Daily Insight: Taking the fall

Fall guy?

It takes some doing to be the biggest financial basket case in the NHS, but Barking, Havering and Redbridge University Hospitals Trust is surely the current holder of that title.

Unexpected cash flow issues emerged in October last year, and subsequent investigations revealed that serious financial governance failings had put patient safety at risk. The trust went on to miss its financial plan for the year by a massive £50m.

The trust’s chief executive Matthew Hopkins was insulated from some of these failings due to being on long term leave between March and September 2017 to undergo a kidney transplant.

But there have clearly been continuing concerns about his ability to lead the trust out of trouble, and Mr Hopkins, a former nurse, has now stepped aside following weeks of discussions between the chair and non-executives.

His departure drew sympathy from several HSJ readers, whose descriptions of him included “exceptional leader” and “the most values driven CEO I’ve ever worked with”.

Others described him as a “fall guy” and asked whether others would follow his lead.

The trust’s finance director for most of the period when the governance issues occurred was Jeff Buggle, who also stepped up to be acting chief executive for four months during Mr Hopkins’s absence. Mr Buggle now works for NHS Improvement, as regional finance director for London.

Steve Collins, the trust’s interim finance director for nine months from March 2017, has been working as an advisor to Tower Hamlets Clinical Commissioning Group.

It was just what people did at the time

An independent review has effectively cleared NHS Improvement officials of their role in arranging a secondment job for a discredited chief executive, after it found they acted in line with “guidelines and accepted practice at the time”.

The review had examined the circumstances in which Bernie Cuthel, the former chief executive of the scandal hit Liverpool Community Health Trust, was given a secondment post at Manchester’s mental health trust.

Although “complaints and issues relating to bullying and harassment” had been reported to the NHS Trust Development Authority (now part of NHSI) before the secondment, the review concluded that the extent of the Liverpool provider’s cultural problems had not yet emerged, and officials would “probably have handled the situation differently had such clear evidence been available”.

Ironically, part of the reason that it took so long for the scandal to emerge was a lack of sufficient oversight from regulators, including the TDA.

The review noted that NHSI is currently developing a new “talent management” framework, which should help distinguish between situations where someone should be sacked, and where they “can be supported to learn and make a valuable contribution”.

These decisions are never going to be straightforward though, as there will always be an understandable reluctance to initiate formal disciplinary actions, given the risks and management capacity involved.

Consider the case of Jonathan Parry, the former chief executive of Southport and Ormskirk Hospitals Trust, in which a year long investigation was required to sack him for gross misconduct.

The financially troubled provider also went two years without a permanent chief executive, during one of the most challenging periods for NHS providers in recent memory.