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Nottingham University Hospitals is under the spotlight again. The Care Quality Commission has issued the trust a warning notice over culture and governance concerns.

This has come just weeks after regulatory action was threatened following an inspection of its accident and emergency department and a few months after “deep-rooted cultural problems” were found within its maternity department.

The trust, like almost all acutes at the moment, is under the cosh during this particularly difficult summer, but the concerns the CQC raised go beyond operational pressures.

Although it is not exactly clear what prompted the warning notice, NUH is undergoing independent investigations into five serious incidents that occurred within its maternity units. An investigation by Channel 4 and The Independent also revealed how dozens of babies came to harm at the trust over the last 10 years.

The trust’s leadership has a huge amount of work to do to rapidly improve accident and emergency care, maternity safety and overall culture within this large and significant organisation.

A complex and difficult situation

Tensions among consultants at University Hospitals North Midlands Trust appear to be escalating. HSJ has now revealed a letter from 50 medics at the trust has been sent to chief executive Tracy Bullock and chair David Wakefield, asking for trust leaders to “protect” staff from bullying.

This story comes after 348 doctors raised concerns over bullying and harassment in an internal staff survey carried out earlier this year.

In response to the survey, the trust has commissioned an independent review to be carried out by prominent workforce race equality standard figure Roger Kline and equalities charity Brap.

After the trust announced its review, signatories to the letter, who were all from minority ethnic backgrounds, warned of “prevailing” poor behaviours.

Prior to this, HSJ revealed a review into the trust’s imaging department found evidence of “unhealthy and toxic” cultures. A separate review into concerns raised by ophthalmology staff has since been commissioned as well.

However, the trust’s recent and previous staff survey results do not suggest it is an outlier with regards to bullying and harassment or racial discrimination.

It is unclear whether the issues here are systemic or a symptom of pockets of poor behaviour within departments. What is clear is that this is a complex and difficult situation for those involved.