Leading ‘trust in distress’ can be like playing ‘whack-a-mole’, says CEO

Leadership at York and Scarborough Foundation Trust was rated “inadequate” last month, as inspectors said they had been ignored when they tried to raise concerns about patient care with some staff.

The trust’s chief executive Simon Morritt told HSJ he accepted all the Care Quality Commission’s findings and stressed the trust had worked hard to build a “positive and constructive” relationship with the regulator.

But he said: “We have to remember the bulk of the inspection activity was last year, in 2022… we’ve done an awful lot since that time in terms of addressing some of the immediate and urgent concerns.

“[The inspection] is a point in time, and it was an elongated process. So, the last visit started November 2022, we’re now in the summer of 2023.

“Staff have had that interaction with the CQC, they’ve seen the initial findings from the CQC, they’d been acting on the issues that have been identified and delivering those – and yet a report comes out in the summer of 2023, so that is a challenge for staff to deal with.”

He added: “I think the most important thing with the CQC, and I don’t really want to comment on their processes, is to build a positive and a constructive relationship…

“We’ve worked hard in the last 12, 18 months to do that. And I think if you’ve got that in place, then you’re better able to manage the consequences of the process, shall we say.

“That’s where I and others within the senior team have been investing quite a bit of their energy, making sure we get those relationships right.”

The trust has seen major changes in its senior team in recent months, including a new chief operating officer, chief nurse and medical director. The organisation is also recruiting a new chair, after the previous chair stood down earlier this year.

The trust has this week opened a new £18m emergency department at York hospital, which it is hoped will improve the flow of patients through accident and emergency and into the rest of the hospital.

Speaking to HSJ at its opening, Mr Morritt said the trust was committed to addressing cultural problems that had been laid bare in the report, although he admitted this would be a long-term project.

Inspectors found evidence that harassment, bullying and abuse were “prevalent”, citing examples of staff referring to a “bullying culture” and using terms like “rife” and “commonplace”.

“What’s important as well is that we’re not blown off course. So, the direction that we set, we stick to that, and we stay on that course,” Mr Morritt said.

“One of the challenges with organisations that are under distress is that you tend to become quite reactive. It’s a bit like whack-a-mole, the next one [issue] that pops up you think we need to focus all our energy over there.

“I think in terms of cultural leadership in values and behaviours, we’ve set a course and we need to stick to that now.”

Asked what was behind the trust’s difficulties, Mr Morritt said the organisation was not in the “best shape” going into the pandemic, with longstanding workforce and finance challenges, and then had been hit hard during covid.

He declined to put a timeline on improvements: “These are difficult times for the NHS. I think if we were to say within 12 months we want to be outstanding, I’d be laughed at.

“I think we need to be realistic, but being realistic doesn’t mean to say that we can’t be ambitious… and we are ambitious, and we want what’s best for our staff and what’s best for our patients. But there’s work to do to get there.”