Exclusive: Trust tried to hide poor care and patient harm

An independent review, seen by HSJ, into failings at Liverpool Community Health Trust between 2010 and 2014 has found a widespread culture of bullying and harassment, as well as an organisation that sought to hide its problems from external bodies.

A panel commissioned by NHS Improvement, led by Bill Kirkup, found there were also failings within regulatory and commissioning bodies, which meant the problems were not identified for more than four years.

Its conclusions echo many of the most serious findings from the Francis inquiry into poor care at the Mid Staffordshire Foundation Trust which was published in 2013.

The review, due to be published on Thursday, was told of “appalling instances of staff treatment” by the trust’s human resources department, including accounts of staff being victimised and suspended when they raised concerns.

There were repeated incidents which the trust failed to learn from as a result of a failure to escalate and investigate properly. These included: 

• up to 19 deaths in custody at HMP Liverpool;
• five wrong site tooth extractions in the dentistry division;
• repeated falls and fractures on intermediate care wards; and
• numerous grade three pressure ulcers within the community division.

The report suggested that the poor culture and unsafe practices originated with the trust’s prioritisation of cost improvement plans over quality and patient safety, which were driven by its desire to obtain foundation trust status.

Savings frequently had to be made by cutting staffing levels. In one year the trust set a cost improvement plan of 15 per cent, when the review said 4 per cent is generally considered as the upper end of achievability. At one stage the dentistry division was tasked with delivering efficiency savings of 44 per cent after an assessment by external consultants, and the review found members of staff were suspended after questioning its feasibility.

At one private board meeting in February 2013, human resources director Michelle Porteus presented plans for “significant staff reductions” in some areas that were “already being highlighted as a cause for concern, partly as a result of staffing shortfalls”.

The reviewers added: “There was no apparent recognition of the irony inherent in this being taken to the same board meeting that had earlier considered the implications of the Francis report into failings at Mid Staffordshire Foundation Trust.”

The atmosphere at the trust led to unrest and low morale among staff, but the review found that when some staff spoke out “they were harassed and, in some cases, subject to disciplinary action, including suspension”.

It said a particular feature of the trust’s approach to safety incidents were “scoping meetings”, which were described as “an interrogation and a frightening experience” from which no learning was taken.

In a “chaotic” HR department, a backlog of outstanding cases built up to 332 cases in 2014, including 26 grievances, many of which were not reported to the board.

The initial impact of the poor culture fell predominantly on middle managers, who were positioned between the trust board’s insistence on pushing through cost reductions and the front line staff who suffered as a result.

The review found that “faced with this undoubtedly challenging position, it is clear that their response was inadequate and inappropriate and, in too many cases, included extreme action against more junior staff, amounting to bullying”.

Although the review praised the efforts of many staff, it said some nurses failed to comply with their professional guidelines and “let their patients down”.

The review found that problems at the trust started to emerge after West Lancashire MP Rosie Cooper began raising concerns with the Care Quality Commission in 2013, along with whistleblowing staff. The CQC published an inspection report in 2014 which identified systemic issues and law firm Capsticks, after being commissioned by the new interim board, published a highly critical assurance review in 2016.

The trust board, including former chief executive Bernie Cuthel, was largely removed in 2014. Ms Cuthel went on to work for Manchester Mental Health and Social Care Trust and an NHS board in Wales.

Helen Lockett, the former director of nursing, was given an interim suspension order by the Nursing and Midwifery Council and her case is due to be scheduled by the regulator. Michelle Porteus, the former HR director, has also since left the trust and works as a consultant.

The former chair Frances Molloy stepped down in 2015 after five years. She now works at a Liverpool based charity health@work.