Hello

I read with some dismay the BBC report about Shrewsbury and Telford Hospital Trust (SaTH), which is already in special measures, but has now been rated inadequate by the Care Quality Commission (CQC).

Several things about the report were both shocking and anger-inducing in equal measure. 

1) “Staff at a hospital trust being investigated over baby deaths say there is a ‘culture of bullying and harassment’”.

That’s a tough sentence to read. What the heck has been going on? A hospital being investigated for baby deaths, and claims of a culture of bullying and harassment! 

2)  “Emergency and maternity services at its two hospitals were deemed unsafe”.

Two rather important services (to say the least) are deemed to be the antithesis of what they should be!

3)  “Trust chief executive Simon Wright said: ‘You cannot be unaffected by a report like this’”.

I believe that that sentence falls into the category of ‘understatement’. A very large understatement. 

4). “Inspectors also said as well as the bullying and harassment claims they ‘found a culture of defensiveness from the executive team’”.

Defensiveness?! Not, openness? Not, ‘how can we help you get to the bottom of this?’. Not, ‘please ask us anything’. 

5)  “Staff felt they were not listened to and were sometimes fearful to raise concerns or issues, there was low morale among staff and high levels of stress and work overload”.

When people suffer from stress and are fearful, that tends to be not good for their health and can often result in suboptimal thinking and problem solving, which given the demands and complexity of treating patients, strongly implies that the culture (at least in some parts of the Trust) was putting patients (and staff) at risk. The tragic circumstances which prompted the inspection and report, appear to add weight to that conclusion. 

6) “The report is stark in its denunciation of the current management – not all of them have the ‘right skills and abilities’ to provide ‘high-quality sustainable care’”.

A couple of things leap out here. Firstly, one of the primary roles of a manager is to be aware of ‘skill gaps’ (self and others) and to take steps to fill any ‘skill gaps’ (self and others). At best, this looks like a lack of self-awareness coupled with a liberal sprinkling of incompetence. In fact in this instance, it’s incompetence about incompetence. 

Secondly, the word ‘ability’, used in this context, implies to me something wider than skill, and that by inference that would probably include the ability to actually manage and lead. 

What sorts of behaviours should we expect to see if a leader or a manager was actually displaying a level of ability commensurate with doing that job well? 

I’d suggest that those behaviours would probably not tend to have any causal link to the following finding from the report: 

“Staff did not feel valued, supported or appreciated by senior staff”.

It’s also unlikely that competent leadership and management would inculcate a culture which, as reported by one nurse, resulted in, “junior staff frightened to raise concerns or questions for fear of being labelled troublemakers”.

Something has gone terribly wrong here. Whilst it’s impossible to say at this juncture who is responsible (without more information) it does appear to be the case that there has not only been the aforementioned skill gap, as well as an ability gap, but also that that ability gap includes a lack of some of thee most basic behaviours that the vast majority of sane people would expect from a leader,  and that those behaviours may have helped prevent at least some of these tragic events from unfolding. 

A list of expected behaviours would include:

Being honest 

Being humble

Taking responsibility 

Respecting others

Caring about others

Developing others 

Much of what I have written here is conjecture. However, I cannot help but feel that some sense of doing the right thing has been lost in the complex warp and weave of the culture of this Trust, and that it was lost by the very individuals who were most needed to maintain it.

Hopefully at least some good will come out of this. Learning from, and never repeating these mistakes would be something. 

It seems to me that we must pay at least as much attention to the character of those in positions of power and influence as we do to whatever skills and knowledge they may have. 

Mike 

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