Essential insight into England’s biggest health economy, by Ben Clover

A hospital cannot run without its consultants – but it’s fair to say the relationship between senior medics and management can sometimes be difficult.

Two stories from London over the past fortnight illustrate this quite starkly. London Eye wrote about some of these issues as they surfaced last year.

Senior management at St George’s University Hospitals Foundation Trust has reached a settlement with – and issued an apology to – a surgeon it wrongly suspended last year.

There have been reviews into the culture of the cardiac unit at the south London hospital going back at least nine years; it’s an issue that has survived multiple changes of leadership, financial crises and governance foul-ups.

Management deserve credit for trying to tackle the “dark force” hanging over the unit. Sadly, whatever the rights and wrongs in the disputes within the unit, Marjan Jahangiri’s case does not seem to have been handled well.

Professor Jahangiri’s initial witness statement said she had been subject to a campaign of harassment (involving menacing packages being sent to her home) after raising concerns about other members of the team.

Quite a battery of reviews and investigations were commissioned.

One, the Hollywood review, the trust has since admitted “did not enable it to resolve its concerns about working relationships within the cardiac surgery unit”. It is not clear why not.

An oversight panel led by Sir Andrew Cash will carry on monitoring the unit, and a review into mortality at the unit between 2013 and 2018 will also continue.

Whether the unit will still be overseen by Guy’s and St Thomas’ FT is not known as this piece went to press.

The settlement has not been disclosed but is likely to be expensive.

Professor Jahangiri’s first witness statement to the High Court said the trust’s chief executive told the surgeon she “had contributed to the ‘special measures’” designation and, as such, he could not support her application for a gold level clinical excellence award.

Her statement said: “The defendant’s actions will have a financial and reputational impact on me if I am unsuccessful with my application.” The status of the application now is not known.

Professor Jahangiri’s witness statement also said she was responsible for training roughly one-third of the country’s trainees in her specialty. These trainees were withdrawn by Health Education England and St George’s said in a statement this had happened “after we raised concerns with them about the impact on trainees and challenges within the service”.

This decision stands as of a trust statement last week; how tenable this position is now is unclear.

The trust said earlier this year that the decision to suspend some of the unit’s work had cost it £11m in lost income.

It is yet to be seen whether the amount of work and complexity of surgery being referred to the unit will recover.

The effect

On the morning of her suspension, Professor Jahangiri was due to operate on a patient. This patient’s procedure was cancelled at next-to-no notice.

Add this very tangible example to the jumble of upsetting personal correspondence, legal processes, disciplinary procedures, impact on training and trainees and financial knock-on effects and you can see why trusts can be loath to tackle problems in units – however “dark” the forces operating within them.

So it is concerning that the General Medical Council has put another London trust in “enhanced monitoring” after complaints from registrars about their treatment by more senior colleagues.

Barking, Havering and Redbridge University Hospitals Trust saw its medical director leave on secondment last year. A report from a consultancy found his position had been made untenable while trying to deal with “inappropriate behaviours” among consultants at the trust.

GMC cited leadership from consultants as one of the factors behind its decision

The medical director on board has a crucial role around culture among the most senior employees of the trust. There is an argument to be made that trusts with long-standing problems in this area should have to appoint externally. This could head off any ideas along the lines of “that’s how things are run here”.