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Challenging challenging behaviour
England’s only fully integrated care trust has been in special measures since 2017 and it is currently at risk of losing some of its trainee doctors due to gaps in the workforce.
A Health Education England inspection report – released to HSJ under the Freedom of Information Act – has highlighted major problems with the trust’s training programme, particularly in acute care.
During an inspection in October, regulators found there continued to be a “risk to the safety and provision of learning” in acute medicine specialty training.
“Challenging behaviour” from senior members of staff was cited in the report as “impacting on trainee safety, wellbeing and learning”, while poor working relationships were leading to conflicts between the emergency departments and the rest of the hospital.
Trainees reported feeling “overwhelmed and unsafe” and raised concerns that, in some cases, on-call doctors showed a “lack of interest or reluctance” to provide support, while repeated calls had to be made “to drag some individuals in”.
The General Medical Council told HSJ this week that no trainees had been removed from Isle of Wight to date and progress will be reviewed during the next joint visit with HEE.
A spokesman for Isle of Wight Trust said “urgent action” is being taken to address concerns raised by the regulators and improve the experience of trainee doctors.
Is the LeDer programme — the initiative for reviewing deaths of people with learning disabilities — fit for purpose?
Recent figures on the thousands of deaths still waiting for review suggest that, as it stands, the programme is not working as it was intended to.
In May 2019, NHS England promised it would invest £5m to address concerns about a growing backlog of reviews which had not been completed. HSJ has now discovered that, despite this funding promise, the backlog increased between May and November from 3,699 to 3,802.
So, even after the cash injection and support engaged from a commissioning support unit to specifically address the backlog, the reviews are piling up.
A large part of the problem is a lack of the people who are qualified and willing to do the reviews.
According to NHS England, almost 2,000 staff have been trained as reviewers — but in the majority of cases doing LeDer reviews will not be their day job.
Beyond this, there’s the issue that clinical commissioning groups have been largely left to manage their own work, with little sanction or incentive to push it forward.
It would be difficult to argue that the LeDer programme is a bad thing. Ultimately, the aim to review and learn from these deaths is a laudable one and if done properly could lead to positive change.
But on the current evidence, it is going to take a lot more welly to catch up with more than 3,800 deaths in the next year — and this only means that learning for the system is delayed.