Doctor pinpoints ways to fix 'bullying' culture amid Shropshire maternity scandal

Bernie Bentick, a retired consultant gynaecologist and now the Lib Dem councillor from Meole in Shrewsbury, spoke out over the failings of Shrewsbury and Telford Hospitals Trust (Sath) ahead of the full Ockenden report, which should be published next month.

Mr Bentick, who was instrumental in starting and developing the Shropshire Fertility Service, believes there should be a regulatory body for managers, more spend and a national wellbeing guardian.

He said: "Over the last few years, there have been frequent news reports of catastrophic failures within other NHS trusts, the most recent including the East Kent Hospitals University Trust, Liverpool University Hospitals NHS Trust, the University Hospitals Birmingham Foundation Trust and most recently the response and handover times in the West Midlands Ambulance Service.

"Many of these scandals have their roots in five actions of former governments. The Thatcher government passed the NHS and Community Care Act 1990, which separated purchasers and providers of NHS & Social Care, setting up competition between providers. The Health and Social Care Act 2003 Act intensified competition with the establishment of 10 Foundation Trusts, which gave GP practices the funds and power to award contracts for almost all aspects of care to Provider Trusts.

"In 2014, a National Tariff Payment System was introduced, which introduced a specific fee for all procedures and many investigations, with adjustments for complex cases.

"In tandem with these changes, the USA concept of ‘Managerialism’ was adopted by The Department for Health and NHS Management, which resulted in appointments of senior NHS trust managers who had little or no experience of front-line NHS activities. At the other end of the spectrum, some excellent clinical staff were promoted to managerial posts without the training or support to perform their new roles.

"The decade of austerity, starting in 2009/10, resulted in stagnation of NHS funding, with individual clinical and other services forced to take annual budget cuts of 3 per cent, This meant that some services lost up to 25 per cent of their budget. NHS activity increased significantly during this decade, with inpatient admissions increasing by almost 30 per cent. Additionally, costs of some surgical treatments, with the explosion of new expensive endoscopic investigations and treatments, were allowed to rise considerably."

He added: "The end result was promotion and generous funding of particular services, especially procedures and particularly surgical ones, for which costs were known and tariffs set. At the opposite end of the spectrum, Cinderella services, principally non-surgical, maternity and emergency ones, withered and eventually collapsed due to dwindling resources and attention, as staffing dropped to unsafe levels.

"Due to these circumstances, a number of trusts or services within trusts began a highly corrosive culture of bullying, undermining and blame, coercing staff into working beyond safe levels and to blame individuals for resource deficiencies, to avoid taking responsibility for those deficiencies. A search of The Heath Service Journal today on the topic of bullying produced 1194 results.

"These malignant regimes were allowed to grow and spread to other services and trusts, and failing NHS executives moved to different positions, but without any mechanism to control the spread of the dysfunctional culture.

"The Care Quality Commission, in particular, has demonstrably failed to achieve its objective of maintaining acceptable levels of patient care, governance, staff well-being and financial competence.

"I and others reported the bullying culture and safety issues to senior Sath managers and the regulators, including the Care Quality Commission, NHS Improvement and The National Guardian between 2016 and 2018, including over 50 specific incidents involving over 100 members of staff. Maternity staff were included in those who were bullied.

"However, this did not eradicate the problem, with bullying still reported by 20 per cent of staff in the 2020 staff survey.

"I believe that there are three reforms which would resolve or improve the current health care crisis. The Government should implement a statutory regulatory body for all NHS managers, with a training programme, exit examinations, accreditation and code of conduct, with sanctions for non-compliance. This would bring NHS managers into line with all other NHS professionals. Only then will there be an effective body to surgically excise the malignant cancer of bullying and dysfunctional culture.

"There needs to be adequate NHS and social care funding to the levels in the best western world countries. The UK current spend is second lowest in the G7 Group.

"And an NHS National Wellbeing Guardian should be established by the Government, to lead the army of wellbeing guardians due to be appointed, following a report from NHS England/Improvement into the mental wellbeing of NHS staff and learners."