Health

‘Culture of bullying by surgeons’ linked to Royal Free blunders



A culture of bullying among surgeons was today linked to a series of patient safety blunders at a top London NHS hospital trust.

Inspectors reported that a “large number” of “never events” — incidents so serious they should never have happened — were partially related to “poor behaviours” by a few consultants at the Royal Free London NHS Trust.

They downgraded the trust’s overall rating from “good” to “requires improvement” and gave each of its three north London hospitals — the Royal Free, Barnet General and Chase Farm — a reduced rating for surgical safety. At least 10 never events were reported by the trust for 2018/19. Eight happened in surgery, four of them at the Royal Free’s Hampstead site.

Today’s report from the Care Quality Commission said: “The trust reported a large number of never events which could be partially related to the poor behaviours among a few consultant surgeons in the trust.

“We found that the surgery and  medical care consultant groups across the trust were not well connected or acting as a cohesive group.”

The CQC report said “there remained a culture of bullying within the  operating theatres”. 

It said the trust, one of the biggest in the country with more than 10,000 staff and covering 1.6 million patients, had not effectively addressed bullying,  harassment and feelings of intimidation “caused by a very hierarchical working environment”.

Hospital managers had organised an “engagement event” to improve working relationships between doctors and nurses — but no doctors attended.

The commission said the “strict hierarchy” meant junior staff were less likely to challenge poor practice by senior doctors. 

More than a quarter of the trust’s staff who responded to an NHS-wide annual staff survey said they had  witnessed an error, near-miss or incident in the previous month. Trust sources today said the concerns related to only a small number of surgeons. There had been no “never event” for the last seven months, they added.  They insisted the problems were not of the same magnitude as seen at St George’s hospital in Tooting, where disputes between cardiac surgeons and a rise in mortality rates are being  investigated.

The CQC report, based on a series of visits either side of Christmas, was  otherwise positive about much of the work of the Royal Free, which is a  pioneer in infectious diseases, kidney and liver transplants and breast and plastic surgery.

But it said it struggled to fill vacancies, there were long waits in A&E and delays for patients waiting for non-emergency treatment.

The trust’s chief executive until earlier this year was Sir David Sloman, now head of the NHS in London. The report said: “Staff were proud to work for the Royal Free and spoke highly of the leadership team.”

Nigel Acheson, the CQC’s deputy chief inspector of hospitals, said: “Although the Royal Free London NHS Foundation Trust’s rating has fallen from good to requires improvement, there is much still to be proud of at the trust, including some outstanding practice.

“The trust was rated good in three of the main categories that we rate, though it was let down in the safe and responsive areas. We want to see improvements quickly and CQC will monitor the areas where the trust is not doing so well.” 

Dr Chris Streather, the trust’s chief medical officer and deputy chief executive, said: “The Royal Free takes a zero-tolerance approach to bullying and harassment and has done a huge amount of work to encourage our staff to speak out if they experience negative behaviour. We remain one of the safest trusts in the NHS, with mortality rates among the lowest in the country … we moved quickly to tackle the issues identified in the report, which we ourselves brought to the CQC’s attention.”



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