• Doctors strongly disengaged with management at St George’s University Hospitals Foundation Trust
  • Perceived management backing of government in junior doctors contract dispute cited as a factor
  • Cost cutting, poor communication and car parking also aggravating factors for medics

Medical staff at a scandal hit teaching hospital where the chief executive has recently stood down are strongly disengaged with management, a leaked report reveals.

Researchers spoke to 353 medical staff including 220 consultants at St George’s University Hospitals Foundation Trust. They gave it the lowest grade on a five point scale in seven out of 10 categories. The three other aspects of medical engagement were given the second lowest score.

St George’s Hospital

St George’s Hospital

Doctors said ‘medical engagement has worsened since the trust achieved foundation trust status’

Some doctors said “senior management support for the junior doctors contract has damaged the credibility of management valuing medical opinion and has alienated medical staff at all levels”.

The report, by firm Engage to Perform, also polled managers at the south London trust and found they “strongly overestimate” how engaged they were with staff.

The company’s report, seen by HSJ, said it had carried out medical engagement surveys at more than 100 hospital trusts and compared to the average doctors at St George’s were “strongly disengaged”.

Doctors at the £665m turnover trust agreed with the statement “medical engagement has worsened since the trust achieved foundation trust status in February 2015”, while managers disagreed.

The trust was investigated by Monitor after it was granted foundation trust status shortly before declaring a large and apparently unforeseen deficit.

The trust’s finance director and chief executive have both left the trust for jobs with NHS Improvement.

The 19 managers surveyed agreed with the medics that “the financial position of the trust is having a detrimental impact on the quality of patient care”.

Both groups also strongly agreed with the statement “the current condition of the trust estate (both buildings and equipment) is having a negative impact on patient care”.

The report said: “Many of the issues driving low medical engagement in the trust are considered to be essentially rooted in a perceived conflict between management and medical values” – with managers focused on cost cutting, which can lower the quality of patient care.

It said medics had reported: “Working relationships between medical staff and managers are compromised by remote and sometimes unfriendly management styles coupled with poor communication structures (particularly too much dependence on email).”

Researchers also heard complaints that “consultant pension and contract discussions have adversely affected medical motivation to become more actively engaged with the management agenda” and this had been “aggravated by car parking, and the dearth of administrative and secretarial support”.

Managers responding to the researchers said some medics “failed to fully involve themselves in the financial issues of the trust and preferred the easy option of blaming management rather than confronting the necessary hard decisions that lie at the core of real decision making”.

Consultants and foundation year doctors were found to be the most strongly disengaged and the most disengaged divisions of the trust were surgery, neuroscience and pathology. The neonatal unit and haematology were most engaged.

A spokeswoman for the trust said: “Simon Mackenzie, the medical director who commissioned the survey, is working with the new chair of the medical staff committee to rebuild engagement with clinicians. The trust board recognises the importance of this issue and is fully committed to working with all medical staff of the trust.”

The report was commissioned in February and the survey was carried out in March.