-judged a decision – which should only be made by the CQC – to put his trust into special measures over care quality problems.
In one email Sir Peter wrote: “[TDA chief executive] David Flory tells me that the [secretary of state] is announcing special measures on Monday.”
Sir Mike replied: “What! I had no idea of this. This isn’t supposed to be his call. But I suppose that is nothing new.” He indicated any decision to place the trust in special measures would not be made until he had “reflected” following a “quality summit”.
However, the CQC and TDA sent the announcement to the media, embargoed to the next day, on the same day as the summit, just four days later.
Sir Peter, who was previously the chair of University College London Hospitals Foundation Trust for nine years, wrote in another message to Sir Mike: “If the TDA wants to use special measures to deal with the finance issues [at the trust] it is one thing, but to hide behind your inspection damages not just one organisation and its patients but the whole system.” He wrote to the East London trust’s board to announce his resignation on December 19.
The NHS Trust Development Authority, which oversees and regulates non-foundation trusts, has the power to put them in special measures on financial or governance grounds. However, it is only meant to use special measures on grounds of quality if this is recommended by the CQC, the quality inspectorate.
Responding to the revelations and criticism of its process and actions of its chief executive, the TDA said in a statement: “Our focus is and remains that we support trusts to provide sustainable high quality of care to patients and where trusts are unable to demonstrate that they can do this, we will intervene.
“The CQC made clear that although BHRUT had made progress in some areas, there remained significant challenges across the organisation and that they should be placed into special measures… a position we fully agreed with.” It pointed to a letter dated 14 January from the CQC to the TDA citing the reasons for putting the trust in special measures.
The revelations will highlight concern about the consistency and processes of the inspection and regulation system, which has been significantly ramped up and empowered over the past year.
Yesterday HSJ revealed Sir Mike had downgraded a planned warning notice to University College London Hospitals Foundation Trust to a less serious “compliance action”, after representations from the foundation trust.
Timeline: Barking, Havering and Redbridge, the CQC and the TDA
February 2013: CQC proposes capping the number of A&E attendances at the trust in response to December 2012 inspection. The report found some examples of poor but not unsafe care.
March 2013: Complaining of “artificial criminalisation”, the trust chief executive threatens legal action if the cap was implemented. The proposed cap is overturned and the trust lodges an appeal with the CQC.
October 2013: BHRT is one of the first “wave” of trusts inspected under the overhauled CQC process, led by chief inspector of hospitals Sir Mike Richards.
December 12, 2013: Email from chief inspector of hospitals Sir Mike Richards to BHRUT chair Sir Peter Dixon: “Can we speak by phone today or tomorrow please? I would like to share my thinking in advance of the BHRUT quality summit.
“I am speaking at two different meetings this morning but will do my best to give this priority.”
Friday December 13: Email from Sir Peter to Sir Mike: “David Flory tells me that SoS is announcing special measures on Monday. All under wraps until then. I am hoping that the report from [consultants] FTI can be the basis for whatever is done going forward but there is going to be a major damage limitation problem in the meantime. It is also hard to see what the point of the summit is now but we shall have to think of something. All the best.”
Friday December 13: Email from Sir Mike to Sir Peter: “What! I had no idea of this. This isn’t meant to be his call, but I suppose that is nothing new. I will investigate.”
Friday December 13: Email from Sir Mike to Sir Peter: “I have spoken to SofS’s office. They assure me that JH is not going to make any such announcement. Indeed I will want to reflect after the QS [quality summit] on Tuesday [17/12] on what will be in the best interests of BHRUT so there will not be a decision then either.”
Friday December 13: Email from Sir Peter to Sir Mike: “Thanks Mike. Hard to see what is going on but David has Ian Carruthers [former NHS South West chief executive] lined up to do a governance review as stage 1 of his special measures which makes it pretty difficult for me to have any effective role going forward.
“I’m still convinced that a full scale turnaround led by the board and supported by TDA is the answer. I’m not intending to be at the trust on Monday which may be just as well!”
Saturday December 14: Email from Sir Peter to Sir Mike: “I’ve thought overnight about sending this and come to the conclusion that I don’t have any alternative.
“David was very clearly taking your name in vain yesterday in our discussion and saying that the decision was yours. To make things worse, I have now heard from Averil [Dongworth, chief executive] that she has been told by Alwen (Williams, London director of delivery for the TDA] to brief her team on Monday about the decision when I had been told not to even discuss it with her.
“If the TDA wants to use special measures to deal with the finance issues it is one thing, but to hide behind your inspection damages not just one organisation and its patients but the whole system.
“I don’t see any easy way out of this but I would just say how much I have appreciated your candour and approach. Good luck.”
Saturday December 14: Email from Sir Mike to Sir Peter: “I am truly sorry about what appears to be happening. I will seek an early call with David Flory.”
Tuesday December 17: Quality summit between CQC and trust held. Statement, embargoed until December 18, sent to media by CQC announcing special measures.
Wednesday December 18: The CQC issues a warning notice to the trust after it fails two of the three national standards on which it was inspected. It recommends the trust is placed in special measures.
NHS TDA announces the trust is to be put into special measures
Thursday December 19: Sir Peter notifies TDA of intention to resign.
Saturday December 21: Sir Peter stands down.
January 14, 2014: SirMike Richards writes to David Flory “To confirm the basis upon which the CQC has made a formal recommendation to the TDA for it to exercise its powers to put in place urgent measures”. (see attached, right)
Asked by HSJ today why Sir Mike had written this letter a month after the trust had been placed in special measures a CQC spokeswoman said: “The letter sets out the full rationale behind the decision to recommend the trust be placed into special measures, confirming what had already been discussed at the quality summit. The time lapse is simply due to the Christmas period.”
February 2014: Sir Peter’s letter sent to the trust’s board and clinical directors (attached, right).
Background of conflict
The decision to place the Barking trust into special measures came against a background of conflict with the TDA over the future of the trust.
A letter sent by Sir Peter to the board in February (see attachments, right) shows the trust had submitted a bid to the TDA to hire turnaround specialist Pelham Allen, who is also chair of the London Cancer Board, while the TDA wanted to implement its own plan.
Sir Peter’s letter said: “We are now in the middle of having yet another set of externally developed plans put in place which have no chance of implementation without the appropriate managerial and clinical support.
“My belief is that the problems of BHRUT and the health economy have to be fixed from within the system.”
The document also reveals that “for nearly six months” Sir Peter, who had been in post since October 2012, had “resisted” the TDA’s attempts to appoint a new chief executive who he did not consider adequately qualified.
The CQC declined to comment on the emails and whether Sir Mike had been pre-empted by the TDA. It said in a statement: “It is the CQC that recommends special measures on the grounds of the quality of care that it has observed, including whether a trust is safe, effective, caring, responsive and well led.
“Following the inspection, the chief inspector of hospitals decided that special measures was in the best interests of the trust and therefore recommended this to the TDA.”
Sir Peter Dixon was not available for comment.