Daily Insight: Liverpool scandal echoes Mid Staffs

Failure across the board

Almost five years to day since the Francis report into poor care at Mid Staffordshire Foundation Trust was published, Bill Kirkup’s investigation into failings at Liverpool Community Health Trust provides new shocks to the system.

The review, covering 2010 to 2014, found a widespread culture of bullying and harassment at the Merseyside trust, which sought to “conceal” its problems from regulators and national bodies.

There were also failings at regulatory and commissioning bodies, which meant LCH’s problems went unseen for more than four years. The failure of oversight was partly attributed to NHS wide organisational changes taking place under the Health Act 2012.

Dr Kirkup identifies repeated incidents that the trust failed to learn from because it did not escalate and investigate them properly. These included:

• up to 19 deaths in custody at HMP Liverpool;
• five wrong site tooth extractions in the dentistry division;
• repeated falls and fractures on intermediate care wards; and
• numerous community services patients with grade three pressure ulcers.

Meanwhile, there were “appalling instances of staff treatment” by the trust’s HR department, including people being suspended when they raised concerns.

Dr Kirkup’s conclusions echo many of the findings from the Francis report. In 2016, the Capsticks report into LCH also warned that the trust ignored key findings from the Mid Staffs inquiry.

In a striking similarity, the Kirkup review suggests the poor culture and unsafe practices at LCH originated with its prioritisation of cost improvement plans over quality and patient safety, which were driven by its desire to obtain foundation trust status.

In response, the government announced a review of the Care Quality Commission’s fit and proper person regulations. The review could look at the ability of the CQC to determine an individual director’s fitness on the board.

Health minister Stephen Barclay also said: “It is important we address a revolving door culture that has existed in parts of the NHS where individuals move to other NHS bodies, often facilitated by those who are tasked with regulating them.”

Those comments came after documents seen by HSJ suggested that former LCH chief executive Bernie Cuthel had a secondment at Manchester Mental Health and Social Care Trust “arranged” by the NHS Trust Development Authority just months after she left the provider in 2014. The documents suggest she was supported by “verbal references” from the TDA (now part of NHS Improvement) and the regulator did not tell the Manchester trust about the serious shortcomings at LCH.

LCH is currently in the process of being disbanded, with Mersey Care FT due to take over the bulk of its services.