Scent of a scandal

• A worrying narrative develops in Morecambe Bay
• Progress for the Cheshire and Merseyside STP
• Best and worst of the staff survey
• Further analysis of progress in Greater Manchester to follow in the next edition

Familiar narrative

The Kirkup Inquiry into Morecambe Bay’s maternity services did much to expose the ugliest parts of the NHS — and local leaders have spent the last five years on a healing process trying to rebuild trust.

So, another patient safety scandal emerging at University Hospitals of Morecambe Bay Foundation Trust would be a deeply depressing prospect.

But, over the last six months, a familiar narrative has been building about the trust’s urology department; describing a failure to provide safe care, defensiveness in the face of criticism, suppression of staff raising concerns, and a reluctance to admit errors and learn lessons.

This is the narrative told primarily by whistleblowing former surgeon, Peter Duffy, who raised multiple safety concerns within the trust, stretching back over more than a decade.

He has cited avoidable deaths due to clinical errors, a patient almost having the wrong kidney removed, a teenager having a testicle removed after a wrong diagnosis, a patient refused a potentially lifesaving operation, and several missed cancers.

Numerous complaints, counter-complaints, investigations, case reviews, General Medical Council referrals and employment tribunals have taken place, with the trust acknowledging a number of care failings.

The primary subject of Mr Duffy’s concerns, another surgeon called Kavinder Madhra, resigned in 2018 and is subject to charges from the GMC which are currently being heard in Manchester.

Mr Duffy, a former consultant of the year at the trust, resigned in 2016, with an employment tribunal subsequently ruling he was constructively dismissed over a pay issue. His initial tribunal claims had argued he was effectively sacked for whistleblowing, but he says he withdrew these due to the threat of huge legal costs if the claims were unsuccessful.

Although he has since moved to the Isle of Man, Mr Duffy has been reluctant to forget his concerns, and last year self-published a book detailing his experiences and how the trust handled the concerns. All of this has been extensively covered by local media, notably by Amy Fenton of the North West Evening Mail.

While the trust maintains the concerns and complaints were dealt with seriously, and that correct processes were followed, the book alleges senior leaders knew of his concerns and failed to deal with them adequately. And Mr Duffy still believes he was ostracised and effectively forced out of the trust for speaking up.

He has proved a coherent and potent critic, and in December received a first apology from UHMB — albeit from Liz Sedgley, an NED who had just become acting chair (and will have had little to no involvement in the past issues).

Conscious of the developing narrative, the trust asked NHS England to commission an independent review of the issues raised last year, and Niche Consulting were appointed in November. Some initial investigations and meetings have taken place since then, but the review’s terms of reference have still to be ironed out.

While attempting to quantify the scale of the patient harm that was caused, the review should also be expected to address Mr Duffy’s wider claims around governance and culture. UHMB’s leadership past and present has won plaudits for the way it handled the aftermath of the maternity scandal, including a “good” leadership rating from the Care Quality Commission since early 2017.

But Mr Duffy’s book would have made difficult reading for the trust’s current board, as well as high-profile leaders who have since moved on.

Mr Duffy suggests Pearse Butler, who now chairs Blackpool Teaching Hospitals FT, and Dame Jackie Daniel, now chief executive of Newcastle’s acute provider, were both unresponsive when he reached out to them directly, while David Walker, now group medical director for three trusts in Essex, is accused of being part of the effort to damage his reputation.

Without hearing from them, it’s difficult to assess the extent to which they could have done more, or should have acted differently. Mr Butler and Dame Jackie did not want to comment for this article, while Mr Walker’s new employers did not respond. But the Niche review will hopefully help answer those questions. If it doesn’t, Mr Duffy is unlikely to let things lie.

ST Progress

Things finally seem to be nudging along for the Cheshire and Merseyside Sustainability and Transformation Partnership, with the first big decision by new chair Alan Yates looking a good one.

Jackie Bene, the highly rated chief executive of Bolton Foundation Trust, has been recruited as the new chief officer.

She is set to leave Bolton at the end of March so, although the STP role is just three days a week, she will surely be able to devote more time and attention to it than was possible for Mel Pickup, who was doing the role in parallel to leading Warrington and Halton Hospitals FT.

Meanwhile, the long-awaited merger of the clinical commissioning groups for Liverpool, South Sefton, Southport and Formby, and Knowsley is formally back on, with a single accountable officer expected to be appointed later this year, followed by an organisational merger in April 2021.

The inclusion of Knowsley is unstraightforward, as it will leave St Helens and Knowsley Teaching Hospitals Trust still spread over two CCGs. St Helens is more distinct from Liverpool and its CCG already in quite an advanced level of integration with the local authority, but the trust’s main hospital site, Whiston, sits just within the boundary of Knowsley. Perhaps they can persuade the councils to change their boundaries?

Staff survey

The 2019 staff survey results were published last week — here’s a quick round-up of the headline results in the North West.