Healthwatch Birmingham and Healthwatch Solihull statement on the Culture Review of University Hospitals Birmingham NHS Foundation Trust (UHB)

Healthwatch Birmingham and Healthwatch Solihull have for some time been hearing disturbing stories of the toxic staff culture at University Hospitals Birmingham NHS Foundation Trust (UHB), which we have been raising directly with the Trust and Care Quality Commission (CQC) with increasing urgency since the CQC identified serious patient concerns in 2021.

The independent cultural review commissioned by UHB in response to whistleblowing allegations last year now quantifies those concerns, and the figures are stark indeed. That only 25% of staff feel their work is valued by UHB as an employer, while 53% reported feeling bullied or harassed at work, would be shocking statistics in any workplace but especially so in an organisation where staff culture can have a direct impact on patients’ lives. One of the most disturbing findings from Healthwatch’s perspective is that only 16% of staff feel confident that the Trust will act if they raise concerns, considered alongside the results from UHB’s own survey of junior doctors at Queen Elizabeth Hospital which revealed that 48% of respondents did not feel they could raise concerns about inappropriate behaviour or bullying without fear of reprisal.

This culture of fear, coupled with the perception of a Board and management that is at best disinterested and at worst actively hostile to staff raising concerns, clearly has serious ramifications for patient safety if dangerous practices are allowed to continue and individuals not brought to account. While Healthwatch is not suggesting anything as extreme as the Lucy Letby case has happened at UHB, it is also apparent that the obstructive attitude of NHS managers when staff raised the alarm was a contributing factor in allowing her horrifying crimes to continue. This attitude must be confronted and eliminated wherever it occurs across the entire NHS.

But while the overall numbers are shocking, it is important that the individual staff at UHB are not treated as mere ‘numbers’ themselves, which the report highlights as a common feeling among many staff who are nevertheless rightly proud of the care they deliver. It is reassuring that a majority of staff feel they work well with their immediate colleagues – even if they often feel disconnected from the wider organisation – and much of the positive feedback we receive from patients at UHB highlights the caring and professional attitude of the staff they interact with on a personal level. We do note however that abuse and intimidation from patients and the public are cited in the report as one of the primary reasons staff feel unsafe at work. While Healthwatch exists to represent the public voice, we believe it is imperative that service users treat all staff with the same level of respect with which they would like to be treated themselves.

As the executive team at UHB has acknowledged in its response, this report has – and should – make difficult reading for the Trust. Healthwatch Birmingham and Healthwatch Solihull are pleased to see that the UHB executive has made an unreserved apology to former and current staff for its role in allowing this toxic culture to take such a deep-seated hold in the organisation. We are clear that self reflection by the Trust leadership is essential to building confidence among staff.

However, actions speak louder than words and as we have reiterated in our responses to Professor Mike Bewick’s initial review in March and the subsequent patient safety review in June, the focus must now be on delivering important changes to culture and practices at UHB in both the immediate and long-term.

We are encouraged that the Board has committed to implementing the recommendations, alongside establishing a Culture and Inclusion Board. Given the understandable concerns about the current UHB Board and executive team’s lack of diversity and connections to the previous regime, this work will be a crucial test of UHB’s commitment to facing up to past failings and fulfilling the Trust’s promise to create a culture that everyone at UHB can be proud of.

These reports need to be the start of a new chapter, not the end of the story for UHB, and Healthwatch will continue to scrutinize and hold the Trust to the highest standards to ensure that the people of Birmingham and Solihull get the care they need and deserve.

– Richard Burden, Chair, Healthwatch Birmingham and Healthwatch Solihull

* Image by Tony Hisgett, CC BY-SA 2.0