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  • RogerKline

Board members have a duty to speak out too

In introducing his 2013 report on Mid Staffordshire Robert Francis wrote:


There lurks within the system an institutional instinct which, under pressure, will prefer concealment, formulaic responses and avoidance of public criticism…..an institutional culture which ascribed more weight to positive information about the service than to information capable of implying cause for concern.

Francis, R: Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. Para 43 HMSO, 2013.

The Standards for members of NHS boards and governing bodies in England (2012 CHRE) state :

6.2. Taking responsibility for ensuring that any harmful behaviour, misconduct, or systems weaknesses are addressed and learnt from, and taking action to raise any such concerns that I identify

6.3 Ensuring that effective complaints and whistleblowing procedures are in place and in use

6.4 Condemning any practices that could inhibit or prohibit the reporting of concerns by members of the public, staff, or board members about standards of care or conduct (21)


It was in the light of these Standards that the Chair (until 31st March 2023), of Bolton NHS Foundation Trust along with two other senior leaders contacted NHS England on 27th March 2023 saying:


This is a very difficult letter for us to write, especially because of the positions that we hold within the Trust. We want to express our concerns about serious governance failings and a toxic, bullying culture at Bolton NHS Foundation Trust which are contributing to an unsafe environment for both patients and staff. We have attempted to resolve some of our concerns internally and directly with the Board but our emails go unanswered, and are often not acknowledged

Culture

The culture of an organisation is shown less by whether it makes mistakes or acts contrary to NHS values, but by how it responds when these are pointed out. These three senior leaders write:

"We have decided to complain now because the Trust has demonstrated, on multiple occasions, that it has no intention of addressing concerns that have been raised by senior and junior staff members, Governors, the Chair and NEDs. Where people have found the courage to express their concerns as part of the Freedom to Speak Up process they have been bullied, silenced, subjected to detriment and were forced to move teams or leave the organisation whilst those who were accused of the bullying behaviours remained in situ. "

Health Service Journal in a report entitled “Trust execs accused of creating a ‘cult of the individual’” summarised some of these concerns and following the letter and that report, the CQC undertook an unscheduled visit. The claims reported by Health Service Journal include:


The letter from the Chair and others also state (and I quote):

  • “The Trust’s safety rating has recently been downgraded from ‘good’ to ‘requires improvement’.

  • Maternity services have been downgraded from “good” to “requires improvement” with CQC stating the Board have not been provided with important and timely information on serious incidents in maternity.

  • There has been a decline in 71% of the questions in the latest staff survey, despite this the results were described in Trust press release as “Still the best in Greater Manchester!”

  • The Board were misled into believing the Trust was largely compliant for Ockenden and the Maternity Clinical Negligence Scheme for Trusts; the Board was only made aware of the truth by a new Director of Nursing who corrected the reporting to the Board.

  • Freedom to Speak Up complainants have suffered significant detriment as a result of speaking up which has led to a culture of forced compliance in parts of the organisation. Senior staff members who have witnessed the detriment suffered by their colleagues have stated that it would be “career suicide” to speak out and that “it is difficult for senior people to speak up at the Trust”. Some of those who have spoken out have confirmed that they were made to feel suicidal as a result of the bullying and gaslighting treatment that they had been subjected to,”

The letter continues:

"There is a very worrying “sugar-coated”, overly optimistic culture which has pervaded the organisation in the past year. Everything is carefully orchestrated and stage managed with a positive spin put on all Board reports and communications. "

Examples are given of how Board Reports do that and of curious governance mechanisms used to influence debate including (and I quote)

  • "Prior to the appointment of the Lead Governor, the Trust introduced an email communication policy for the Council of Governors which required all email communications to, and between, the Governors to be directed through the Director of Corporate Governance; Governors are blind copied on all emails and are unable to directly communicate with each other.

  • "Executives routinely send WhatsApp messages to each other and meeting Chairs during Board and other meetings instructing them what to say in the meeting and who to bring in to speak."

The Trust response

Unfortunately, the Trust response to the letter and the HSJ article was to circle the wagons. There was no acknowledgement that in raising such concerns, the signatories were acting in accordance with the expectations of the Standards they were appointed to uphold. There was no explanation of why these concerns had not been addressed when privately raised previously. Instead other Board members were wheeled out to say how good things were whilst the CEO’s briefing to staff appeared to refer to the concerns raised as a “distraction” in her email to staff (“Fiona’s Friday” of 26th May).


The Guidance for NHS Boards on Freedom to Speak Up in NHS trusts and NHS foundation trusts (July 2019) published by NHS Improvement, NHS England and the National Guardian’s office states:


“it is the behaviour of executives and non-executives (which is then reinforced by managers) that has the biggest impact on organisational culture. How an executive director (or a manager) handles a matter raised by a worker is a strong indicator of a trust’s speaking up culture and how well led it is.”


The Guidance sets an expectation that:


“The board demonstrates its commitment to creating an open and honest culture where workers feel safe to speak up by ….. having a sustained and ongoing focus on the reduction of bullying, harassment and incivility (and) sending out clear and repeated messages that it will not tolerate the victimisation of workers who have spoken up and taking action should this occur with these messages echoed in relevant policies and training.”


HSJ reported that: “After the trust was contacted by HSJ, Ms Noden issued an internal message to staff saying: “A small number of people have contacted a national media source to raise concerns about their experiences in the workplace”."


But these were not just any “small number of people”. They included very senior well-respected Trust leaders. They appear to have done what any self-respecting Board members and governors would (and should) have done on behalf of patients and staff who cannot so readily speak for themselves.


The Trust refusal to engage with these concerns reminds me, I’m afraid of aspects of the leadership style of the current CEO’s former Trust. Here, as there, it is how a leadership responds to concerns raised that says most about the culture of the organisation.

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