Everything you need to stay up to date on patient safety and workforce, plus my take on the most important under the radar stories. Contact me in confidence. Shaun Lintern, patient safety senior correspondent.

Board at loggerheads

A governance disaster is unfolding at Wirral University Teaching Hospital Foundation Trust, with an intransigent chair who is beyond the point where remaining in post is a viable option.

Equally worrying is the performance of NHS Improvement, which seems incapable of responding with speed or agility to what is happening. It has commissioned an independent investigation into allegations of serious governance and management failings but this is being overtaken by events.

In the post-Mid Staffs era, the NHS is supposed to be striving for a culture of openness and staff should feel able to speak out. Executives at Wirral appear to be doing so, but the latest details suggest they are meeting opposition from most of their non-executive colleagues.

The exception among the NEDs was the highly respected John Coakley (a former medical director at Homerton University Hospital FT) who resigned on Monday.

When explaining his resignation to HSJ, he took a swipe at his former non-executive colleagues, who he suggested were not giving their “wholehearted support” to the “excellent executive team”.

This followed a private board meeting where, multiple sources told HSJ, discussions descended into executives versus non-executives over the continued tenure of the chair Michael Carr.

It appears the executives, who felt forced to raise concerns about Mr Carr and former chief executive David Allison to NHSI in November, believe the chair remaining in post is preventing the board and the trust from moving forward.

Their concerns seem valid considering a letter from lead governor Angela Tindall to the board after the meeting, which said Mr Carr will remain until the end of June (when his term ends). This means no new substantive chief executive will be appointed until long after.

Meanwhile, the trust must limp on amid this “complete breakdown of relationships”, as one source put it.

No major concerns over the safety or quality of patient care have been raised to date, but the trust’s culture among its medical staff is one of the worst in the country – it had one of the lowest scores for medical engagement in a survey of doctors involving 110 trusts.

There have also been several allegations of bullying and harassment, from at least as far back as 2012.

What is more, the trust is struggling to deliver key performance targets with only 81 per cent of type one accident and emergency patients seen with four hours, and the same percentage of referral to treatment patients being treated within 18 weeks.

Financially, the trust was more than £7m off plan by quarter two in 2017-18 with a year to date deficit of £12.8m.

Given what we know about the effect culture can have on care quality, no one should be comfortable allowing the situation at the Wirral to persist.

Challenge for new NHSI leadership

This is the first real test for new NHSI chair Baroness Dido Harding and chief executive Ian Dalton. The more stories that emerge from Wirral, the more they risk appearing like spectators to a slow motion crash. Should patient care concerns emerge, they will find it difficult to say they were not warned.

NHSI is waiting for the outcome of the independent investigation and would no doubt say due process must be followed. But this does not prevent it taking steps to secure the board and governance processes where there are clear risks.

I have previously highlighted the powers NHSI has under the Health and Social Care Act 2012 to make sure providers comply with their licence.

If the Monitor part of NHSI is satisfied a licence is being breached (or at risk of being breached), it can impose conditions on a trust including the removal of a chair or board members.

Senior figures at other organisations have lost their jobs with barely a nod to due process when political demands or performance against sensitive targets have been a factor.

It is time for Mr Carr to step down and allow the trust to move forward under new leadership.

It is also time for NHSI to stop hesitating and act in the best interests of patients and staff who deserve better.

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