A healthcare watchdog has used its enforcement powers at the East of England Ambulance Service NHS Trust, following an inspection which found poor leadership had fostered bullying and abuse.
The Care Quality Commission has today published a report following an inspection of the trust between June 25 and July 15, in response to escalating concerns of risk to patient and staff safety.
The CQC had received information from sources including seven whistleblowers – some senior leaders – relating to safeguarding patients and staff from sexual abuse, inappropriate behaviours and harassment.
Inspectors found the board was aware of at least 10 incidents between April 2019 and March 2020 relating to serious allegations of sexual assault, harassment or inappropriate behaviours but had failed to take appropriate action.
They also found three instances where the trust did not suspend staff with serious criminal allegations made against them because they were either on annual leave or sick leave.
The report says: “Senior leaders showed a lack of awareness of some of the fundamental requirements to safeguard patients and staff from abuse.”
The inspection found the trust’s leadership did not cultivate a transparent culture, with some senior leaders adopting a combative and defensive approach when facing reasonable challenge. Staff were undervalued, not empowered to raise concerns and treated disrespectfully when they spoke out about problems.
The inspectors said some of the trust’s leaders lacked adequate skills, knowledge and experience for their roles and that their inability was compounded by their weak use of processes to understand and respond to the challenges they faced.
These shortcomings manifest themselves in the trust’s failure to learn from sexual harassment directed towards staff in the workplace, the inspectors say. Leaders also failed to act decisively when staff faced allegations of predatory sexual behaviour towards patients.
As a consequence of the inspectors’ findings, the CQC has used its enforcement powers to hold the trust to account. This includes requiring the trust to overhaul its safeguarding processes and report back to CQC about issues it must address, including long-standing concerns regarding bullying and harassment, and ensuring adequate pre-employment checks are undertaken.
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The CQC also referred the trust to the Equality and Human Rights Commission due to a potential breach of the Equality Act 2010.
England’s chief inspector of hospitals, Ted Baker, has also recommended the trust enters special measures, which means it will be inspected again and, if insufficient improvement has been made at that stage, the CQC will use its enforcement powers further.
Ted Baker said: “Some leaders adopted a combative approach which deterred staff from speaking out, including on serious issues such as safeguarding and abuse. This fuelled a negative culture, where bullying was normalised, and put patient and staff safety at risk.
“We used our enforcement powers to keep people safe. I have also recommended the trust enters special measures so it can receive the support it needs.
“We continue to monitor the trust closely. We will return to inspect it, to determine whether improvements have been made.”
NHS England and NHS Improvement have begun putting a package of support measures in place to help the trust address the serious concerns raised.
The trust has set up an improvement committee involving multiple stakeholders and a review of systems and policies.
Nicola Scrivings, chairman of the East of England Ambulance Service NHS Trust, said: “Today’s report calls out where we need to improve and we will now do everything possible, as fast as possible, to make the improvements required.
“We are working closely with the CQC, NHS colleagues and other partners to take action right now to address these concerns and put this right for the long-term.
“In a message to staff today, the executive team has again reinforced its commitment to listen to and support anyone who raises concerns.”
A CQC inspection last year rated the trust as requires improvement overall, with services rated outstanding for caring and inadequate for leadership due to continued non-compliance in areas that impacted patient safety.