Reports of bullying, harassment and a toxic culture at University Hospitals Birmingham Trust (UHB), highlighted in a BBC Newsnight programme before Christmas, continue to reverberate not only in the region but also nationally. For a Trust that had a ‘formidable team with a strong national reputation’ under the leadership of former CEO, Dame Julie Moore, these revelations have shocked many.
Most of the Trust’s difficulties appear to stem from Dame Julie’s successor’s leadership style, described as ‘dictatorial and over-zealous’ in his uncompromising determination to retain this reputation at all costs. In the pursuit of excellence, Dr David Rosser and his senior team’s management approach had a widespread and negative impact on staff and their ability to look after their patients.
Bewick Report highlights clinical safety concerns
In the light of the Newsnight report, which centred on concerns raised by Birmingham Healthwatch, plus interventions by local MP, Preet Gill, and Unison, Professor Mike Bewick was commissioned to carry out three rapid reviews into three areas: patient safety, governance, and culture. The first of these, patient safety, has just been published. Interestingly, despite the subject of the review, the investigating team did not specifically interview either affected patients nor patient representative bodies. Nonetheless, interviews with current and previous members of staff uncovered several serious examples of patient safety being significantly compromised in certain specialities such as haemo-oncology.
The review team tracked the source of many of the problems back to the 2018 merger between UHB, of which the main hospital is the Queen Elizabeth Medical Centre, and the Heart of England Trust (HEFT), which comprised three hospitals (Good Hope, Birmingham Heartlands, and Solihull). There was no obvious attempt to acknowledge and assimilate the cultural and management differences between the four sites and the senior management team, led by Dr Rosser (who has recently resigned), was described as having a ‘no-nonsense approach to failure’ and ‘often lacking in kindness and empathy’. As far as the HEFT hospitals were concerned, it was clearly the QE way or the highway.
Tragic consequence of toxic culture
Although the negative effect of an inflexible management attitude was keenly felt in some areas, it was not universal; some clinical areas were unaffected. But in those that were, the picture painted is bleak. A tragic catalyst for many to speak out against the ‘toxic’ culture of ‘inappropriate behaviours’ (which included coercion, bullying and inconsistent application of clinical standards) was the suicide of a junior doctor, Dr Kumar. Reports from the coroner’s inquest revealed that she felt ‘belittled’ at work and believed that QE was a ‘hypercritical environment’ in which to work. The way the senior management responded to her death, and their dealings with her family afterwards, was seen as callous and hard-hearted.
High standards, not intolerable pressure
Unfortunately, incidents of poor management behaviour at UHB are not isolated examples. In 2021, I quoted a Parliamentary Health & Social Care Committee report into the safety of maternity services which recognised that an NHS-wide endemic ‘blame culture’ acted as a major barrier to patient safety. There is a difference between having high expectations and imposing an intolerable pressure to perform. Encouraging medical practitioners to be transparent and honest about their failings and putting patient safety at the centre of everything they do will only happen if they feel supported and valued by those in positions of power, and not if they feel they are entering a battlefield every time they come to work.
Although Professor Bewick noted in summary that UHB is, overall, a safe place to receive care, he acknowledged that anything affecting staff morale would directly affect patients, particularly given the current difficulty of attracting and retaining staff. It is imperative that UHB restores its reputation as a centre of excellence, not only to continue to attract the best of the best, but also to ensure that patients have full confidence in the treatment they receive.