Statement from the Cross-Party Reference Group on the Phase One Bewick review into patient safety at University Hospitals Birmingham NHS Foundation Trust (UHB)
The Cross-Party Reference Group has been appointed to provide input into the three reviews, hold them to account and provide independence by bringing together local voices.
We would firstly like to thank Professor Bewick and his team for leading this first phase investigation into patient safety at UHB. We recognise that the full extent of concerns together with recommendations will be addressed in the subsequent two phases of this review.
Staff welfare, culture and morale all play an important factor in patient outcomes and overall patient safety. The culture of fear that has been created is evident to see throughout this report and while this will be further explored in a succeeding phase, we remain concerned about the defensiveness so clearly on display. The allegations made by whistleblowers were not isolated incidents, but the result of a deep-seated and toxic culture. While Dr David Rosser has recently announced his retirement, one member of staff, albeit a Chief Executive, cannot be responsible for this alone. Feedback from staff has made it clear that there must be collective accountability by the senior leadership for the distressing culture afflicting the Trust. This has had a devastating impact on the lives of many staff who go to work in an NHS environment which has sadly led to many leaving the Trust and the tragic suicide of Vaish Kumar. We have seen this trend echoed in other NHS reviews for example, by Sir Bruce Keogh following the Francis Inquiry and Don Berwick’s report of ‘a promise to learn, a commitment to act’. Therefore, the Group will meet with the organisation leading the culture review of UHB to have oversight of the terms of reference and composition of the working group.
Given Professor Bewick had just six weeks to investigate and has only been able to offer limited recommendations, the report still paints a disturbing picture of serious failings at UHB. When a person goes to hospital, it is a worrying time for the patient, and they should not have to face additional concerns about the quality of care they may receive. We do remain concerned about above average mortality rates and the number of ‘never events’. As such, we must understand what monitoring, as suggested by Professor Bewick, will be put in place? We would also like to understand what the threshold is which would trigger an external review?
While the report says that it is satisfied with the leadership team, we continue to hear concerns from staff about whether those leaders who have presided over the bullying culture will be able to change their leadership style to create a positive culture and command the trust of staff. We must now hear from the new Chairman about the appointment process of Non-Executives Directors that have taken place, those that remain, the diversity which they represent, and the development of reviews of NED including, monitoring and attendance. This will be a vital part to both patient and staff confidence in the Trust.
There are also several gaps in the report including the lack of recommendation resulting from the conflicting CQC reports. We must be granted access to previous documents such as the Fit and Proper Person Review (FPPR) which have not been shared. Releasing these reports and details of the process and people involved in commissioning and carrying them out is important to help ascertain any conflicts of interest, whether decisions made have contributed to the propagation of UHB’s toxic culture, and whether these amount to a ‘cover up’.
Many of the concerns that have been raised are deeply troubling and so, for the sake of patients and staff alike, the recommendations from the first phase of the three reviews must immediately be carried out with an implementation plan presented to the Group. We require clarity around the timescales for carrying out these recommendations and to understand where accountability lies.
While it was reassuring to learn that Professor Bewick will be involved in all three phases, we require the assurance that the same transparency in publishing the next two individual phases of the review will apply. The Well-Led Review should be close to concluding but it is concerning no details have been shared with the group of its focus and whether the report will be made available.
University Hospitals Birmingham NHS Foundation Trust touches the lives of so many, at a time when patients are at their most vulnerable. The Cross-Party Reference Group wants them to succeed. It is therefore imperative that the reviews are seen as the beginning of the journey so that we can implement the learning and create a culture that fosters openness for better patient outcomes.
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