Review finds ‘bullying and toxic’ culture at NHS trust

A review has found ‘entrenched’ cultural problems at one of England’s largest NHS trusts, including bullying and coercion.

The investigation by consultancy IQ4U and led by former NHS England deputy medical director Professor Mike Berwick found a wide range of issues at University Hospitals Birmingham NHS Foundation Trust (UHB), from a “bullying and toxic” environment to concerns with leadership.

The review was commissioned by the trust after a BBC Newsnight investigation in December 2022 found that a culture of fear among staff had put patients at risk, with one person describing the trust as “a bit like the mafia”.

Phase one of the review, which focused on clinical safety, found that the trust’s “firm and fair” approach was commonly seen as “overzealous and coercive” by staff.

There was a feeling of anger across the trust after senior managers failed to attend the funeral of Vaish Kumar, a junior doctor who killed herself after claiming that working at Birmingham’s Queen Elizabeth Hospital “just broke me”.

The review heard concerns over promotion processes, bullying, and fear of retribution if concerns were raised. The report said these elements would be explored further in the review’s second phase, which will examine the trust’s organisational culture.

Governance over medical disciplinary processes was also a concern, with the report stating that the decision-making process as to when a doctor should be reviewed under the higher professional standards procedures seemed “erratic and unpredictable”. Some clinicians stated that this process was used as a “coercive tactic to silence dissent”.

“Those who gave feedback to the review were concerned that individuals ‘who were favoured’ would not be held to account. This perception of the environment that they worked in filled many with the fear of speaking up,” the report said.

“A theme of an inequitable and inconsistent approach to both disciplinary processes and reward systems undermines legitimate attempts to both actively manage underperformance and reward excellence and merits an active review of the transparency and equity of both processes.”

A report issued to the UHB’s trust in October 2022 showed that 34.7% of complaints raised via the trust’s ‘freedom to speak up guardians’ related to harassment and bullying. Only 53.8% of respondents to an internal survey felt safe in raising concerns at UHB.

Prof Berwick said: “Our overall view is that the trust is a safe place to receive care. But any continuance of a culture that is corrosively affecting morale and in particular threatens long-term staff recruitment and retention will put at risk the care of patients across the organisation – particularly in the current nationwide NHS staffing crisis.

“Because these concerns cover such a wide range of issues, from management organisation through to leadership and confidence, we believe there is much more work to be done in the next phases of review to assist the trust on its journey to recovery.”

Recommendations made in the report included reviewing prospective senior appointments to ensure they have the necessary leadership skills; reviewing the processes to support trainee doctors who are concerned about their mental health; delivering awareness training on how to identify bullying, coercion, intimidation and misogyny; and adopting a ‘no blame’ culture when whistleblowers report concerns.

UHB chief executive Jonathan Brotherton said the trust had accepted Prof Berwick’s recommendations.

“There are a number of significant concerns that we need to, and have started to, address; we will continue to learn from the past, as we move forward,” he said.

“We want to develop a positive, inclusive work environment where people want to come to work, in a place that they are proud to work in, to do their very best for our patients. While we will not be able to fix things as quickly as I would like, we do need to do it as quickly as possible, for the benefit of patients and staff; I am committed to ensuring this happens.

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“We must now focus on continuing to provide the best possible patient care, building a values-led culture and supporting our incredible colleagues.”

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