A review into claims of bullying and a culture of poor leadership at an NHS trust has been criticised as lacking “completeness and transparency” by a health watchdog.
The Parliamentary Health Service Ombudsman (PHSO) said it had “real concerns” over reviews of patient safety, culture and leadership at the University Hospitals Birmingham NHS Foundation Trust (UHB), claiming the process was not “evidence-based”.
The PHSO said it had received 501 complaints about the trust since January 2021 and found evidence of avoidable patient death, but had not been invited to contribute to the reviews of UHB carried out by the Birmingham and Solihull Integrated Care Board (ICB) and NHS England.
Those reviews were initiated after concerns were raised by current and former staff members who said the trust was “mafia-like” and that some had been threatened for raising concerns for patient safety, according to the BBC.
The trust has previously denied allegations of poor patient safety and bullying and said that it was “committed” to working with the PHSO and families affected, while the chief executive of the Birmingham and Solihull ICB has since told local councillors that no patient safety issues were found.
On Tuesday, the PHSO said its investigation into UHB uncovered “a number of serious concerns” around culture and leadership, including a “defensiveness” when discussing patient safety and a “failure to fully accept or acknowledge” findings, including incidents of avoidable death.
It’s hard to see how the review can be evidence-based if it doesn’t consider all the evidence. It raises real concerns around the completeness and transparency of these reviews.— Rob Behrens, Parliamentary Health Service Ombudsman
That led the ombudsman to enact the Emerging Concerns Protocol for the first time in August 2022, allowing it to share information about a hospital that may indicate risks to patients, their families and carers, and staff.
Rob Behrens, Parliamentary and Health Service Ombudsman, said: “Our decision to trigger the Protocol was not taken lightly, but we had significant concerns about the Trust.
“It’s vitally important that the NHS learns from its mistakes. To do that, there needs to be a culture of openness, not defensiveness.
“We need to see significant improvements in culture and leadership and how the Trust engages with our investigations.”
The BBC said on Tuesday that David Melbourne, the chief executive of Birmingham and Solihull ICB, had previously told local councillors that their patient safety review had “not identified any red flags”, something Mr Behrens said the PHSO’s evidence disagreed with.
The PHSO understood that it would be able to participate in the reviews relating to leadership and culture, but has since been told that it will not be able to do so.
Mr Behrens said: “I’m extremely disappointed that NHS England denied us the opportunity to contribute to its review.
“It’s hard to see how the review can be evidence-based if it doesn’t consider all the evidence. It raises real concerns around the completeness and transparency of these reviews.
“We all share the same goal in wanting to see improvements at UHB so that people living in the West Midlands and using its services can access the best possible care with confidence.
“Working together and feeding our evidence and expertise into those reviews is by far the best way to achieve that goal.”
We welcome the offer of support from the Ombudsman’s office, who we have recently met, and are continuing to work with them to use their expertise where it can offer the most value as part of the planned cultural review.— NHS England in the Midlands
The PHSO has written to NHS England to express concern over its exclusion from the review.
A spokesperson for NHS England in the Midlands said: “The reviews into University Hospitals Birmingham Trust have been commissioned to rigorously scrutinise leadership and culture in the organisation to ensure they are providing safe care for patients, as well as providing transparent information on any areas where support and challenge are needed at the Trust.
“We welcome the offer of support from the Ombudsman’s office, who we have recently met, and are continuing to work with them to use their expertise where it can offer the most value as part of the planned cultural review.”
A spokesperson for NHS Birmingham and Solihull said: “We have not heard from the Ombudsman on this matter but would welcome a conversation and are keen to provide assurance on the processes we are following.
“The review is and will continue to be, independent and we have published regular updates at our Board and at local scrutiny groups.
“The cross-party reference group is an additional commitment to ensuring independence.”
A critical letter has also been sent to the UHB’s interim Chief Executive expressing “disquiet” over the trust’s earlier responses to patient safety concerns.
The trust appointed a new chief executive last August, after the Emerging Concerns Protocol was enacted by the PHSO.
A spokesperson for the trust said: “The chief executive has responded to the PHSO’s letter, to provide reassurance that their concerns have been taken seriously and we have been working to arrange further meetings to agree how our organisations can work better together in the interests of our patients and staff.
“We are committed to working with the PHSO, to ensure that all families have a clear understanding of any issues relating to their loved one’s care.”
The publication of the review into patient safety, due last week, has been delayed, with no date provided as to when it will be published.
