'Breakdown in relations' between A&E consultants and board

In an independent review, the Royal College of Physicians has told Dudley Group Foundation Trust that it will not achieve improvements needed to its accident and emergency department until relationships are repaired, HSJ understands.

The royal college review is the latest in a series of probes into the trust’s emergency department and wider culture (see timeline below), including a separate review which has found bullying allegations against some of its executives to be unsubstantiated.

According to several sources, the unpublished royal college review highlighted concerns that acute medical wards were being used as a “dumping ground” by the emergency department and report that A&E nursing staff felt “vulnerable” and unsupported by consultants.

The trust received a final version of the report in January.

The provider has declined to share a copy, but multiple sources said it also found;

• that A&E and acute medicine consultants were not working together effectively;
• some changes had been introduced by the trust board without engagement with the consultant body; and
• there was no culture of learning or strong governance within the department.

The review was commissioned in May last year in response to several concerns raised by the Care Quality Commission about the safety of the trust’s emergency department.

Diane Wake, the trust’s chief executive, said: “Our medical director Julian Hobbs commissioned the Royal College of Physicians to undertake an independent service review of our adult emergency medicine service and this was undertaken between 17 and 18 May 2018.

“We accept the report and its findings. Our senior consultants in our emergency department and urgent care have the report to form an action plan to address the issues raised.

“However, the report represents a point in time. The clinical leadership of the department has changed, and many of the recommendations have already been put in place. In the past year, we have seen patient outcomes improve, including sepsis mortality, falls, pressure ulcers, hospital acquired infections and never events.”