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Review condemns treatment of trust staff who blew whistle on poor care

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k653 (Published 09 February 2018) Cite this as: BMJ 2018;360:k653
  1. Gareth Iacobucci
  1. The BMJ

An NHS trust “bullied and harassed” staff that raised concerns about poor care and swingeing staffing cuts, an independent review has found.1

The review, commissioned by the regulator NHS Improvement, identified “appalling instances of staff treatment” at Liverpool Community Health Trust between 2010 and 2014, as the trust tried to suppress systemic failings that caused harm to patients.

It found that the trust failed to learn from serious incidents that occurred because of failings in the care it provided. These included the deaths of up to 19 people in custody at HMP Liverpool, five patients having the wrong tooth extracted in the trust’s dentistry department, repeated falls and fractures on intermediate care wards, and numerous patients with pressure ulcers.

The panel also censured NHS and regulatory bodies for failing to spot problems earlier. It noted that the Care Quality Commission (CQC) only identified the extent of the problems after being alerted by West Lancashire MP Rosie Cooper. The report said that the structural upheaval that followed the 2012 health reforms may have contributed to organisations’ failure to communicate effectively.

The report drew parallels with findings from the official inquiry into failings at Mid Staffordshire NHS Foundation Trust,2 where the prioritisation of savings over clinical quality and patient safety, driven by the desire to achieve foundation trust status, led to a damaging culture and unsafe practices.

The Liverpool trust sought to reduce its staff headcount, despite already being understaffed, in a bid to make unrealistic savings targets, the report said. The panel noted that the trust undertook an “aggressive” savings plan, with cuts of 22% over five years.

At one private board meeting in February 2013, the report documented how the trust’s then human resources director Michelle Porteus proposed plans for “significant staff reductions” in areas that were “already being highlighted as a cause for concern—partly as a result of staffing shortfalls.”

“There was no apparent recognition of the irony inherent in this being taken to the same board meeting that had earlier considered the implications of the Francis report into failings at Mid Staffordshire Foundation Trust,” the panel said.

The inquiry heard that when staff spoke out “they were harassed and, in some cases, subject to disciplinary action, including suspension” from the trust’s human resources department.

Health minister Stephen Barclay said the government accepted the review’s recommendations in full, including the need to review the CQC’s fit and proper person test, which determines an individual’s suitability to hold responsibility for the overall quality and safety of care in an organisation.

Barclay said, “What happened to patients is a terrible tragedy for all of the families involved. The report also makes clear the devastating impact on many of the frontline staff. On behalf of the government, I want to apologise to them.”

Ian Dalton, chief executive of NHS Improvement, said the regulator would respond fully to the review’s findings and recommendations by late March 2018. “The report has important lessons for our organisation and the whole of the NHS,” he said.

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