NHS Improvement investigation exposes 'deep cultural issues' at trust

The report, published this afternoon, was commissioned by NHS Improvement after multiple revelations about the trust’s governance by HSJ, following the resignation of the former chief executive David Allison in December.

It also revealed the investigation tried to find the source of leaks to HSJ by examining email accounts at NHSI and the trust.

The report, by former primary care trust chief Carole Taylor-Brown, set out how relationships at the trust between Mr Allison, former chair Michael Carr and executive directors and non-executive directors deteriorated during 2017 – culminating in four executive directors blowing the whistle to NHSI in November.

It said: “It can only be concluded that there appear to be some deep systemic cultural issues within [the trust], on which the trust is in need of external assistance and advice to enable matters to be appropriately surfaced.

“Staff also need further external support in regard to freedom to speak up, so that they can have confidence that such issues will be properly considered and dealt with, without the concern that speaking up will have adverse consequences for them personally.”

The report said the behaviour of Mr Allison was “intimidating” and examples of his behaviour “were substantiated by other witnesses”.

It added: “Some of these suggested that executives had on occasions been under unreasonable pressure to resolve issues without these issues emerging as problems.”

Mr Allison denied any suggestion that his behaviour was inappropriate.

The report highlighted that the turnover in board and sub-board positions was high. Twenty-four senior managers resigned between April 2012 and December 2016 including two refreshes of the executive team.

As relationships deteriorated last year, four executive directors raised their concerns about Mr Allison’s behaviour with Mr Carr, who resigned last week.

The report confirmed he did not take action. It said: “The failure to do so left all parties concerned in an invidious position, and in the absence of any substantive feedback or apparent actions, further undermined the trust and confidence between the executive directors and the former chair in particular, and possibly the wider NEDs.

“Ultimately, trust and confidence in the handling of these matters became so eroded that it compromised the effective leadership of WUTH, and when the former chair breached individuals’ confidentiality without consent, the relationship between him and the executive directors was irretrievably broken.

“The failure to act and deal with these issues appropriately exposed WUTH to a period of unstable leadership, which fell short of the principles enshrined in the NHS constitution and responsibilities of the board as a whole.”

The report also said Mr Carr revealed the identities of three of the directors who blew the whistle to NHSI at a meeting in December.

It concluded: “As the year progressed, all executive directors became increasingly disaffected by the former chair’s leadership of the board, which they felt was inhibiting open discussion of some issues (the former chair with some support from NEDs denies the latter).”

NHSI chief executive Ian Dalton said: “It is clear from this report that poor governance and culture at the trust contributed to a breakdown of relations between senior leaders and non-executive board members. This prevented them from working together to provide their patients with the safe, high quality care that they rightly expect.

“We have appointed Sir David Henshaw, who has a proven track record of providing good leadership to hospitals facing difficulties, as the interim chair. He will work with us, alongside the interim chief executive, to support the trust to make much needed improvements to their culture, allowing the trust to move forward and address the concerns raised in this report.”