Exclusive: Review uncovers misogyny and paternalistic culture at major trust

The damning report into University Hospitals Sussex Foundation Trust found that multiple women reported eye-rolling and dismissiveness in meetings. Female surgeons in particular felt “constantly excluded” by their male colleagues.

The review team also learnt that no action was taken after a female staff member reported unwanted romantic advances and inappropriate comments from senior male colleagues.

The report was written by Niche Health and Social Care Consulting, which specialises in independent investigations. It was commissioned after a poor Care Quality Commission report and “undertakings” from NHS England. It was based around interviews and focus groups with staff, governors and leaders, a survey of board members and a wider survey of more than 1,000 staff members.

The review team found senior leaders said there was a “paternalistic culture” in the organisation, with all decisions passed through the executive.

It called on the trust to build “psychological safety” in the organisation, which was also described as having a “medically dominated culture”, where doctors were “pandered” to.

Several times the report references staff feeling that if they acted against bad behaviour, they would not necessarily be supported by senior leaders.

The trust’s chief executive, George Findlay, announced his resignation earlier this month, and HSJ understands he has already left the trust.

The trust was formed by a merger between Western Sussex Hospitals FT and Brighton and Sussex University Hospitals Trust, which was known to have longstanding cultural issues, in 2021. The report said: “The organisation currently feels like a collection of hospitals, each with distinct legacy identities, rather than a single trust.”

Other concerns raised in the report included:

• Medics and other professional groups were found to be oppositional in some areas. One senior manager said: “If the doctors don’t want to do something, they just don’t do it… we pander to them because we are scared of them leaving.”
• Direct and authoritative leadership styles were felt to be dominant, with those who did not fit this mould feeling less valued. The tone in emails could be inappropriate, which some felt bordered on bullying.
• The trust had very low levels of signed-off consultant job plans (34 per cent against a target of 95 per cent) and some clinical leaders spoke of non-compliance with job plans, overbooking of annual leave, and failure to engage with basic processes such as appraisals.
• Clinical lead posts being seen as “undoable” leading to a high level of vacancies, clinical leaders feeling exposed and a lack of clarity from the organisation about what was expected from them.
• Many staff did not know what the trust values were.
• Some non-executive directors were found to “bring limited contributions” to meetings.

However, around half the senior leaders interviewed said the trust was “a nice place to work” and that executive directors were highly supportive, despite criticism.

The report also pointed to some successes, such as improved performance against access targets and added that there is “cautious optimism among some internal and external stakeholders”.

The team made 22 recommendations in total, all of which have been accepted by the trust, which now plans to appoint an independent partner to help it address the cultural and behavioural issues.

Andy Heeps, acting CEO, said: “We have accepted all the recommendations, and we are already working to respond to them. But we will go further. Our new strategy will set out how we will develop better leadership and culture across our hospitals. This trust has massive potential, and we want to work with our colleagues to realise that potential.”