Agenda item

The Chief Executive (CE) of Barking, Havering and Redbridge University Trust (BHRUT) provided a verbal update on the appointment of Tony Chambers as Interim Chief Executive BHRUT following the investigation and subsequent sentencing of Lucy Letby.

The CE advised that throughout the multi-stage recruitment process for Tony Chambers, all measures were followed regarding the interview and pre-employment procedures, however there were no findings in relation to misconduct during his time at Chester Hospital (CH). Amongst the 11 applicants for the post, four applicants were shortlisted and interviewed, including Tony Chambers who briefly mentioned his experience and some of the challenges he faced at CH.

Tony Chambers’ experience at BHRUT was dominated by Covid-19, with him being only ten weeks in-post when the pandemic began. There had been an external review on the key decisions regarding safety and equality during the time of his appointment, for which there had been a clear governance process and there were no concerns raised. In April 2020, a whistleblowing measure was put in place as an independent guardian policy for staff who were potentially concerned that their issues were not dealt with effectively. Issues raised in relation to management, safety, work and bullying increased between April to October 2020, which signified a positive trend as staff openly proceeded with complaints without anonymisation. This worked to support a changing BHRUT workplace culture as staff could attempt to resolve issues before escalation.

The appointment of CE and Directors was also discussed. In line with the Fit and Proper Persons framework, there was transparency across an individual’s career at BHRUT. From pre-employment checks, appraisals, references, exit interviews, enhanced DBS checks and a formal completion of assessment, all senior staff experienced the same procedures. A leader competency framework was also in place; also based on transparency, the CE commented that Tony Chambers would have met the Trust standards today, although based on the media, his image was flawed.

The criminal trial focussed on the actions of Lucy Letby and did not analyse the conduct of the NHS Trust and therefore, media coverage on the topic of conduct was highly speculative.

A series of questions were asked to the CE BHRUT regarding their responses and reflections on the Letby case. On a question on the Trust’s plans for prevention of such cases in the future, the CE suggested that the Letby case was considered an isolated case which was not ideal to inform policy changes. He also ensured that there were no characteristics which would have indicated that Letby was involved in such criminal activity, where it was further noted that the potential role of race could have misinformed the response of the Senior Leadership Team at CH.

The CE outlined the progress of policy change in response to a question on rebuilding trust from the perspective of the public. A focus on behavioural characteristics alongside seeking external critical reviews and independent bodies of scrutiny would be used to improve transparency and responses to future cases. It was highlighted again that there was no concern surrounding the Trust’s decision at the time of Lucy Letby’s employment at CH.

The CE stressed the importance of the clinical voice in leadership especially where data is involved. It was noted that the public board published positive information on factors such as mortality rates in both Queen’s Hospital (QH) and King George’s Hospital (KG), both of which performed well. Other trends regarding pressures on the Emergency Department in hospitals had been address and there were several positive changes made, which in turn contributed to reducing waiting times at KG. Such improvements represented BHRUT’s ongoing progress following policy changes.

A question was asked regarding the NHS England Fit and Proper Persons Framework for board members, and whether issues around bullying were considered on the risk register. The CE mentioned that as part of the NHS open environment principle, all staff were actively involved in a training programme to manage situations should concerns arise. Following this, a Member raised a question regarding the increase in staff raising concerns using the existing guardian policy and grievance policy in place. It was noted that in consideration of the large scale of the organisation, the number of cases was not problematic, nor should actions be taken to reduce it at the time. All staff were encouraged to follow the implemented procedures should they raise any concerns about the workplace, although staff were also given active bystander training which dealt with issues without engaging in the formal procedure.

A further question was asked in relation to staff wellbeing at BHRUT, and the support measures in place to maintain a standard of welfare amongst staff. With increases in staff raising concerns about the workplace, the CE mentioned that staff were less willing to so do if bullying was experienced with senior staff. The CE explained that whilst it was difficult to change the culture in an organisation, it continued to be a work in progress. Interventions included dismissals for inappropriate behaviour; targeted action for some areas; and improving the staff survey response rate which displayed improvements more recently. Other support services included formal therapy for staff, as well as supervision and more security staff to support staff, especially on the frontline. Examples included an increase in security staff at KG from two to four staff for frailty services in the Emergency Department and reductions in abusive interactions between sonographers and the public in the Maternity ward as a result.

The CE was asked for information on further areas for improvement at BHRUT. Improvements at both QH and KG were outlined; changes to specialist services, a virtual ward for care and support for the elderly and reduced waiting and admission times at KG were highlighted. Following the previous Care Quality Commission inspection which rated KG as ‘inadequate’, the interventions placed contributed to the most recent inspection which suggested significant improvement had been made with a high standard of clinical care and outstanding patient feedback. Other interventions such as reducing agency staff had aided the retention of staff, thus improving productivity and efficiency among the workforce. This allowed for the progression of staff instead of having restricted roles on certain pathways at the Trust.

The CE also encouraged the idea that more services should be introduced in Barking Community Hospital or shopping centre facilities for better accessibility amongst the wider community. This would consequently reduce the strain on hospitals as the pressure on services resulting from higher cancer rates being identified post-pandemic, for example, would require staff to work harder and longer hours.

The Committee noted the update.