Monitor has stepped in to replace the chair of University Hospitals of Morecambe Bay Foundation Trust after three separate independent reviews last week revealed a catalogue of leadership and governance failures.
The foundation trust regulator has installed Sir David Henshaw, who also chairs Alder Hey Children’s Foundation Trust, at the provider. It has ordered chief executive Tony Halsall to appoint a chief operating officer and a turnaround director.
The intervention came after a review team sent into the trust by Monitor in November 2011 reported that governance was “inadequate” and “below the standard that we would expect in an NHS foundation trust”. Morecambe Bay was only granted foundation trust status in October 2010.
A second team, sent in at the same time, concluded there were still “significant risks for the safety of mothers and babies” at the trust’s Furness General Hospital, despite improvements being promised following a Care Quality Commission inspection last July.
The review concluded it was impossible for nurses to take breaks at the six-cot neonatal unit without leaving just one staff member on the ward. “Senior nurses and managers are aware of this but no contingency plans appear to be in place,” it said.
The third Monitor review reported that the trust had accumulated a backlog of around 14,000 patients with overdue follow-up appointments, without recognising it was a “serious clinical problem”.
The regulator took this third investigation as evidence of the board’s inability to drive effective management across the trust’s three geographically disparate hospitals: Westmorland General, Furness General and the Royal Lancaster Infirmary.
“Many staff cited the unsuccessful merger of three previous organisations in 1998 as the origin of cultural and behavioural problems at the trust, which persist to date,” it said in a letter to the trust.
“The board lacks the skills to change the culture of the organisation, given the length of time these cultural issues may have persisted. Furthermore, it is not clear that the current board has the capability to effectively introduce and embed the necessary changes.”
The Monitor-commissioned governance review, by consultants PricewaterhouseCoopers, reported that the board did not receive adequate information about care quality and risk for it to ensure problems were identified and managed.
The challenge and scrutiny that board members offered on performance and risk was “not at a level we would expect”, and the trust’s quality metrics were focused on “externally set targets” rather than continuous improvement. Messages reported to the board were “sometimes diluted”, and it was not clear who was held to account for risk management at divisional level.
The review found clinical leadership was “weak”, with limited engagement of clinicians in the management of performance and “insufficient accountability of medical staff”.
It also warned that some of the savings schemes in the trust’s £12.5m 2011-12 cost improvement programme were not reviewed for potential risks to care quality until after they had begun to be implemented.
Sean Gibson, Unison regional organiser for health, said: “The question for me is, has Monitor fulfilled their duty? This organisation was given foundation trust status less than two years ago. Was full due diligence [undertaken] at the time?”
A Monitor spokesman said its initial assessment of the trust, in April 2009, “identified a number of serious concerns related to the quality of maternity services”, which it formally referred to the CQC. A CQC inspection at Furness General Hospital in June 2010 “did not identify any concerns”. “In light of the CQC’s view and our work to test the governance arrangements at the trust, in September 2010 Monitor judged that the trust met our authorisation criteria,” he said.
A CQC spokesman said the June 2010 review had focused on the trust’s progress on “specific issues” relating to the 2008 death of baby Joshua Titcombe at the hospital. It had “verified” the trust had made “sufficient improvements” to ensure essential standards were met. However, “subsequent information”, including the coroner’s findings on Joshua’s death, triggered another inspection in July 2011, which identified “major concerns” with the maternity service.
“When things go wrong with the delivery of care, it can happen very quickly – which is why we are proposing to move to annual inspections of NHS and social care from April,” the CQC spokesman said.