Scathing report finds Nottingham University Hospitals Trust 'requires improvement'

Nottingham's hospital trust has been hit with a scathing report by inspectors who found a "culture of bullying" at the organisation – including reports of racial discrimination.

Nottingham University Hospitals Trust (NUH) which runs Nottingham's Queen's Medical Centre and City Hospitals, has been rated 'requires improvement' by the Care Quality Commission (CQC).

Concerns over the leadership of the organisation were so serious the trust was served with a warning notice after the inspection – requiring them to make widespread changes.

A number of allegations of bullying cases at the trust were found to be "directly attributable to racial discrimination", and some staff were "too frightened" to speak up.

The trust said it is "working hard" to make changes.

Inspectors held an unannounced visit of the trust in June and July 2021, looking at Urgent and Emergency Services and surgery Queen's Medical Centre and surgery at City Hospital.

The leadership of the trust as a whole was heavily criticised by inspectors who rated this part of the organisation 'inadequate'.

Three areas were rated 'requires improvement' while 'caring' was rated 'outstanding'.

Maternity services at the trust are already being investigated by the CQC following baby deaths and injuries.

The new 90-page inspection report published on September 15, said: "There was a culture of bullying across the organisation. We were told of bullying incidents occurring across the trust with a 'lack' of ability to address or resolve incidents in a timely fashion and that culture, policies and procedures did not provide staff with adequate support.

"We were told of a number of bullying cases were directly attributable to racial discrimination. The trust's latest staff survey showed; the trust was above average for Black, Asian and Minority Ethnic staff experiencing bullying or harassment."

Some members of staff were "fearful of raising concerns" and there were "high numbers of staff feeling overworked" in some areas of the trust.

However, the trust was praised for the way its staff treated patients with compassion and kindness and respected their privacy and dignity.

The CQC has handed the trust 28 points to improve on, including addressing the bullying "across the organisation", and addressing "the disconnect between the board and the wider organisation".

The report said: "There was not collective leadership at board level.

"We found the culture to be top-down and directive. It was not one of fairness, openness, transparency, honesty, challenge and candour. During some of our interviews we found executive staff to be defensive and not compassionate.

"We were told there was separation between the board and the divisions and this was the worst it had been in many years."

And maternity services at the trust, which are rated inadequate, "continued to face considerable challenge in embedding and sustaining a culture of high quality sustainable care".

The report added: "Staff who spoke to us appeared fragile and told us they felt unsupported and unable to raise concerns despite actions taken by CQC immediately following the 2020 inspection."

There was also a large number of uninvestigated incidents across the trust which amounted to 600 cases across surgery.

The report detailed one incident where "a patient who had undergone treatment that was not required due to misidentification".

Inspectors visited the Emergency Department which reported that 74 people experienced delays of 12 hours or more during a period of 12 days in July.

The report said: "The longest wait was recorded as 21 hours and 44 minutes with a lack of admitting capacity being recorded as the reason for the delay."

Staff said it was 'overcrowded' with the highest number of attendances ever seen in July 2021, when 695 patients were treated in a day – 145 more than the usual numbers.

There was a "high level of anxiety among staff" in the department regarding the "lack of capacity and space to meet current demand".

Rupert Egginton, Deputy Chief Executive and Chief Financial Officer at Nottingham University Hospitals NHS Trust said: "We would like to assure patients and colleagues that we are working hard to address the serious concerns highlighted in the recent CQC report, focussing on standards of leadership within the Trust.

"It's important to note that the report does not criticise clinical services and recognises the care, dignity, compassion and kindness that our staff provide for our patients; but it's our job as the leaders of the Trust to ensure that the foundations of our organisation – our processes, governance, and learning from incidents – improve to allow our teams to provide safe, high quality care within a positive, open and supportive culture."