A leaked report has delivered a damning verdict on the NHS leadership in Staffordshire, describing the health economy as beset with an ‘oppressive culture’ and in ‘perpetual crisis mode’.

The “distressed economy” report by management consultancy KPMG criticises the lack of collaboration between different organisations and suggests it is time for some leaders in Staffordshire to move on to new roles.

The report, seen by HSJ, highlights cultural problems across the region that it says are leading to poor behaviours and are impacting on patient care.

It was commissioned by the NHS Trust Development Authority, NHS England and Monitor, to analyse why the Staffordshire health economy has struggled to meet performance targets or achieve long term financial stability.

In its conclusions it says Staffordshire continue to exhibit “relatively poor behaviours and an insular culture”.

The report said: “We have observed a generally oppressive culture across the [local health economy]. The impact of the [Mid Staffordshire] inquiry is still very palpable across many parts of the [health economy] which is driving certain behaviours. We believe that some behaviours emerged as a result of the inquiry but others are more deep seated.”

The behaviours the report highlights include:

  • strongly worded emails which escalated or inflamed issues;
  • people saying one thing in a meeting and behaving differently outside - the KPMG team said they believed this was widespread;
  • people pre-announcing decisions and seen as “bouncing” colleagues into the decision; and
  • people saying they will take actions and that they then do not, and turning up late and leaving early at strategic meetings.

The health system was also in “perpetual crisis mode”, the report said, with a lack of clinical leaders and a managerially focused leadership with “many examples of silo working”.

“The vast majority of the senior leadership have been in Staffordshire for some time,” it said. “This can bring undoubted benefits but sadly, the negatives are the prevalent aspects we have witnessed.”

Clinical commissioning groups in Staffordshire do not collaborate and their plans, including financial contracts, are not aligned with each other or providers, the report says.

It added: “We have found quality issues that are impacting on patient care in the management of the frail elderly pathway. Patients are being readmitted to a greater degree than we would expect and patients are less likely to be discharged to their usual place of residence than comparable systems. Some aspects of the service in a number of community hospitals are affected by recruitment issues.”

It recommends closer working between acute providers, a reorganisation of community services with closer integration, and single pathways of care.

The authors also calculated a potential deficit of £216.8m by 2018-19, although the report did not consider the outcome of the trust special administration process at Mid Staffordshire that has resulted in a £253m investment in Staffordshire up to 2017.