Judy Terry is a marketing professional and a former local councillor in Suffolk.
At last, exactly a month after the Care Quality Commission (CQC ) published its latest report, the East of England Ambulance Service NHS Trust has been put into Special Measures. This is amid claims of a ‘toxic work environment’ and ‘bullying normalised’. NHS England’s Regional Director commented: “…there are long standing concerns around culture, leadership and governance.”
So why has it taken so long for NHS England to actually take action, when it is now evident that the Trust has repeatedly breached legal requirements in the last four years, and successive reports were an indictment against the poor leadership which has been at the heart of the Trust’s challenges for years?
13 cases of sexual misconduct and predatory behaviour, including staff abusing patients, were made to the Police between April 2019 and March 2020.
Last autumn, three ambulance staff at the East of England Ambulance Service NHS Trust died unexpectedly within days of each other; at the time, alleged to be suicide, with Coroner reports awaited.
Despite an internal investigation in the wake of these tragedies, amid ‘escalating concerns of risk to patient and staff safety’, seven ‘whistleblowers’, including some in leadership roles, called for a further Care Quality Commission (CQC) visit. The inspection, conducted in June and July, resulted in another damning report, published on 30th September 2020.
Key issues identified include:
- Repeated breaches since 2016 of Regulation 17 (good governance) of Health & Social Care Act 2008;
- 12 breaches of legal requirements;
- A poor culture and ineffective governance, with senior leaders showing a lack of awareness of some of the fundamental requirements to safeguard patients and staff from abuse;
- Senior leaders being ‘combative and defensive’ when facing reasonable challenge, and lacking ‘adequate skills, knowledge and experience for their roles’;
- High levels of bullying, harassment and discrimination;
- A disconnect between senior leaders and staff, with inadequate support for staff to raise concerns without fear of reprisal.
The CQC reported the Trust to the Equality & Human Rights Commission due to “potential breaches of the Equality Act 2010”, but was not specific about reasons for the referral.
Despite this commentary, once again, the CQC noted ‘requires improvement’. Fortunately, however, the Chief Inspector of Hospitals recommended that the Trust be placed into Special Measures.
A new chairman was appointed to the Trust in November 2019; a former Royal Mail regional director, Nicola Scrivens’ experience includes chairing Cambridge Housing Association, and Cambridge Community Services NHS Trust, but one has to ask if the appointment was an open process, when the Trust has been accused of ‘nepotism abuse’.
On receipt of the CQC’s latest report, she acknowledged the shortcomings:
“The report calls out where we need to improve and we will now do everything possible, as fast as possible, to make the improvements required….. we are working to take action to address these concerns and put this right for the long term.
“The Trust aims to provide outstanding quality of care and performance for patients, and be an exceptional place to work, volunteer and learn. … the executive team has again reinforced its commitment to listen to and support anyone who raises concerns.”
So what does being in Special Measures actually mean? This is surely an opportunity for an outsider, rather than an NHS insider, to bring objectivity and an empathetic culture to this vital service, someone committed to protecting staff (and patients) rather than managers’ interests?
Unfortunately, such an idea doesn’t appear to be on the agenda; instead, plans include an Improvement Director, and buddying up with other ambulance services; a full time ‘Freedom to speak up’ guardian has already been appointed.
And what criteria will be applied for the Trust to exit? Presumably, recommendations from previous reports will form the basis for success; just last November the Trust concluded a short consultation with staff, patients and various organisations on a Corporate Strategy for 2020-2025 which identified a range of key issues, including:
- Provide long term leadership stability to ensure the Trust is well led;
- Ensure staff feel valued and supported, with emphasis on wellbeing and mental health;
- Improve training and development to help staff reach their full potential.
In December, following the paramedics’ deaths, a further report was commissioned to examine ‘the circumstances surrounding the deaths to ensure that all appropriate actions were taken and will continue to be taken, to ensure staff welfare is the highest priority and learning identified and translated into improvements by the organisation to mitigate the reoccurrence of any similar events’.
Shared with the CQC, NHS England/Improvement, relevant coroners and families, the twelve recommendations noted ‘the need to make improvements around guidance, policies and additional training and support for managers and staff’ and included:
- Develop training for managers in supporting staff with mental health problems – in partnership with specialist mental health professionals;
- Consider how it can contribute to and learn from the range of suicide prevention strategies and initiatives across its catchment area and incorporate suicide prevention into its strategic goals;
- Establish a programme of change and development to address sexual harassment and change the behaviours of staff and managers that enable it to thrive;
- Amend the Disciplinary Policy in relation to suspension of staff to include a clause reflecting the need to undertake a risk assessment at the time the decision to suspend is made;
- Review its arrangements for first line management support in order to move to a model that provides front line staff with consistent and regular management support;
- Senior operational managers should be reminded of their responsibilities under the Duty of Candour Policy; and, crucially,
- Carefully consider the findings of all current investigations, together with this one, to assess any common themes or consistent messages that would suggest the need for remedial actions and further organisational development initiatives.
At the time, the Chief Executive, responded:
“I am committed to instilling a culture which sees, respects and cares for all staff… we are making progress on our action plan to address these recommendations and half our actions will be completed by the end of May (2020), with all recommendations addressed by the end of September.”
That went well didn’t it!
The Trust receives about a million emergency calls a year, employing more than 4,000 staff, covering six counties: Bedfordshire, Cambridge, Essex, Hertfordshire, Norfolk and Suffolk, with 19 Clinical Commissioning Groups, which are supposed to have some responsibility for ‘commissioning’ ambulance services, but are silent. However, Cambridge MP, Daniel Zeichner, praised the caring and responsive service, acknowledging that the Trust’s troubled history is due to leadership shortcomings, “I hope this latest action will be a wake-up call to management… “
But Covid appears to have prevented Health & Welbeing Boards meeting – once again, I urge them to get together to create a sub-committee to monitor the Trust and its progress under Special Measures. They have a responsibility to hold people to account, and owe it to the wonderful frontline and back office staff who literally save lives, and to their local residents (or should I say voters).