Exclusive: Leaked report cites concerns over 'arrogant' consultants

The review at Barking, Havering and Redbridge University Hospitals Trust, was conducted after anonymous letters were sent to NHS Improvement in January, which alleged “widespread bullying and intimidation of medical consultants” by executive directors.

But Deloitte, which conducted the review, said many of the nurses and managers interviewed as part of the investigation were “bewildered” by this line of inquiry – as they had assumed the review would examine the treatment of staff by the consultants.

The review, which was published on the trust’s internal intranet and then leaked to HSJ, said: “Specifically, our focus groups highlighted a range of material issues at the trust in relation to the culture amongst a pocket of medical consultants.

“This included allegations of: intimidating and disrespectful treatment of colleagues (including nurses, receptionists and fellow medics); an arrogant approach and a sense of entitlement relative to other professional groups; examples of groups of consultants covering-up poor clinical practices; and low levels of transparency in relation to job planning.

“The culture of the consultant body is a significant outlier relative to other trusts with which we have worked and is in urgent need of modernisation.”

The report said Dr Nadeem Moghal, the trust’s medical director, had unsuccessfully tried to challenge these behaviours. It recommended he be removed, following a breakdown in relations. As previously reported, Dr Moghal has recently gone on secondment.

It said the anonymous allegations against executives had been “exaggerated” and “ill-informed”.

However, Deloitte also examined the trust’s handling of concerns raised by the senior medical staff committee in November last year - in which dozens of consultants said they had lost confidence in the executive board.

The review made criticisms of both sides, including the following findings;

• Medical director (Dr Nadeem Moghal) was described as a “man of integrity with good intent”, but his execution of intentions did not build trust and confidence across the consultant body;

• There were fundamental issues regarding the “competency and maturity” of the senior medical staff committee, largely based on “naivety”. This included an “inflammatory” question in a survey about the level of confidence in Dr Moghal, and the “inappropriate” circulation of draft terms of reference for the committee.

• A “formal investigatory response” from the trust, into the actions of the committee chair and vice chair, was “not proportionate….and significantly fuelled an already volatile situation”;

• Although the trust was correct not to treat the letter as a “whistleblowing incident”, it did not meaningfully investigate general allegations about consultants feeling intimidated and fearful to discuss concerns;

• Few consultants took up offers to meet with the chair and chief executive to discuss concerns, suggesting that the heightened level of discontent expressed in the letter was accentuated by concerns around car parking arrangements and the trust’s financial situation;

• Although concerns were clearly centred around the medical director, the letter from the committee expressed a loss of confidence in all executives. However, a request from the trust for the letter to be withdrawn had an adverse impact as it was perceived as “undermining the gravity of the concerns”;

• The medical engagement improvement plan was “widely viewed as an ineffective mechanism for addressing the fundamental challenges facing the trust”.

The trust is currently in financial special measures, after a large cash shortfall emerged in October 2017 and subsequent investigations revealed multiple governance failings. It has requested more than £100m of bailout cash to maintain its payments in 2018-19.

Chris Bown, the trust’s interim chief executive, said: “We’re pleased this report shows there is no evidence to support the allegations that medical consultants were being bullied or intimidated at our trust. We have also made good progress against the key recommendations. However, there are further lessons. The reports about the behaviours and culture of a pocket of medical consultants are particularly concerning and we will be dealing with this.

“I have reiterated to all colleagues that my door is open, and I am encouraging anyone who has witnessed occasions of bullying, intimidation or poor clinical practice to come to me in absolute confidence.”