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.
Before Christmas, HSJ revealed serious governance issues at Wirral University Teaching Hospital Foundation Trust.
The chief executive, David Allison, left with immediate effect but only after four executive directors had blown the whistle to NHS Improvement because they believed trust chair Michael Carr was unwilling to act and so they felt forced to go to NHSI. After the concerns were raised with NHSI in November, the regulator initially took no action other than to offer Mr Allison a six month secondment role (an offer withdrawn in the new year). Mr Allison had stepped down under pressure from the chair and executives.
The directors’ concerns were not only about Mr Allison but wider governance at the trust, including bullying, the misrepresentation of executives’ views to governors and a culture of staff not speaking up.
On Thursday, HSJ revealed these concerns included alleged sexual harassment of junior doctors by a consultant – who has been dismissed for gross misconduct – as well as bullying in the accident and emergency department.
Following HSJ’s reporting, NHSI moved swiftly to announce that it would investigate the concerns and took back its job offer to Mr Allison. But it has given no details about what it plans to do and I understand it has taken no formal action at the trust yet.
Under the Health and Social Care Act 2012, NHSI, acting as Monitor, has a responsibility to ensure that trusts are compliant with their provider licence.
The trust’s licence requires it to have an “effective board and committee structure”. It must have “clear reporting lines and accountabilities throughout its organisation” and “systems and/or processes for escalating and resolving quality issues”.
The terms of the licence say the trust should “obtain and disseminate accurate, comprehensive, timely and up to date information for board decision making” and “there is sufficient capability at board level to provide effective organisational leadership on the quality of care provided”. Directors raised information not being made available to the board, governors and committees, and the accuracy of meeting minutes, among their concerns.
The evidence from the four executive directors, given to NHSI in November, suggests these conditions are not being met.
If NHSI/Monitor is satisfied a licence is being breached or even at risk of being breached, it can impose conditions on a trust – including the removal of the chair or other board members.
It is difficult to see how the regulator has met its obligations under the act given the chair remains in place and no formal regulatory intervention has occurred – the directors raised concerns about Mr Carr, as well as Mr Allison. If whistleblowing by four of a trust’s executive directors does not satisfy it that a provider at least risks breaching its licence, what can?
NHSI’s duty in law is “to protect and promote the interests of people that use healthcare services”. As we saw at Mid Staffordshire, Southern Health and Morecambe Bay, a trust where governance is flawed runs a greater risk of failing patients and staff down the road. The widespread governance issues at Wirral should give everyone pause for thought.
Many of the NHS’s recent scandals included elements of regulatory failure, including organisations waiting too long to act or being wrongly assured by those trying to avoid the intervention.
NHSI has still not taken formal action against this trust. To retain credibility, it needs to show it has learned the lessons from those episodes in how it deals with what is now happening at Wirral.
Jobs withdrawn from former trust chief amid investigations
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Lintern's Risk Register: NHS Improvement's lack of urgency at Wirral is a concern