Revealed: Crisis at top CCG amid claims of bullying and ‘toxic’ culture

HSJ can reveal today that Sheffield CCG medical director Zak McMurray has also been on “special leave” with full pay for more than a year after he raised a whistleblowing concern against the CCG’s accountable officer Maddy Ruff.

The culture in the CCG has been described as “toxic” by former and current employees, who spoke to HSJ on condition of anonymity. They claimed bullying, favouritism and harassment was widespread.

HSJ has also learned that NHS England commissioned an external review of the CCG which confirmed many of the concerns and identified widespread issues about poor behaviours by senior CCG staff as well as dissatisfaction over the handling of bullying and harassment cases, a lack of a clear strategy and poor relationships between members of the governing body.

The review warned the situation at the CCG, which is responsible for more than £800m of health spending, could ultimately lead to its decline unless action was taken.

Sheffield South East MP Clive Betts, told HSJ the suspension of Dr McMurray was an “untenable situation” and stressed the review was not a complaint about Dr McMurray but about the way he had been dealt with.

He said local MPs had been approached by “a number of senior people in the CCG and people from the city council who were concerned about the way the CCG was operating”. He said this included “management, the atmosphere working there, favouritism and conflicts around appointments – a whole range of different issues”.

“I’ve never had as many senior people in a public sector organisation complain about how the CCG was being run,” Mr Betts said. “It was alarming.”

Despite MPs demanding a review of the CCG, Mr Betts said NHS England has not shared it with them. The review was carried out by a former Primary Care Trust chief executive Denise McLellan, who questioned 87 people. The document was shared with the governing body earlier this month.

Councillor Chris Peace, cabinet member for health and social care at Sheffield City Council, also joined the criticism of the CCG, saying in a statement: “We share many of the concerns that have been raised by the MPs and welcomed the opportunity to input into the internal review.”

One source told HSJ that, after accountable officer Maddy Ruff joined the CCG in 2015, “things changed dramatically”. The source added there was a “breakdown in relationships” and described a “culture of coverup” in the way management responded to issues.

A separate senior source close to the CCG management said: “There was a very unhealthy culture and uncaring culture [at the CCG].”

Another worker with knowledge of the issues said it was vital the situation improved, adding: “Sheffield is a complex system and it deserves a good leader.”

Multiple sources said whistleblowing concerns were raised after an incident in October 2017 when Ms Ruff “demanded” the names of applicants for a senior post in the Sheffield health and care system on the day of shortlisting.

During a later public meeting on an unrelated topic, Dr McMurray, who was one of those who raised a concern, spoke out about plans to cut back on Procedures of Limited Clinical Value. Following this, he was put on so-called special leave in February 2018.

The CCG would neither confirm nor deny Dr McMurray’s absence on full pay.

But Dr McMurray told HSJ in a statement: “I can confirm that I have been on special leave for just over a year now. I wish to reassure my patients that my absence is not due to a disciplinary process and is not conduct or ability related. I am unable to comment further at this time.”

Key findings from the NHS England review into Sheffield CCG include:

• Poor decision-making processes which resulted in frustration and poor behaviours by senior staff;
• Disagreements between executive team members which were not addressed effectively or handled properly in line with NHS values;
• Widespread dissatisfaction about how bullying and harassment cases were handled;
• A leadership team which lacked a clear strategy, while stakeholders were not confident the executive team had the right skills to lead the CCG;
• An ongoing investigation involving governing body members putting the organisation under strain and communication had been poor;
• Stakeholders panels for senior appointments which felt their views were ignored without feedback; and
• Internal career progression opportunities which were not fairly offered.

The review acknowledged Sheffield CCG, which was rated “good” by NHS England in 2018, has a number of strengths, with committed staff and plans to further transform services.

HSJ asked NHS England a number of questions about whether it was aware of the whistleblowing incidents, the concerns about the CCG and Dr McMurray’s “special leave” but it declined to provide a response.

In a statement, CCG accountable officer Maddy Ruff said the CCG took all concerns raised by staff seriously and was committed to dealing with them “responsibly and professionally”.

Addressing the whistleblowing concerns, she said the CCG “strictly adheres to its legal obligations to maintain confidentiality where required in relation to any whistleblowing or HR process that is carried out at the CCG”.

She added: “This means we cannot discuss details of individual employment matters to protect their right to confidentiality.”

On the NHS England review, she said it “highlighted some staff didn’t feel supported by senior managers around handling of bullying cases”. She added: “Some of the recommendations include having a more proactive strategy on the role of the CCG in Sheffield and the wider region.

“Although we’re disappointed with some of the findings in the report, we recognise we could do better. We are taking the recommendations in the report seriously.”