As every organisation knows, the quality of its leadership will determine its success or its failure. In almost every case where I have reviewed failings at NHS Trust hospitals, poor leadership, whether at departmental or whole Trust level, has contributed to that failing.
One high profile example was the Heart of England NHS Trust’s failure to stop Ian Paterson harming countless women as a result of its ‘weak, indecisive leadership’. Now another hospital, the Royal Sussex County Hospital, has been rated inadequate by the CQC relating primarily to safety and leadership concerns.
Toxic work environment
There have been rumblings at the Royal Sussex for a few years: in 2020, Health Education England held an Urgent Concern Review into core and higher surgery after trainee surgeons were removed from the general surgery department after reports of poor governance, risk oversight and culture. Concerns had been raised repeatedly about the lack of leadership and ‘ownership of the problems within General Surgery’ but with little effect. Poor professional behaviours by consultants, an ‘unpleasant and toxic working environment’, and concerns about trainee supervision all contributed to worries about patient safety. Fast forward to May 2023 and the CQC report makes for uncomfortable reading after whistleblowers raised leadership and safety concerns – and this in spite of a series of inspections in previous years highlighting areas for improvement and imposing enforcement action. Indeed, following the August 2022 inspection after complaints about UGI surgical service, elective surgery was suspended ‘to protect patients from harm’.
Leaders shape an organisation’s culture
Cultural problems at the Trust appear to run deep. Although the CQC noted that the executive board had ‘the experience, capacity and capability to lead effectively’, this was not borne out by the evidence. There was a gulf between how the board viewed their performance as modelling ‘a compassionate leadership style’ and promoting ‘a fair and just culture’, and how staff viewed their management style: autocratic, bureaucratic, and lacking empathy. Staff reported that lack of senior leadership left them feeling ‘neglected and forgotten’. Bullying and harassment appeared to be rife, and staff were found to have ‘concern fatigue’ whereby repeated efforts to raise concerns had been ignored. Other staff were too worried about reprisals to consider complaining.
All this points to a dysfunctional picture with leaders being totally unaware – or refusing to acknowledge – problems that appear to be endemic in key departments. Of course, the people who really suffer are frontline staff trying to do a good job in difficult circumstances and their patients. Concern about patient safety has been a recurring theme throughout all the various inspection reports, from adverse outcomes following surgery to criticism of poor governance procedures, such as inadequate record keeping. Trust leaders won’t avoid negligence claims if they put their heads in the sand and pretend that everything is OK. Weak leadership at department level is almost certainly likely to be mirrored at Trust level. If staff feel unable to raise concerns safely to the main executive board then there is little hope that their immediate senior leaders will be inclined to take notice.
At the Royal Sussex, the various inspections by the Royal College of Surgeons, the HEE and the CQC demonstrated that very little progress has been made over a four-year period. This is a reflection of poor leadership failing to create and maintain a positive culture in which staff feel valued and supported. As we all know, every hospital is facing various challenges, but some are coping better than others – good leaders will always find a way to keep staff on side and patients safe.