The chair of an acute trust has resigned, calling on NHS chief executive David Nicholson to investigate the behaviour of East Midlands strategic health authority in pressurising him to meet access targets.
David Bowles, chair of the United Lincolnshire hospitals trust, says he refuses to work in a system which he says has not learnt the lessons of Mid Staffordshire and which has lost sight of patient safety issues, and that it is his duty to resign and bring attention to that.
His stance has been supported by the other non executives at the trust, who have also written to Mr Nicholson asking him to investigate.
Mr Bowles said he was repeatedly asked by the SHA to give an “unequivocal guarantee” the trust would meet the 18 week referral-to-treatment target. Mr Bowles refused to give a categorical assurance, emphasising the pressures the trust was under from increasing emergency demand, the need for effective demand management in the local health economy and that extra capacity to deal with demand could not come on stream until later this year.
“I would like to know from David Nicholson whether he thinks it is fair and reasonable to ask for that guarantee,” he told HSJ. “I would like to know whether this is a renegade SHA or do ministers agree with unconditional guarantees on non-urgent targets.”
In an email, seen by HSJ and attached in full above, to shadow health minister Mark Simmonds, who is MP for neighbouring Boston and Skegness, Mr Bowles said: “What I have witnessed from outside the trust appears to be a substitution of bullying for performance management and an obsession with targets rather than safety.”
“It is often said that the culture in the NHS, particularly at the more senior levels, is not to listen, not to understand, to avoid responsibility, and to blame others.
“In the interests of patient safety I can not and will not give the unequivocal assurance that the SHA is seeking on non-emergency targets especially at a time when the Lincolnshire health economy is out of control with the highest ever level of weekly emergency admissions this month.”
He added that he had had allegations from staff about bullying by NHS staff from outside the trust.
HSJ understands Mr Bowles told the Appointments Commission last month that he intended to step down and that the commission made moves to suspend him last week, prompting him to leave immediately.
An interim chair is understood to have been appointed to replace him has been appointed - although no public statement had been made that Mr Bowles was leaving.
Last year the trust opened almost 100 extra beds to cope with demand and it plans to open another 80 this year; the pressure from emergency admissions has been so intense that it has converted beds from elective care to emergency care to help cope.
Current weekly emergency admissions are 13.5 per cent above the winter of 2008-9, and the trust has had record levels of emergency admissions in February, March, May and June. In the first quarter of this financial year non-elective and outpatients cases were significantly above contract.
The trust was one of 32 English trusts that missed both the 18 weeks admitted target in March and the A&E target for the January-March quarter. But in May and June it hit the targets, and it achieved all its targets for much of last year, with problems only really emerging in December.
Mr Bowles is a former chief executive of Lincolnshire County Council, where he had to call in external auditors and the police, and the leader of the council was jailed for misconduct. He has extensive management experience in both the public and private sectors, and has worked in the NHS.
The trust had a complete change of non-executives at the end of 2006, when seven resigned. Interim chair Bill Baker said at the time that he had been “discarded” while another non-executive, Mark Anderson, said they had come under pressure from the then Trent SHA. In the period 2000-06 the trust averaged more than one chief executive a year.
A Department of Health spokesperson said: “Providing patients with high quality, safe care is our top priority. Targets have played an important role in delivering real improvements in services for patients and have revolutionised a once failing system, where 12 years ago it was not uncommon for patients to have to wait over 18 months for an operation.
“The NHS recently achieved the shortest waits since NHS records began but we are clear this should not be to the detriment of safety or quality - hospitals up and down the country are meeting their waiting targets, without compromising the standards of care provided to patients.
“The NHS Constitution has set out the right for staff to have healthy and safe working conditions, one which has no place for bullying, harassment or discrimination. The NHS has taken strong steps to eliminate bullying and harassment in the workplace and all NHS employers are expected to have policies and procedures in place to tackle this.
“Funding is allocated to primary care trusts on the basis of a formula that takes into account the needs of their local populations and we expect PCTs to commission health care services to meet these needs from the funding they receive.”
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- Acute care
- Board Talk/governance/assurance
- David Nicholson
- East Midlands
- Emergency care
- Government/DH policy
- LINCOLNSHIRE TEACHING PCT
- Local government
- Mark Simmonds
- MID STAFFORDSHIRE NHS FOUNDATION TRUST
- Primary care
- UNITED LINCOLNSHIRE HOSPITALS NHS TRUST