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Shock report urges Royal Free Hospital to tackle ‘bullying’ among staff

Care Quality Commission says Hampstead hospital 'requires improvement'

16 May, 2019 — By Tom Foot

BULLYING is rife at the Royal Free, inspectors warned, as they told the Hampstead hospital that it “requires improvement”.

The hospital, in Pond Street, was given its worst-ever rating when health watchdog, the Care Quality Commission, published 600 pages of findings on Friday.

Nurses had told inspectors of a “culture of bullying” with consultants “shouting at them during operations”.

The Commission’s report follows a month-long probe which found bullying complaints are “significantly higher than the national average”. Lower-paid staff reported “bullying, shouting and insulting communication”, particularly if senior staff were “disturbed during the night to deteriorating patients”.

As a result, staff were “scared of escalating patients” in need of greater care. The problem was “largely due to inappropriate consultant behaviours that had historically gone unaddressed”, the Commission warned.

One nurse told inspectors: “There’s a hierarchical mentality that makes it unpleasant most of the time.”

Schemes introduced to tackle bullying were found to have not been effective and described as “tick-box” exercises. Doctors had failed to turn up to anti-bullying events.

The Royal Free Charity had tried to improve morale by buying Christmas trees and a massage chair for potential new staff on recruitment days, the inspection found.

Responding to the report, Royal Free Unison rep Jim Mulligan said yesterday (Wednesday): “A lot of this should have died out in the 1950s. Surgeons need to be aware that staff are all trying to do the same thing as them. It’s no use acting like ‘I’m the big I am’. “Patients, I think, would be horrified at what is going on, but luckily they are unconscious.”

He added: “Bullying affects staff recruitment and sick pay. Staff get depression. It all costs money. The trust is tackling it, to be fair to them. But it is like trying to turn around an oil tanker. We have to change the culture, and start treating everyone as an equal.”

Sir Robert Francis’s 2015 report on the Mid Staffordshire scandal revealed how staff trying to work while being bullied were more prone to making mistakes. A decade of cuts to the NHS is said to be one of the main drivers of bullying in the NHS, as tensions boil over between over-stretched staff.

For example, the Commission said the allied health professional service – a generic term for nutritionists, occupational therapists, physio and podiatry – was “significantly under-resourced” and was struggling to “meet the needs of patients who presented with highly complex, long-term needs”.

Chief executive Caroline Clarke

There are “ongoing staff shortages”, particularly in cardiology, and there is a “high risk of lost patient records in elderly care”.

During a mystery shopper-style visit to a cardiology ward – for heart attack patients – inspectors were left furious after being “ignored” while repeatedly buzzing to get in.

“When trying to gain access to ward 10W, staff failed to respond to three-door entry buzzers and, although two nurses saw our inspection team through the window, they continued to ignore us. We observed this was common practice on some wards,” the report said.

The report said there had been an increase “in the number of patients being cared for overnight in the recovery area in the operating theatres due to a lack of suitable beds” and that “long waits in A&E were a regular occurrence due to lack of capacity to meet service demand”. In the A&E, a fifth of shifts were filled by agency workers. A shortage of beds meant the emergency department being blocked was a “daily occurrence”.

A 10-year old endoscopy ultrasound machine was an “extreme risk” because it “frequently failed” and had led to a “cancelled list and potential delays in the diagnosis of biliary cancers”.

The Commission’s report probed the final months of the tenure of chief executive Sir David Sloman, who left the Royal Free in January after almost 10 years in charge.

Now running all of London’s NHS, the report said he had a favourite slogan: “Keep your eyes to the horizon, and nose to the grindstone.”

In a statement, Royal Free chief executive Caroline Clarke said: “The past two years have been a period of great change for the Royal Free London. We are one of only four trusts in the NHS selected to implement a ‘group model’; we have opened the brand-new Chase Farm Hospital on time and on budget; and we have implemented a new electronic patient record faster than any other trust. All of this has been achieved successfully and safely.”

She added: “Now it’s time to consolidate and turn our attention to making sure we get the basics right. This report will help us focus our attention on some key areas where we know we need to improve and we look forward to inviting the inspectors back in the near future to show them just how much progress we have made.”

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