Statement on the Bewick review into patient safety and concerns at University Hospitals Birmingham (UHB)

Professor Bewick’s report paints a disturbing picture of serious failings at University Hospitals Birmingham NHS Foundation Trust (UHB) and shows that the allegations made by whistleblowers were not isolated incidents, but the result of a deep-seated toxic culture which contributed to Dr. Kumar’s tragic death. This raises many questions around why so many warning flags and concerns have been seemingly ignored before now. What is clear is that UHB now has no excuse and no time to waste in challenging and changing a toxic culture and dangerous practices that have persisted for far too long.

As an independent organization representing the voice of patients and service users, patient safety is Healthwatch’s paramount concern. Patients and their loved ones now need greater reassurance and firm evidence that UHB is safe, particularly given concerns about the Trust’s reponse to its high mortality rates and number of ‘never events’. While Professor Bewick and his team highlight specific areas of concern such as the inadequate response to Dr. Nikolousis’ initial reviews of haematology, neurosurgery and levels of nursing staff at Good Hope Hospital, we must remember that this is an interim report completed in just six weeks. If concerns about any other departments have emerged – or do so in future – they must be immediately and rigorously investigated and acted upon.

An atmosphere of fear enabled by a defensive and dysfunctional management will inevitably impact upon patient safety. The views of the Queen Elizabeth Hospital’s own Senior Medical Staff Committee (SMSC) are particularly damning in this respect, with charges that cronyism, bullying and unprofessional leadership have corroded staff confidence to a point that is damaging UHB’s ability to deliver basic care, as well as staff recruitment and retention. Failures in the Trust’s duty of candour to patients, the use of GMC referrals as a coercive tactic and a tendency to blame ‘never events’ on individuals rather than considering systemic causes and solutions are also disturbing indications of a culture in which organizational reputation overrides much more serious concerns.

Management attitude has had a devastating effect on staff morale, most tragically in the case of Dr. Kumar, where the Trust’s initial official response was widely condemned as lacking compassion and understanding. UHB must tackle these issues immediately, both through the staff training and mental health support that Professor Bewick recommends, and through a robust ‘zero tolerance’ attitude towards bullying. There also need to be new robust and open processes developed with staff and patients to ensure that no-one working at or in the care of UHB feels ignored or intimidated when raising concerns.

At the outset, Healthwatch set out four ground rules against which these reports must be judged.

Transparency and independence: While the details of severe issues at UHB in Professor Bewick’s report reassures Healthwatch that he and e his team have maintained balance and proportionality, this is only the first of three reviews, and there is greater onus on the forthcoming reviews into culture and governance to demonstrate transparency, particularly as they are being commissioned by UHB and NHE England respectively.  We also note that the observation in the review that some parts of the Trust appear in denial about the existence of problems corresponds Healthwatch’s own interactions with senior management UHB in the past, in which we have been concerned about their willingness to accept and respond to constructive criticism. Alongside the structure and behaviour of senior management, the role of the council of governors and Non-Executive Directors now warrants further scrutiny, given that there seems to have been a failure to act upon concerns at the highest levels. This lack of effective listening and engagement also permeates the entire Trust. Healthwatch has regularly raised patients’ dissatisfaction with the PALS service directly with UHB, but a service like PALS cannot function effectively for patients in a corporate culture of secrecy and defensiveness.

Reviews must follow the evidence where it leads: Staff and the public need to know whether any information asked for by the review team was withheld, by whom and for what reason. The Parliamentary Health Service Ombudsman (PHSO) claims that its patient safety concerns have not been adequately acknowledged or investigated, and it is essential they are included in these reviews. Healthwatch is also aware that some whistleblowers we have spoken to have not yet been approached for further details of the allegations from their perspective, and it is equally essential to win their confidence and engage them in the review process in the coming weeks.

Findings made public: While Healthwatch is pleased that this interim report has been made public, we require assurance that the same will apply to the forthcoming reviews. We and others now demand to see previous documents such as the Fit and Proper Person Review (FPPR) which have so far remained hidden. Releasing these reports and details of the process and people involved in commissioning and carrying them out is important to help ascertain whether there were any conflicts of interest, whether decisions were made that may have contributed to the propagation of UHB’s toxic culture, and whether these amount to a ‘cover up’.

Commitment to action: It is imperative that UHB implement the changes recommended by Professor Bewick and his team in this interim report without delay, and there must be an equal commitment to acting on any recommendations in the forthcoming reviews. Furthermore, NHS England must embed an ongoing process of engaging with staff and patients to ensure sustained change and that the serious issues identified at UHB no longer occur there or in any other NHS organization. But while such an approach will hopefully safeguard staff and patients in the future, the board at UHB must take responsibility for failings in the past, with clear accountability for those found to be at fault either through their own actions or failure to take action. In this respect we fully agree Professor Bewick’s conclusion that ‘it is necessary to confront the past as the first stage of recovery’.

This interim report and the upcoming reviews into culture and governance must not be the end but the beginning of an urgent process of learning and transformative change at UHB. Everyone with a degree of influence in the local health sector owes it to patients, the dedicated staff who care for them and the memory of Dr. Kumar to work together to ensure the deep-seated problems at UHB are tackled quickly and effectively. For our part, Healthwatch commits to supporting this process in our role as an independent organization representing the patient voice, and we encourage anyone with experiences of care at UHB to share their views with us, so we can hold the Trust accountable for delivering the urgent improvements the people of Birmingham and Solihull need and deserve.

• Richard Burden, Chair, Healthwatch Birmingham and Healthwatch Solihull

* Image by Tony Hisgett, CC BY-SA 2.0