• Review commissioned by new AO also found culture of turning a blind eye
  • Current and former leadership apologise and say report makes for “difficult” reading
  • However, review finds no widespread “discriminatory practices”, bullying or ill-treatment
  • Article contains language readers may find distressing

A review of a clinical commissioning group has discovered “microaggressions and insensitivities” towards Black, Asian and minority ethnic staff, and the use of derogatory slurs about other groups.

The report into Surrey Heartlands CCG also uncovered incidents of shouting, screaming and bullying among other inappropriate behaviour. And it was reported some staff were unwilling to accept Black Lives Matter events as important, stating “all lives matter”.

The review also discovered a culture of denial and turning a blind eye to consistent concerns, with staff fearful of speaking up. In particular, the HR department was said to have been repeatedly told about the behaviour of one staff member but had chosen to ignore or delay dealing with the issues. 

It added the CCG — which was formed by a four-way merger in April — had an “excessively large executive team”, which some staff regarded as “detached and invisible”. There were also claims some managers had created unadvertised job opportunities, which could be seen as indirectly discriminatory.

However, the review found “no evidence for widespread discriminatory practices” and “no clear evidence for a widespread culture of bullying and ill-treatment” — but it added the systems to deal with concerns had failed and there was a sense of “organisational inaction”. 

’Difficult reading’

Claire Fuller, the CCG’s interim accountable officer, ordered Plymouth University emeritus professor of management Duncan Lewis to carry out the review after she took over in July. The report said her leadership style was “broadly welcomed, if challenging” with some staff feeling visibility of the executive had improved since she took over.

In a letter to all staff, Dr Fuller and chair of the governing body Charlotte Canniff said, “The report makes difficult reading, but it is important that we both recognise and acknowledge the content and the distress that has been experienced by many of you, for which we unreservedly apologise.

“On behalf of the whole senior leadership team we would like to make it clear that this behaviour will no longer be tolerated, and we will work with you to develop a more inclusive, less hierarchical and positive culture of transparency that will move our organisation forward and make it an enjoyable place to work.”

Matthew Tait, who was chief officer of the merged CCG and its predecessors — Guildford and Waverley, North West Surrey, Surrey Downs, and East Surrey CCGs — until July, said: “I found this report difficult to read and I personally apologise for any distress caused to staff by the issues identified.”

Mr Tait is now interim deputy integrated care system lead in the Buckinghamshire, Oxfordshire and West Berkshire system.

The review was commissioned three months after the CCG was formed and includes references to the previous CCGs and the cultures in them.

Recommendations

The report makes 21 recommendations, all of which the CCG has said it will implement. These include:

  • The CCG should formally acknowledge concerns raised by staff over microaggressions towards colleagues from BAME backgrounds;
  • The CCG should formally acknowledge that staff have experienced and raised significant concerns about behaviours and apologise for not having acted to address these concerns;
  • An experienced executive member should be appointed with responsibility for workforce matters, as well as strengthening other HR functions and appointing an equality, diversity and inclusion specialist. The report notes the CCG did not submit a Workforce Race Equality Standard return this year; and
  • Job evaluations should be carried out to make sure pay banding is equitable, fair and comparable. A talent management strategy should be established and recruitment process reviewed to ensure transparency of opportunity.

What the review found

  • Language such as “pikies”, “chavs” and “retards” was used in some of the CCG’s offices, and some comments about people’s sexual orientation could be “clearly interpreted as homophobic”. Staff with disabilities and long-term conditions also talked about discriminatory behaviours.
  • BAME staff felt they did not have the same chance to advance as other staff and that it was career limiting to speak up about their experiences. They felt white colleagues did not understand or try to understand the prejudices and biases they encountered, while some blatantly rejected the idea of them.
  • There was an “unhealthy fascination with pay bands”, possibly due to a top-heavy expensive executive and senior management structure, allowed through poor HR processes as the legacy CCGs merged. This had led to “unrealistic and, in some cases, unjustified” beliefs about what pay band people were entitled to and people being characterised by their pay band. There was a widely-held perception that banding was “indiscriminate and tied to favouritism”. A small number of staff were concerned about family members of managers being appointed, along with staff being favoured because they had worked with a manager before.
  • The CCG was seen as very hierarchical with staff reprimanded for speaking to the executive directly rather than going through their manager. In some cases, staff felt they were micromanaged with managers standing over them as they wrote emails or telling them to make up their hours if they were seen chatting. There was, however, praise for some managers.
  • Staff reported bullying and humiliating behaviour from a small number of alleged perpetrators. Many staff reported being shouted at, and some had been screamed at aggressively in front of others. GPs were often mentioned for perceived bad behaviours — including shouting at staff — but there was a sense they had to be pleased at all costs.
  • Widespread concern about changes to the shape and structure of the executive and the impact on lower levels of this, and a sense that people were positioning themselves for the aftermath of this process. Staff felt engagement and consultation was “piecemeal or haphazard” and were concerned about job security.
  • An HR function which lacked expertise and was underresourced, with staff feeling the HR department ignored concerns about behaviours and a perception that equality, diversity and inclusion concerns, bullying and ill-treatment were not taken seriously by HR colleagues.
  • The majority of staff felt it was a stressful work environment with “tempers often flaring, short fuses and angry interchanges. Email exchanges were sometimes felt to be “bad tempered and irritable” with emails sent at 2am or 3am. There was a failure to grasp the seriousness of stress at work. Working from home during covid had added to stress for some staff, with back-to-back meetings and extended working days.
 

Source

Review presented to CCG board

Source Date

November 2020

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