• Consultants at Cumberland Infirmary say they’re pressured to put targets above patient safety
  • Training at the trust could be subject to enhanced monitoring after junior doctors’ bullying concerns
  • Newly merged trust pledges to make improvements

Consultants at an acute hospital have reported being bullied by senior managers to move patients inappropriately and to prioritise targets over quality and safety.

Senior emergency medicine doctors at North Cumbria Integrated Care Foundation Trust’s Cumberland Infirmary told the Royal College of Emergency Medicine that high pressures from poor flow through the hospital have left them concerned for their professional reputation and registration in the event of a serious incident.

RCEM president Katherine Henderson, who visited the hospital in January at the request of a senior emergency medicine doctor, was also told by ED clinicians they “felt they had been bullied by senior managers to move patients inappropriately, to re-prioritise work, to prioritise 12 hours ahead of quality and safety”.

The consultants said there had been “incessant calls from senior managers asking for information and actions which was impacting on their ability to do their jobs properly”, according to a board paper published this month.

Concerns of new doctors

Training at the trust is also expected to be placed in enhanced monitoring by the General Medical Council after new doctors reported widespread bullying and harassment and “chaotic” handovers at the hospital.

Last week, Health Education England formally requested the GMC take action at the trust after 12 first year doctors reported being subject to or witnessing bullying and harassment, including coercive behaviours, by clinical and non-clinical staff.

HEE, which also visited the hospital in January, were told by the first years that handovers were “chaotic and not as effective as they could be” and that night cover was “taken down approximately 25 per cent of the time”.

HEE was told additional locally employed doctors had been taken on to staff the hospital at night but “a longer-term solution is required”.

A report by trust medical director Vince Connolly, published in January board papers, said “we unfortunately expect a return (sic) GMC enhanced monitoring” as a result of HEE’s visit.

Dr Connolly also said the trust is “appreciative of the work and dedication of ED colleagues” and a “number of actions” were in place to address their concerns.

A formal request

HEE said it has been “closely monitoring” concerns raised by junior doctors about clinical supervision and governance of night cover at Cumberland Infirmary. But a scheduled visit on 14 January “did not provide assurance the situation was improving”.

A HEE spokeswoman said: “HEE has made a formal request to the GMC for enhanced monitoring of the training concerns identified at North Cumberland Integrated Care [FT]. In addition, the trust has been asked to put in place a number of specific measures to ensure full staffing, ownership and management of night cover.

“HEE hopes that now the issues have been identified the matter will be resolved quickly.”

The GMC confirmed to HSJ it was considering HEE’s request for enhanced monitoring of North Cumbria Integrated Care.

A GMC spokesman said: “We are now considering the evidence presented by HEE and will be in direct contact with them if any further supporting information is required.

“We aim to make a decision on a formal request as swiftly as possible to ensure we act quickly on any serious safety concerns.”

Dr Connolly, in his report, said the trust has “less than five months” to act on the concerns raised by the HEE and junior doctors. He said trainees could be withdrawn from the trust if, in GMC enhanced monitoring, the issues are not addressed in a timely way.

‘Challenging unacceptable behaviours’

North Cumbria Integrated Care FT was formed in October 2019 from a merger between North Cumbria University Hospitals Trust and Cumbria Partnership FT. The GMC had enhanced monitoring at North Cumbria University’s West Cumberland Hospital between 2014 and 2015, when it was concerned about supervision in core medical training.

A trust spokeswoman said: “We are currently working with Health Education England to improve the support and experience of our doctors in training. Following their visit, we have already taken steps to improve and strengthen the hospital at night team and the handover process to ensure better support and supervision for our trainees.

“As a newly merged trust our new chief executive has worked in hand to create a better place to work for all of our staff which includes challenging unacceptable behaviours.

“We are reporting directly to [HEE] in relation to this which will also improve the quality, safety and experience of our patients.”

In response to the concerns raised by the RCEM, the spokeswoman said: “The trust is experiencing a period of significant pressures across our services in line with the national picture. We are working closely with our clinical leaders to address the issues raised by the RCEM.”