Senior managers at major trust ‘disempowered’, warns external review

The review into governance at Sheffield Teaching Hospitals Foundation Trust highlighted “consistent feedback that the directorate leadership felt disconnected from strategic decisions being taken by the trust [and that most were] either unaware or felt they were too often being excluded” from decisions.

It also calls for investigation into “potentially considerable under-reporting” of concerns by staff, warning that an “unusual” freedom to speak up model that sees guardians drawn from staff governors could lead to a “potential conflict between the two roles”.

The external review, which was carried out by the Good Governance Institute and reported in June, was released to HSJ following a freedom of information request.

The trust commissioned the review following the Care Quality Commission’s decision to take the highly unusual step of downgrading the trust’s maternity unit from “outstanding” to “inadequate” after a damning review by its inspectors reported concerns about staff numbers, training and transparency.

The review was not entirely negative about the trust’s executive leadership. It praised what it described as “an overall and positive sense of shared purpose in the leadership of the organisation” and said the organisation had “broadly the right governance structures and processes” in place to make improvements.

In a statement issued to HSJ about the review, trust chief executive Kirsten Major said the provider had already made “good progress” addressing these concerns. She also argued the sense of disempowerment “was not a surprise” because the report had been carried out when many pre-covid meetings and visits could not take place.

She added that the trust had strengthened opportunities for discussion and decision making across the senior leadership team.

The review follows a challenging period for the trust. A CQC inspection of the entire organisation published in April saw the trust moved from “good” to “requires improvement”, prompting mandated support from NHS England’s regional team.

Sheffield operates a devolved leadership structure of 11 clinical care groups overseen by a central team.

However, the review said the executive team is “relatively small” for such a large organisation and said resourcing of healthcare governance in directorates was “surprisingly variable”.

It said: “Overall we gained a strong sense that directorates felt a higher level than they wished of disempowerment preventing them from delivering on their devolved role requirements. This was in part related to the risk-averse culture of the trust where it was felt that decisions that could be made quickly by the directorates were instead required to go through an overly bureaucratic approval process through the trust executive group.”

The Good Governance Institute, which declined to comment, said in its report: “…We noted an overall and positive sense of shared purpose in the leadership of the organisation, evidenced in examples of good team working and shared problem solving. However, we believe more work is needed to increase the connectivity of directorate leaders to strategic decision-taking.

“We also feel the trust would gain from enhancing the levels of active support to directorate leaders to enable them to act more effectively at the level of accountability built into the trust’s devolved governance structure.”

Ms Major said in a statement that the trust scored well on safety reporting metrics, but she added: “We are never complacent and are reviewing the FTSU process, investing in additional resource to support the FTSU team and are speaking to other trusts to gain any learning that might be appropriate.

“The review suggests the trust might be ‘risk averse’ on occasions but we believe that there is a balance to strike between taking risks and ensuring safe, quality care, good governance and financial probity.

“It is right that these considerations will impact on our risk appetite on occasion, but we are looking at our processes to see if we can simplify and speed up decision making where appropriate and we continue to encourage all levels of staff to continuously innovate, challenge how we do things and make change where it has benefits for our patients.”