• West Suffolk FT drops from “outstanding” to “requires improvement”
  • Trust’s “style of executive leadership did not represent or demonstrate an open culture,” says Ted Baker
  • Report follows ministers ordering NHSE/I to review allegations trust led “witch-hunt” to identify whistleblower

A trust battling allegations it led a “witch-hunt” to try and identify a whistleblower has today been stripped of its “outstanding” rating by the Care Quality Commission.

The critical assessment of West Suffolk Foundation Trust, which is now rated “requires improvement” overall, is the latest significant blow for the hospital. Once among the sector’s top performers, it is now facing fundamental questions about its leaders’ conduct and its overall performance.

It is very unusual for a provider to drop two ratings from a single inspection, and the change makes West Suffolk one of a very small number of trusts which have earned then lost an “outstanding” rating.

CQC chief inspector of hospitals Ted Baker said: “The style of executive leadership did not represent or demonstrate an open and empowering culture. There was an evident disconnect between the executive team and some consultants.”

He added: “Our inspection… found that improvement was needed, and it is disappointing that their previous rating of outstanding has gone down to requires improvement.

“We had particular concerns about the assessment of risk to mothers and babies in maternity services and have issued a warning notice meaning that improvements must be made by the end of this month.

“Safety concerns were not consistently identified or addressed quickly enough, and incidents were not always reported in a timely manner. Wider lessons were not identified or shared effectively to improve patient safety.”

The regulator also raised concerns about how not all staff felt “respected, supported or valued, or felt that they could raise concerns without fear”.

CQC inspectors visited WSFT services between September and October 2019, with a well-led inspection at provider level taking place over two days in October that year.

The trust was rated “good” in caring and effective but “requires improvement” in safe, responsive and well-led. All areas have gone down one rating except for well-led, which has gone down two.

The rating downgrade follows ministers ordering NHS England and Improvement to launch a “rapid and independent” review into WSFT following concerns over how it handled an alleged “witch-hunt” for a whistleblower.

 The CQC inspection found:

  • Inspectors were not assured the trust acted in line with its own policy or taken reasonable steps to ensure regulation 20 (duty of candour) had been appropriately applied by being fully open and transparent in relation to lost follow-up concerns.
  • There was an apparent disconnect between the executive team and several consultant specialities. Some staff felt concerns were not recognised, which was impacting on consultant involvement with the running of services.
  • Within maternity services, concerns were raised over the skills and abilities of leaders to run the service. Leaders were not effective at implementing meaningful changes that improved safety culture within the organisation.
  • With outpatient systems, there was a lack of robust systems to identify and track patients requiring a follow-up appointment, or those on surveillance pathways. Actions had not been undertaken in a responsive manner once concerns were known. This had resulted in significant patient safety risk within the vascular service, and an extended period of time where potential risk across other specialities remained unknown. 

The trust was told to make several improvements, including:

  • Definitive steps to improve the culture, openness and transparency throughout the organisation and reduce inconsistencies in culture and leadership;
  • Processes for incident reporting, investigation, actions and learning are embedded across all services, and that risks are swiftly identified and managed; and
  • Implementation of a nationally recognised monitoring vital observations tool for women attending triage on labour site and maternity day assessment, as well as the antenatal/postnatal ward.

Trust chief Stephen Dunn said the trust was “clearly disappointed” with the inspection’s findings. He added: “We must continue to quickly and effectively fix the issues raised in this report.

“We’ve addressed the immediate safety concerns and the trust has taken action, including the introduction of nationally recognised monitoring for women and their babies.

“We’ve listened to what the CQC has said and getting things right for our patients is our top priority.”

Trust chair Sheila Childerhouse said “it is clear” in some areas staff are not feeling as supported as they should be.

She added: “We appreciate and value our staff and know their knowledge and expertise will be at the heart of addressing some of the problems the CQC has identified.”

Rinesh Parmar, chair of the Doctors’ Association UK, which campaigns for better working conditions for doctors, said: “The CQC’s findings have sadly tallied with what doctors on the frontline have told us, in particular, that ongoing patient safety concerns raised by clinicians have been dealt with in such a manner that staff no longer feel able to speak up.

“Despite this, dedicated staff at West Suffolk have spoken tirelessly of their commitment to patients, and we hope now that this report, in combination with the recently commissioned rapid review, will be the start of positive change within the trust.”

Updated 10.21am: Adjustment in relation to how unusual it is for a trust to lose an outstanding and drop two ratings.