Statement on the second review of patient safety concerns at University Hospitals Birmingham NHS Foundation Trust (UHB)

June 30, 2023

Healthwatch Birmingham and Healthwatch Solihull acknowledge the efforts taken towards tackling the deep-seated problems at University Hospitals Birmingham NHS Trust (UHB) detailed in Professor Bewick’s latest report. We also welcome a sense of openness from the Trust’s current leadership team, who have not sought to gloss over the very serious issues that have been brought to light, in contrast to the denialism that often characterised UHB’s previous responses to criticism. Being prepared to face up to past and present failings is a vital starting point to rebuilding trust among staff and patients. This is particularly important for long-standing members of the board and management if they are going to play a positive role in the Trust’s future as well as having been part of its past.

However, the report makes clear that much more progress needs to be made and more questions now need to be answered. While UHB has begun to instigate significant changes to governance arrangements and management organisation, we need to ask how the board allowed a toxic culture to develop and go unchallenged for so long. Their apparent lack of oversight around the Fit and Proper Person Review (FPPR) into former CEO Dr. David Rosser is particularly concerning.  We hope that the more activist and independent board which current Chair Dame Yve Buckland says she wishes to create should be an important contributor to change in this regard.

Change at the top is essential, but immediate action is required to change the culture at all levels of the Trust. Professor Bewick notes some positive examples of improved support for junior doctors in particular, yet also states that the hearts and minds of many staff have yet to be won. Truly listening to staff – particularly those raising safety concerns – is key. Professor Bewick’s latest report has exposed further clinical safety issues in departments such as neurosurgery and haemato-oncology, stressing the need for further in-depth reviews of these areas. But it also contains evidence of new and worrying issues such as misogynistic behaviour, sexual harassment and a ‘medical patriarchy’ which restricts career opportunities for staff from a more diverse background. We applaud the bravery of UHB staff who have raised these concerns, which UHB must not flinch from addressing in such a way that does not dissuade others from coming forward.

Creating a greater sense of ownership and responsibility among all staff will help challenge the centralised and hierarchical culture that left too many feeling undervalued, bullied and fearful about speaking up when they saw things that were wrong. It should also help with many of the operational challenges around staff recruitment and retention the facing the Trust. Staffing levels are a serious problem across the entire health service. However, these have been exacerbated at UHB by turmoil among current staff and negative perceptions of the Trust deterring potential new recruits. A clear demonstration that there has been a genuine and radical change in the culture at UHB will be imperative for attracting and keeping the staff necessary to deliver high quality care for patients.

For it is the patients that are the most important people to consider and who must not be forgotten amid all the technicalities of governance and restructuring. We want to see a greater degree of openness and responsiveness to patient voices at both individual hospital and Trust-wide levels. Patients have a right to know that they will consistently receive high quality treatment in a safe environment when they need it. Concerns about delays in cancer waits and at A&E were among the triggers that led to deep-rooted issues at UHB first being exposed. Although there are still significant problems to address, it is only right to credit the efforts of UHB staff for the real progress that has been made reducing the numbers of people waiting far too long for treatment.

We would also like to acknowledge the willingness of Professor Bewick and his team, Birmingham and Solihull Integrated Care Board (NHS BSOL) and the new UHB leadership to involve Healthwatch Birmingham and Healthwatch Solihull throughout the review process so far, and we would like to see a similar level of engagement from NHS England in the future.

When the reviews were announced in December, three of the four ground rules put forward by Healthwatch Birmingham and Healthwatch Solihull at the time were designed to ensure the transparency, independence and thoroughness of the reviews, with the fourth about securing a commitment to action to bring about change in practice. That fourth rule must now be the priority, and we can assure the people of Birmingham and Solihull that we will continue to represent their collective voice and hold UHB accountable for delivering wide-ranging improvements for the benefit of patients.

Richard Burden, Chair, Healthwatch Birmingham and Healthwatch Solihull

Image by Elliott Brown, CC BY-SA 2.0, File:Queen Elizabeth Hospital Birmingham from Selly Oak Triangle.jpg – Wikimedia Commons 

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