Published: 30/01/2003, Volume II3, No. 5840 Page 6 7
An investigation into corporate governance at Royal United Hospital Bath trust has accused it of having been in 'the grip of a powerful self-delusion' about its performance. It also attacks 'a culture of misrepresentation' which existed at the trust during the tenure of its former executive team.
Former North West region director Professor Robert Tinston was appointed by the trust in May last year to hold the inquiry after two external reviews identified concerns about 'deliberate manipulation' of waiting lists and 'serious' deterioration in finances at the trust. The Tinston report describes 'a trust in the grip of a powerful self-delusion about its real performance and the desire to continue to support this leading to a culture of misrepresentation'.
It says: 'Those responsible for performance managing the trust failed to break this destructive spiral, despite some warning signals.'
The report dates the breakdown of internal performance management to 1999, with the departure of the then director of operations.
Professor Tinston told HSJ that the 'general timeframe' of his inquiry was 'about the last 10 years and more specifically from 1996-97 onwards when it was clear people outside the trust had begun to identify concerns'.
The inquiry looked at the situation 'up to about last March, which is really when the system started to get a grip' of problems at the trust.
Barbara Harris was chief executive of the trust from 1993 until being appointed director of the NHS Leadership Centre in April 2001. She stood down from the Leadership Centre post in December 2001 following a critical Commission for Health Improvement report that condemned the management style at Bath when she was at the helm.Richard Gleave took over as chief executive in October 2001 but stood down in June 2002, when Jan Filochowski joined the trust on secondment.
The inquiry says that the former executive team 'appear to have adopted a policy of marginalising the trust board, or at the very least presenting important information at board meetings in an unduly optimistic and favourable way'.
Professor Tinston clarified: 'We are clearly talking there about the executive team before Richard Gleave.' The report says the trust's weak control and accountability arrangements 'conspired to undermine fundamentally the management of the RUH'.
Generally accepted accountancy principles and practices were overlooked, masking the trust's financial position: 'It appears to have been simply too painful and difficult to deal with the financial problems at ward/departmental/directorate-level.'
The report also echoes CHI's criticisms of the movement of staff within the trust. 'Managers have been moved (and on occasions promoted) with little notice and sometimes without 'due process'.Managers described the trust's culture as one where people were either 'in favour' or 'out of favour'.'
Despite assurances given by the Department of Health in June that the review would also examine employment of trust staff at the NHS Leadership Centre, the report fails to mention the issue.
In the wake of Barbara Harris' departure from the Leadership Centre in December 2001, HSJ revealed that a number of former RUH Bath staff had joined the Leadership Centre in the previous few months.
The report makes only a nonspecific reference to the need for the trust and the wider NHS to 'establish proper procedures for seconding staff '.
Professor Tinston told HSJ he was not asked to look at the issue of staffing at the Leadership Centre.
'That was never discussed with me. It was never mentioned that it was part of my remit. The DoH didn't speak to me about the terms of reference.'
Where are they now? What members of the RUH Bath executive team did next Although Professor Tinston's original remit included advising on disciplinary action, his report - due to go to the board yesterday - says that during the early stages of the review the trust 'reached a decision about disciplinary matters and is pursuing these independently of the review.'
Former chief executive Barbara Harris was sacked by the trust in August last year.The trust refused to confirm or deny at the time whether a disciplinary hearing had taken place.
Ms Harris is understood to be taking legal action against the trust.
Former finance director Martin Dove resigned this month after being suspended since May last year.His secondment as finance director to Inventures, the trading arm of NHS Estates which shares a Bath office with the NHS Leadership Centre, was terminated.
Medical director Professor Graham Smith resigned his directorship and was suspended from his substantive post last year when an unrelated investigation was launched into possible misuse of NHS resources to treat private patients.There was no suggestion that it was in connection with problems with waiting lists or finance.
RUH Bath chief executive Jan Filochowski, who arrived at the trust in June last year, said: 'I believe the report is full, accurate and fair.We have already implemented a number of the recommendations and will now move forward on the remaining ones.'