Regulator sorry for manager’s ‘five years of hell’

Debbie Moore was a senior manager at the former Liverpool Community Health Trust, where there was a major care scandal in the early 2010s.

As head of healthcare at HMP Liverpool, where many of the most serious failings were identified, Ms Moore was suspended in 2014 and referred to the Nursing and Midwifery Council. She was accused of multiple failures to take action or escalate concerns, of failing to investigate deaths, and discouraging staff from reporting incidents. 

However, in a first public interview about her experience, she told HSJ she was “scapegoated” for the problems at the prison, where she says she worked tirelessly to address the issues and had repeatedly flagged concerns to the LCH management team.

External inquiries have found the trust would routinely downgrade risks escalated by divisional managers, as it sought to make drastic cost savings in pursuit of foundation trust status.

In 2019, five years after first being referred to the NMC, a fitness to practise panel dismissed all 12 charges brought against Ms Moore.

The regulator had largely argued the persistence of the problems at the prison meant there must have been a failure to act.

But, in a lengthy judgment document, the panel made no criticism of Ms Moore’s actions in relation to any of the charges, and on most found “an abundance of evidence of the considerable efforts that [she] and the rest of the [prison] healthcare team made to escalate and address these issues”.

Ms Moore told HSJ the NMC’s initial investigation had in fact determined, back in 2015, there was no case to answer, but then the regulator wrote to her again to say this had changed and the case was being pursued.

She said: “I absolutely understand the NMC’s role and that things need to be looked into, but don’t let it go on for so long, and don’t have your own investigation at the beginning and then ignore what it tells you… I don’t care how much media pressure there is, they should be ashamed of themselves.

“They have absolutely no idea what this has done to me. To keep it going for so many years was so cruel. I went through five years of hell. People say ‘let it drop’, but I can’t.”

In response to questions about the eventual decision to pursue the charges, the NMC told HSJ in a statement: “We recognise that it took too long to conclude this case and we are very sorry for the impact that this has had on Ms Moore and all those involved.

“While this was an incredibly complex case, involving multiple third-party investigations, we recognise that there are things we should have done differently.”

It said it was also making improvements to its investigation process, including “taking greater account of context when things go wrong”.

Taking account of the context

Ms Moore believes the case would not have proceeded — and she would not have lost her job — if the context of the failures in the prison, and her situation, had been properly considered.

She began working as part of a permanent healthcare team based at HMP Liverpool in 2002 — which at the time was an almost unique service — and progressed through the bands to become the manager of around 100 staff by 2007.

The prison’s health team were rated positively by regulators, including after a full inspection in 2009, and won a Guardian Public Service Award in 2008 for the work they were doing around enabling employment for offenders after being released. Ms Moore said prison healthcare teams were coming to Liverpool from around the country to see how the service was run.

However, she said several things changed from 2010, as government austerity measures were rolled out, which sent the prison into a fairly dramatic decline.

Budget cuts meant fewer prison officers to bring prisoners to the healthcare unit, meaning crucial screenings and assessments were often cancelled, allowing problems to develop. The physical estate also began to deteriorate badly, with toilets left uncleaned and large areas becoming rat infested.

The healthcare team’s budget was cut by 20 per cent, which meant it could not recruit to vacancies, while visits from GPs were also reduced. 

Meanwhile, a change in the prison’s designation meant the population increased and became more transitory. New laws also meant very ill prisoners who would previously have been released on compassionate grounds were kept in jail, which substantially increased the severity and quantity of the work faced by the healthcare staff.

An issue with the pharmacy contract commissioned by NHS England also meant the third party provider was only responsible for dispensing, without medication being checked by pharmacists.

Ms Moore said she and the other managers “essentially spent this period firefighting to mitigate the risk”, frequently working seven days a week and often as nurses on the floor, because the team was so short-staffed and overrun.

Calling for help

Throughout this period, Ms Moore said she repeatedly “called out for help to avoid a disaster”, by escalating problems to her managers. She also flagged concerns with the prison governor, but was then warned by LCH against raising concerns through external channels.

She would see her risks downgraded once they reached the executive offices, while the trust would refuse to properly investigate deaths in custody or other serious incidents.

She said: “I was so frustrated by it. At one point, I even turned up [at] a trust board meeting unannounced to raise these risks directly, but they wouldn’t take it on. They were just obsessed with their FT bid and everything appearing okay.”

