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Half of Keogh trusts had issues with raising of staff concerns


Staff reported problems raising patient safety concerns at half of the 14 acute trusts investigated in a major review, analysis by Nursing Times has revealed.

The findings of a review into the trusts, which all had higher than expected mortality rates, was published earlier this month by NHS England medical director Sir Bruce Keogh.

A failure to act on information that showed cause for concern and the absence of a culture of openness were two of the problems identified across many of the hospitals, the Department of Health said.

Analysis of the reports on each of the 14 trusts by Nursing Times found seven needed to address issues around the raising of concerns or incident reporting by staff.

Nursing Times is currently fighting to make it easier for staff to raise legitimate concerns by asking trusts to pledge their support to our Speak Out Safely campaign.

Sir Bruce’s investigators at Buckinghamshire Healthcare Trust found a “perceived culture of blame in reporting incidents and highlighting areas of concern”.

Their report said: “Some members of staff we spoke with… gave examples of where they had received negative personal feedback in raising incidents and areas of concern.”

In one incident a chest drain had been left unsealed. But it was not reported due to concerns a nurse considered to be “extremely conscientious” would be disciplined by the trust – instead of the systemic risk of treating patients with complex needs on non-specialty wards being addressed.

Staff also said the incident reporting system required too much information about those involved, rather than the process at fault, which created a “fear of blame and retribution”.

Investigators at North Cumbria University Hospitals Trust said discussions with staff suggested many “felt intimidated and bullied”.

“Some staff requested we shut windows when talking to them in private drop-in sessions – suggesting fear in speaking openly about issues. Others were visibly upset,” their report said.

The report on Medway Foundation Trust stated:  “We met a large number of committed and concerned staff who frequently reported that they feel unable to raise patient safety concerns and when they do, little or no action is taken.

“Staff need to know that they are not only being listened to but that their concerns are being acted upon,” it said.

Meanwhile, some staff at Blackpool Teaching Hospitals Foundation Trust “expressed difficulties in reporting incidents” and nursing staff reported that feedback could be given more consistently.

Staff at Burton Hospitals Foundation Trust felt the outcome of serious untoward incident reporting was not communicated back to them, with the exception of maternity teams.

“Some staff also did not agree that there was a ‘no blame’ culture at the trust, investigators said.

Colchester Hospital University Foundation Trust was told to consider how it acted on concerns raised by staff. Staff told investigators about a lack of feedback when issues were “escalated upwards”.

The investigators at Dudley Group Foundation Trust heard about historical issues relating to theatre staff management, including raising concerns about quality.

All of the trusts investigated are undertaking strict improvement plans.

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Are you able to Speak Out Safely? Sign our petition to put pressure on your trust to support an open and transparent NHS.


Readers' comments (4)

  • I'm curious whether the Keogh report team will now extend their investigation to the non-acute trust areas seeing as commissioning is all the rage. How about including the Out of hours services, the GP services and surgeries?
    There's so little left of NHS now this report is actually highlighting the concern in a contained way

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  • One might suggest that Education is key to changing the future performance of the NHS both at undergraduate and post graduate level in response to a multitude of issues that have been in the press. Since Nurse Education moved to Higher Education many of the suggested aspirations appear to have failed. The move to Higher Education has been closely linked to the perceived poor performance and crises and low client satisfaction. The Francis Report being the latest. Is it time to audit what Universities have been doing with the massive amounts of money that have come to their coffers from government. It's time for some of the Nurses in Parliament to look at and champion this. The culture of Universities has been a real challenge to staff who worked under the NHS ''college'' system. There is no openness or transparency and questioning just makes you a target. The NMC needs to be replaced by a new statutory organisation that can address the current challenges and save nursing from losing the support nurses have previously had from the public.

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  • michael stone

    'Investigators at North Cumbria University Hospitals Trust said discussions with staff suggested many “felt intimidated and bullied”.'

    I keep repeating this - FIRST make it impossible to 'bully' staff who honeslty raise concerns (by puttting the right systems in place), THEN stress their professional duty to raise concerns.

    It looks a lot like 'going over the top' in WW1, to raise a concern in some parts of the NHS, so far as I can see - that can't encourage anyone to speak up !

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  • I'm fairly confident a great deal of staff working in Cumbria in general would agree with that quote attributed to North Cumbria trust.

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