Trust leadership rated ‘inadequate’ as CQC accuses staff of ‘ignoring’ problems

The Care Quality Commission found multiple reports of staff raising concerns at York and Scarborough Foundation Trust, but that staff felt they were “ignored”, dismissed or “swept under the carpet”.

The trust’s leadership has been rated as “inadequate”, down from “requires improvement”, although its overall rating remains “requires improvement”.

At a hospital level, maternity services on the Scarborough site dropped two ratings, from “good” to “inadequate”, matching the rating for maternity at York. Urgent and emergency services at York also remained “inadequate”, although those at Scarborough improved.

The inspection started in October 2022, but the assessment of leadership was extended to March after the watchdog received further concerns.

The CQC said “poor leadership was having an impact across all of the services” and there were occasions “where leaders displayed defensiveness or appeared to tolerate poor behaviours from staff.”

The trust said it had been under “sustained pressure” but had already begun to make improvements, including a new information system in maternity services and a review of nursing establishment numbers.

When inspecting emergency services at York, the CQC said its officers “repeatedly” had to escalate concerns about the management of patients, including to the chief executive, to ensure action was taken. The report said staff could be “very challenging” when their inspectors raised concerns directly, and some “ignored requests for patients to be reviewed”.

Inspectors said the emergency waiting room had become a “ward with no oversight”, overseen by a single healthcare assistant. Pressures on the emergency department, which is set to move to a new facility imminently, meant staff had to provide care and treatment to patients in public areas.

Echoing the findings of an external review previously reported by HSJ, staff said they wanted more support from managers before the department hit crisis point.

A survey of more than 1,000 staff carried out by the CQC found more than half of those reporting harassment, bullying or abuse did not think appropriate action had been taken.

The report said: “There was evidence to suggest that such practices were prevalent, with staff referring to a ‘bullying culture’ and using words such as ‘rife’ and ‘commonplace.’ Perpetrators included managers, colleagues and people using services…

“Staff felt that it was futile to raise concerns as there was a general feeling that nothing would change.”

In maternity, workforce shortages meant staff felt unsafe on a daily basis. Labour units were often closed, with a lack of senior leadership oversight and no follow-up to check women diverted elsewhere.

A recent restructuring of the senior leadership team had also left staff feeling “disillusioned [and] unsupported”.

Sarah Dronsfield, the CQC’s deputy director of operations in the North, said: “We fed back our serious concerns to the trust leadership team and we expect to see rapid and widespread improvements.”

Simon Morritt, the trust’s CEO since 2019, said: “As is the case across the NHS we have been under sustained pressure and this has impacted our ability to consistently provide the standard of care we all want, which is reflected in the concerns highlighted by the CQC.

“Nevertheless, we accept the CQC’s findings and recognise that we have much more work to do to make sure all our services are of the high standard that our patients and staff expect.

“We were pleased that in giving a rating of ‘Good’ for the key question of ‘care’….”

The trust remained “good”-rated for care and “requires improvement” for safety, but was downgraded from “good” to “requires improvement” for responsiveness and effectiveness.