North by North West: The ‘magic Morecambe Bay’ facade

Four years ago, Morecambe Bay was seen as a turnaround success story, having apparently bounced back from its high profile maternity scandal.

Popular health commentator Roy Lilley regularly wrote of “magic Morecambe”, describing it as the “envy of the NHS”, while the trust achieved a “good” rating from the Care Quality Commission, including for its leadership.

But that façade has gradually crumbled over the last two years, with serious problems emerging in further specialties, and the trust being placed back in special measures earlier this year.

The long-standing and deeply entrenched problems in one of those specialties, urology, were forced into the open during an employment tribunal in 2018, and have now been extensively detailed in a 226-page external review commissioned by NHS England.

Niche Health and Social Care Consulting identified more than 500 examples of actual or potential patient harm, including one shocking case in which the patient died after a series of care failings, followed by an abject failure to learn lessons from what happened.

The review also details numerous missed opportunities to deal with highly toxic relationships between consultants, which made for a dysfunctional department that impacted on patient care.

A key criticism is the trust’s leaders were so focused on a turnround and improvement narrative after the maternity scandal, that they had no time for, or interest in, negative messages in other specialties.

Particularly striking is a list of 15 separate external reviews of different areas of the trust between 2012 and 2020, which contain an “unmistakable pattern” of shortcomings around leadership and governance, but which it failed to appreciate amounted to systemic and widespread problems, and therefore did not trigger comprehensive action.

Ironically, the trust was even told in 2012 that it did not respond effectively to external reviews.

There is significant mitigation, as the report acknowledges there were huge demands on the board over the last decade, limiting its capacity for new problems. One can also understand the determination to encourage a more positive narrative for the organisation after the high-profile maternity problems, given its ability to recruit staff was going to be crucial to any turnaround.

But this only goes so far. The report is clear the damaging relationships and systemic failings in urology were so extreme that the trust should still have acknowledged something was deeply wrong at a much earlier stage.

Old watch

Much of what happened was under the watch of executives and board members who have since retired or moved on, including Dame Jackie Daniel, who was chief executive from 2012 to 2018.

She left when the ‘magic Morecambe’ narrative was still in full swing, and secured the CEO job at Newcastle Hospitals, one of the largest trusts in the country.

There is no real direct criticism of Dame Jackie in the report, although it does talk of her being given regular feedback on problems within the urology consultant workforce from late 2016, from which there was “no clear output”. She did not want to comment on the report’s findings.

When she left for the North East she was replaced by finance director Aaron Cummins, whose “visibility” and efforts to deal with problems on multiple fronts over the last two years appear to have given regulators confidence he should stay in the role.

However, the Niche report does highlight an example as recent as September 2019, when he was still attempting to paint the failings as confined to urology, despite those 15 external reviews over the previous seven years.

Medical leadership

The review also makes difficult reading for David Walker, the trust’s medical director from 2015 to 2019, who now holds that post for the large acute provider, Mid and South Essex FT.

According to Niche, serious problems and “negative working” in the department was highlighted directly to Dr Walker by the Royal College of Surgeons in 2016, and an action plan agreed, but this “was not progressed until over three years later”.

It also said he had reviewed actions resulting from patient safety concerns raised by a whistleblower, and gave assurances to regulators and the board, although “these [actions] were not adequate in our view as they were based on poor investigations at the time”.

Meanwhile, when a negligence claim from a patient led the trust to realise a surgeon had been routinely leaving plastic needle guards in testicular prostheses, under the mistaken belief this was recommended by the manufacturer, the review said it was concerning that Dr Walker decided not to classify this as a “never event”.

Niche also referenced a report about “raising concerns”, presented to governors by Dr Walker in 2017, which it said was “heavily skewed towards the positive”.

Dr Walker, who also did not wish to comment, was succeeded in 2019 by Shahedal Bari, who stepped down from the role at the start of November 2021. This came after medical care, including its leadership, at Lancaster Royal Infirmary was rated “inadequate”.

Other key figures

Other key directors in the supposed turnaround years included Mary Aubrey, executive director of governance from 2013 to 2019, who is now an independent consultant after a stint at Isle of Wight Trust, and Sue Smith, who was executive chief nurse for the last eight years, whose portfolio also included governance for the last two years. She announced her retirement in the summer.

David Wilkinson, director of people and organisational development since 2013, remains in post.

Pearse Butler was the trust’s chair from 2014 to 2018, before moving to the acute trust in Blackpool and then retiring earlier this year. He was succeeded at Morecambe Bay by Ian Johnson, who held the post for around two years before retiring. Mike Thomas was appointed in January 2020 and is still in post.

No interviews

Interestingly, well-placed sources told me the trust was told/advised by NHS England not to do any media interviews around the report, or indeed the recent CQC reports, and so they didn’t.

Perhaps the view is they’ve done too much talking already.

NHSE’s communications team insisted that all trusts are ultimately free to make their own final decision on such things, although I don’t know any local comms directors who feel like they could reject NHSE’s advice.