The Ward Round: Is the shine coming off Sheffield?

The health and care system in Sheffield usually attracts attention for the right reasons. Two of the three main trusts are rated “good” by the Care Quality Commission, while Sheffield Clinical Commissioning Group has garnered the same rating from NHS England. South Yorkshire and Bassetlaw, in which Sheffield lies, is one of the first-wave integrated care systems and there is a history of collaboration in the region.

On the surface, there is a lot of positive work going on in Sheffield. You could argue it is a forward-thinking health economy. But recent revelations may suggest something is going very wrong for parts of the health economy.

A little over a month ago, HSJ revealed Sheffield CCG was facing serious questions over its leadership and culture, following a critical NHS England investigation and whistleblowing complaints that came out into the open.

Then, last week, we reported mental health trust Sheffield Health and Social Care FT is also facing accusations of bullying and poor culture in one of its directorates, which the chief executive confirmed it is looking into.

The NHS England investigation into the CCG found there were widespread issues, from dissatisfaction to how bullying and harassment cases were handled and poor relationships between members of the governing body to a lack of a clear strategy.

It then emerged that NHS England had known about accusations of bullying levied at the CCG and senior directors within it for over a year, and yet nothing – it seems – had been done. In response to our story, the CCG said these accusations, put to chief nurse Jane Cummings in an anonymous letter, had been thoroughly investigated.

However, after the story was published, I received calls from CCG employees – at all levels of seniority – who claimed they were not aware of the accusations in the letter and questioned, how it could have been transparently investigated. If it was, surely they would have heard about it or been consulted?

The conversations with former and current staff haven’t just been about the anonymous letter. One anonymous employee told me they felt “belittled and insulted” by a member of the senior team. Another was close to tears describing the lack of support they received from their managers and work stress resulted in them leaving the organisation for good.

The CCG has confirmed it has started work on an improvement programme, which will be led by senior director Nicki Doherty. In response to comments made by former MP for Sheffield Brightside and Hillsborough David Blunkett this week, the CCG has since told HSJ an external director is being recruited collaboratively with NHS England to provide “oversight” on the improvement plans.

Whoever is appointed as the external director will fulfil a crucial role in ensuring the improvement plan properly tackles the crisis of leadership, governance problems and future direction of the CCG, without being too close to the organisation itself.

Something else to keep an eye on are “longstanding issues within the nursing directorate”, which were mentioned in the independent review. They were not investigated in the review and have instead been reported to the director of nursing in NHS England for Yorkshire and the Humber. It is as of yet unclear what will come of this.

There are serious questions remaining as to what impact the cultural and leadership problems has had on commissioning and on patients in Sheffield. If the CCG is not working well for its staff, can the same be said for its public?

The issues that have emerged don’t just need to be addressed locally but also nationally. Considering the ongoing special leave of the CCG’s medical director, what does this say about how whistleblowers are treated in the health service?

According to the letter sent to trust and CCG leaders from Dido Harding and Julian Hartley setting out workforce actions, “positive leadership” in the NHS has not been consistently demonstrated and they want to address it. What will this mean in the future when anonymous concerns are raised? And what will it mean for the leadership teams?

Culture and leadership will be a focus of the workforce plan, and it is arguably essential for systems such as Sheffield that this national focus comes to fruition sooner rather than later.