• Norfolk and Norwich hospital and its leadership rated inadequate
  • CQC chief said ‘bullying culture’ remained at trust and praised whistleblowers
  • Professor Baker said there had been an “obvious deterioration” in services

Norfolk and Norwich University Hospitals Foundation Trust has been placed in special measures after inspectors rated the trust and its leadership inadequate, having found a “bullying culture” and an “obvious deterioration” in services.

The Care Quality Commission also rated the trust inadequate on the safety of its services. The trust was rated requires improvement for whether its services were effective and responsive, and rated good for whether its services were caring.

The trust said it accepted the watchdog’s findings. The critical assessment followed NNUH being rated requires improvement by the CQC last August as part of an inspection prompted by allegations of bullying, as reported by HSJ.

CQC chief inspector of hospitals professor Ted Baker said: “It is extremely disappointing to see a trust that not only hasn’t improved since our last inspection, but where there has been an obvious deterioration in how the services are run.

“Although staff at the trust were clearly caring and committed to helping patients, and we found some areas of outstanding practice, we were very concerned by how the trust is being led and with many of its systems and processes.”

Professor Baker praised whistleblowers for raising “a significant number of reports” to the CQC. He said: “A bullying culture remained at the trust, and one of fear of reprisal amongst staff if they should raise concerns.

“I would like to thank all those staff who raised concerns with our inspection team. They have made a major contribution to the recognition of the problems at the trust, which is the essential foundation for any improvement.”

The CQC said:

  • The relationship and culture between the site management team and the senior nursing and clinical teams must improve so that patient safety is equally weighted against operational pressure to reduce risk to patients and staff.
  • Processes for whistleblowing must be reviewed and the trust’s leadership must take definitive steps to improve the culture, openness and transparency throughout the organisation.
  • Bed and site management processes need to be reviewed to increase capacity and patient flow.
  • The completion of staff annual appraisals must improve and there needs to be an effective process for quality improvement and risk management across all departments.

The CQC said it had however also found “some areas of outstanding practice”.

It said: “Inspectors found there were impressive pathways for the management of stroke and fractured neck of femur patients. The urgent and emergency service worked with the trust’s specialist teams, even in the ambulance bay, to assess and treat patients quickly and effectively as possible with regard to these conditions.”

NNUH chief executive Mark Davies said in statement: “We thank the CQC for their report and have accepted its findings. Lack of capacity and sustained high levels of demand over winter put our services under extreme pressure and I would like to apologise to our patients that we were not always able to provide the level of service that we would have wanted.

“The NHS has been through one of the longest, toughest winters on record and I would like to thank staff across all professions and support services at the trust for everything they have done, and continue to do, for our patients and colleagues. The CQC team also recognised the consistently caring approach by our staff.

“We are also improving facilities and increasing staffing (alongside Norfolk and Suffolk Foundation Trust) for patients with mental health needs in crisis.”

He added: “We absolutely recognise there is still much to do and that we have some significant challenges to deal with, particularly in relation to staff feeling able to speak up and raise concerns, and we must improve next winter’s escalation plans and improve our systems and processes overall. We are working on our improvement plan with the help and support from NHS Improvement and also the King’s Fund.”

NHS Improvement confirmed it had placed the trust in special measures. Inspections were carried out between 10 October 2017 and 28 March 2018.