• Independent report exposes widespread culture of bullying in Wirral A&E
  • Report reveals persistent culture that has developed over many years
  • Says problems “products of an environment in which such behaviours have been unchallenged”
  • Report is the latest concern to emerge about the management and culture at the trust

A bullying culture at Wirral University Hospital’s emergency department has been allowed to persist for years with a lack of action by senior managers, according to an internal report.

The document, released to HSJ by the trust, described how “the focus on moving patients had superseded that of giving good care and some of the anecdotes we heard shocked us”.

It said the approach to the practice of “boarding” patients, where they are placed in a bed away from the speciality they need, was leaving staff “distressed” and that they were not being listened to. This was now “commonplace, happening on a very regular basis” with staff feeling unable to challenge it.

The report said one staff member said they had challenged similar things in the past and suffered consequences, adding: “They are not willing to make further challenges.”

The report, produced by consultancy Thinknow Ltd, described how ward beds were “hidden” from emergency department staff, leaving the accident and emergency matron to “literally walk the wards in the evenings to find these beds. We also heard some specific examples of how this was failing patients”.

The report was commissioned by the trust after chief operating officer Janelle Holmes received an anonymous letter from nurses in November alleging a bullying culture in the A&E.

Ms Holmes was one of the executive directors who blew the whistle to NHS Improvement about their concerns over the management of the trust under former chief executive David Allison and trust chairman Michael Carr. It comes after the resignation of a non-executive director earlier this month and reports of serious culture bullying issues among medical staff.

The report said a small number of staff exhibited bullying behaviour and these staff had failed to demonstrate any insight into the effect of their behaviour. It described “tribal divisions” characterised by staff being referred to by their pay band with newly promoted nurses targeted.

The authors, who interviewed more than 40 staff, said the situation was not simply down to poor behaviour of some staff. It said: “An absence of strong leadership, management and support in a very challenged clinical and performance environment has created a vacuum that has been inappropriately filled.

“From the stories that we heard, we believe that these circumstances have developed over a period of many years and that many staff have grown tired of challenging what they now see as accepted, although undesirable, norms.”

In conclusion the report said: “Whilst we heard about many examples of totally unacceptable behaviour, we acknowledge that the individuals concerned are all products of an environment in which such behaviours have been unchallenged and thereby have not been rectified.”

It recommended “a moratorium” on past behaviour followed by a clear message that such actions would no longer be tolerated.

In a statement to HSJ, trust acting chief executive David Jago said the trust acted as soon as concerns were raised. He added: “We are now working with colleagues in our emergency department to address the issues raised and to move forward in a positive way.

“Our senior team are fully supporting colleagues throughout this entire process. We thank staff for their participation in this review as this will help us to identify areas where we need to improve.”

Key findings of the report also include:

  • The ED was described as “operating as an island” with A&E blamed for four hour target failures
  • The authors said: “Staff feel under huge pressure to compromise clinical and care standards in order to meet the target and are blamed by other departments for these compromises.
  • High numbers of breaches of the four hour standard occur daily and this is also perceived to be an acceptable norm.
  • The style of management and leadership across the trust seems to have created priorities and systems that whilst stated to be for the purpose of improving flow, actually only create vortex within the trust.
  • Many staff were unaware, even when prompted, of the Freedom to Speak Out Guardians.
  • Some people said that there are cliques of staff who get to work whatever they want and get first chance at the overtime
  • A frequent complaint was about the configuration of a period of nights to days and lots of people commented that this was unsafe. A similar concern was expressed regarding shift patterns on Paediatrics.
  • Staff became emotional when sharing details of incidents they had witnessed.
  • The vast majority of staff “could not remember the last time they were thanked for their efforts or were told they had done something really well.”