Exclusive: Director resigns over 'complete governance breakdown'

HSJ has learned that John Coakley, a former medical director at Homerton University Hospital FT, resigned as a non-executive director at Wirral on Monday. He took up the role last July.

He told HSJ his resignation was prompted by his perception that the executive team was not being properly supported by the rest of the board.

Dr Coakley’s departure followed a private board meeting last week, which sources at the trust said descended into acrimony with the entire executive team at odds with other non-executive directors over the continued tenure of trust chair Michael Carr.

Mr Carr was the subject of serious allegations by trust executives alongside former chief executive David Allison. HSJ revealed the details of the allegations late last year after the executive directors felt forced to take their concerns to NHS Improvement.

HSJ has also learned that the trust’s consultants have carried out an online survey of senior doctors asking whether they have confidence in Mr Carr, the board and the executives. The medical consultant body has previously demanded Mr Carr attend a meeting to “give account of himself” but he refused.

Separately, a letter sent to members of the board following last week’s meeting, signed by lead governor Angela Tindall, referred to the “apparent instability of the board”. The letter revealed Mr Carr would remain as trust chair, despite the breakdown of relationships, until the review of his term in June.

Dr Coakley said: “I think the current executive team are doing a sterling job and really working hard to improve quality and keeping patients safe as well as trying to turn around the medical culture at the trust.”

Asked about his reasons for resigning, Dr Coakley said: “The executive team need the wholehearted support of the board and my perception was that that was not forthcoming.”

Another source at the trust said: “There has been a total and complete breakdown of relationships and governance. At the board meeting the executives were all clear that they felt the chair needed to go and go now so a new chair and chief executive could be appointed but the NEDs did not support them.”

At least one executive director is believed to have become tearful during a “frank exchange of views”.

In the letter to trust directors, Ms Tindall revealed the poor communication and governance difficulties. She wrote: “One of the concerns of governors is the level of communication and the effect that recent developments have had on the standing of the trust and its day to day working.

“Employee governors in particular relate the concerns caused by the apparent instability of the board, the need for NHS Improvement to investigate this trust and press articles more generally.

“The trust is in an obviously pressured environment and the main comment of the governors at this stage is that everyone has an obligation to act jointly in the trust’s best interests.”

On the position of Mr Carr, she said: “I was also informed yesterday that executive and directors present at the private board meeting suggest that Mr Carr should resign earlier and disquiet is expressed about his remaining and as to relationships and the ability of those directors to fulfil their duties properly.

“I am informed that the chairman has indicated that he will step down when required, if that is in the trust’s overall best interests… he will not seek to remain beyond the annual review of his current extended term which arises at the end of June.”

She said the appointment of a new chief executive would not happen until a new chair was in place. 

Referring to executive directors, Ms Tindall wrote: “On behalf of the governors I ask all directors to fulfil their individual and collective responsibilities diligently and properly even if the circumstances are not what they would wish. In periods of instability and change the trust needs good and effective leadership more than ever.

“I understand that it has been suggested that current circumstances might affect or have affected patient care; this is suggested because of the effect that this situation is having on senior employees and/or because it prevents matters being raised or addressed properly.”

NHS Improvement and Wirral University Teaching Hospital Trust were approached for comment.