The charges about discouraging staff from reporting incidents were born from confusion around reporting processes, she said. A change in system meant staff were being encouraged to submit through the NHS datix system, instead of through the prison system as they had previously. 

In early 2013, management cuts within the trust meant Ms Moore was redeployed to another prison for several months, after which she said the problems at HMP Liverpool escalated steeply.

She requested to be sent back in, but before doing so met privately with a senior commissioner from NHS England to raise her concerns. She said the commissioner promised to take action on the pharmacy initially, and this would provide a platform to intervene on all the other problems.

Escalation

By early 2014, concerns had escalated at LCH more widely, with staff whistleblowing in multiple parts of the trust, including the prison, to the Care Quality Commission.

This prompted a damning inspection report and intense media scrutiny. The LCH board, led by chief executive, Bernie Cuthel, were dismissed by NHSE.

A new interim board led by Sue Page — now interim chief at South Tees Hospitals FT — was appointed, and her experience of visiting the prison is detailed in a Deloitte review that was later commissioned.

Ms Page told the review: “I walked in there and there was a team of completely disillusioned unsafe staff… We went through the whole day with these staff and it was quite clear there was bullying, harassment, there was no leadership…what we uncovered in the prison was just dreadful.”

Ms Moore said one “disgruntled” member of staff made the bullying allegations, while some team members were angry at the efforts she had made to deal with staff shortages, such as asking mental health nurses to undertake some physical healthcare duties.

According to Ms Moore, she requested to meet with Ms Page as soon as the new CEO was appointed, but the request went unanswered and she was suspended without being given a chance to explain her side of things. Ms Page did not wish to comment when contacted by HSJ.

A subsequent inquiry by Bill Kirkup found one member of staff who described the prison’s culture as “bullying”, but its ultimate conclusions on the prison were more generalised: “There appeared to us to be a lack of ownership of the issues, with everyone blaming somebody else.

“The truth of the matter is that there was a lack of governance systems, leadership, accountability, a lack of effective HR management, and a failure of management and oversight at all levels of the organisation.”

Aftermath

Despite the new board sending a turnaround team into the prison in 2014, inspectors found the prison services had deteriorated further after a visit in November that year. This led to LCH relinquishing the contract and Lancashire Care FT taking on the service.

Serious problems persisted, however, with numerous deaths in custody aned whistleblowers reporting multiple incidents. Following an inspection in September 2017, Her Majesty’s Prison Inspectorate concluded HMP Liverpool was the worst prison they had visited, with the healthcare unit again coming in for significant criticism.

This led to a new governor being appointed, while Lancashire Care announced in October 2017 it would be pulling out of its contract early.

Another provider, Spectrum Healthcare UK Ltd, then took over the service and inspectors earlier this year found some dramatic improvements had been made throughout the prison. 

Ms Moore believes this has been the result of significant additional investment by commissioners, and HSJ is seeking to obtain figures.

Meanwhile, Mersey Care FT has taken over the rest of LCH and a second inquiry by Dr Kirkup is investigating around 150 deaths that occurred at LCH between 2010 and 2014. It is expected to conclude next year.

Earlier this year, a fitness to practise panel found the trust’s former director of nursing, Helen Lockett, had bullied staff and attempted to minimise concerns that were being raised.

‘Best job I ever had’

Ms Moore, who is 59, has since moved to the south of England and now works in medical negligence.

She said: “Once everything blew up in the media, we were absolutely scapegoated by LCH and the new board, without a shadow of a doubt. I never got a chance to put my case forward.

“When I heard the outcome of the NMC hearing, I just broke down in tears. I couldn’t believe they’d taken so long, to put us through all that, just to come to the same decision they’d made right at the beginning.

“The number of times my name was in the Liverpool Echo — my son still works in the prison and has had to put up with all the gossiping for years — it’s been a nightmare for the whole family and completely life-changing.

“Even in the criminal system it wouldn’t take that long for a case to come forward. It also cost me thousands of pounds and having to take unpaid leave to have to keep travelling down to London to meet with my union and be at the hearing every day for weeks and weeks.

“Working in the prison was the best job I ever had. You have to be quite a confident person to work in a prison, but this has absolutely destroyed my confidence, and my career as well.”