Daily Insight: Culture war casualties

Reviews into “culture” problems have become increasingly common in the NHS, including long overdue assessments of the prevalence of racism.

These investigations can be incredibly hot to handle, and NHS Blood and Transplant has offered an array of lessons over the last few years of what not to do.

Hundreds of documents and emails obtained by HSJ suggest senior staff within the agency had cited multiple factual “inaccuracies” in one external review, before it became public.

Yet, in late spring 2020, the managers identified and implicated by the review, Peter Basham and Christina Whittington, were told it was too late to formally respond or make changes, as it had already been circulated widely within the organisation.

Within days of this, the report was leaked to The Guardian, after which NHSBT published the report without any corrections or clarifications.

Mr Basham was removed from his regional manufacturing manager post after Betsy Bassis, the former CEO, said there should be “consequences” from the report. Meanwhile, Ms Whittington felt she had no option but to step down from her role as regional operations manager for blood supply. There was never any investigation into their leadership.

Both subsequently had internal grievances upheld and received private unreserved apologies from NHSBT, after strongly refuted suggestions they had fuelled or supported racism.

However, the agency has refused to offer a public apology, for fear it would undermine the general message portrayed in the review, and its subsequent efforts to tackle racism.

One insider said: “Even if it wasn’t completely correct in all its facts, the essence and main message about a racism problem at NHSBT were absolutely right. The big problem is it was supposed to be a preliminary diagnostic, looking at wide cultural issues. It was never an investigation into specific cases or actions by individuals.

“What should have happened is for individuals to be given the chance to challenge criticisms about them before it was circulated to anyone. Then either those personal criticisms should have been removed, or they should have been investigated properly by NHSBT.”

Quiet merger? 

It would seem a strange time to try to quietly merge two gigantic hospital trusts.

The idea that Barts Health Trust (turnover £2bn-plus) and Barking, Havering and Redbridge University Hospitals Trust (turnover around £800m) should have the same exec team was already a challenging one.

So the internal opposition to the move from within both trusts that seems to have put paid to this idea was always expected.

But what is also relevant now, and wasn’t in 2021 when joint chair Jacqui Smith was appointed, is that BHR has turned around its accident and emergency performance.

It’s early days, but its most recent performance results are a remarkable turnaround for an organisation whose stats on this measure were long the worst in the country and which often set new record lows.

It seems an odd time to shake up senior management, leaving a single exec team covering a vast swathe of north east London. Even north west London which has a shared chair and a committee in common across four acute providers does not have single executive directors across the whole patch.

NHS England London’s review of acute provider collaboratives in the capital, due out in March, may yet mandate something more concrete than the existing arrangements (reasonable volumes of elective work are already being shared) but will likely face similar resistance.