Inspectors have rated the leadership of Nottingham University Hospitals Trust as inadequate after hearing of widespread bullying and staff fearful of raising concerns.
The trust, one of the largest in England, has faced significant criticism over the safety of its maternity services from families who have accused it of covering up poor services.
The CQC said some managers at the trust lacked integrity and were more concerned with the trust’s external reputation instead of addressing problems.
As an example the regulator said the challenges in maternity led to support from a nearby NHS trust but there was limited executive oversight of the service with problems being address outside of their role.
It said the trust board was not working effectively and whistleblowing information said executive directors had poor relationships and were working in silos. Some staff did not know who their leaders were, and many said they were not visible or approachable.
Inspectors for the watchdog issued the trust with a warning notice after the inspection in June and July this year.
The regulator said bosses must take action to improve its leadership, culture, governance and management of risks.
An independent review of poor maternity care is being planned for maternity services after an investigation by The Independent revealed dozens of baby deaths and incidents of infants being brain damaged over a 10 year period.
Sarah Dunnett, CQC’s head of hospital inspection, said: “We were concerned about the culture of bullying across the trust with many staff being too frightened to speak up. We were told of bullying incidents occurring that hadn’t been addressed quickly and staff hadn’t been adequately supported. We were told several bullying cases were directly attributable to racial discrimination which is not acceptable.
“There was a high level of anxiety among staff in the emergency department about the overall lack of capacity and space to meet the needs of people using the service. Although staffing was reviewed frequently, it was often challenging to resource the department when it was over capacity which resulted in patients being nursed in areas where staff were not always present which placed them at risk.”
She added the inspectors did see examples of good practice too including good management of surgery services across both hospitals with high quality care a priority. Staff were said to be caring and respectful and working hard to achieve the best outcomes for patients.
She said: “The trust knows where we expect to see improvements. We will continue to monitor the service closely to ensure the necessary improvements are made.”
The CQC visited the Queen’s Medical Centre as well as the City Hospital sites. The overall rating of the trust has been downgraded from good to requires improvement while the trust was rated as outstanding for the quality of care.
The trust has been told tackle the “disconnect between the board and the wider organisation” as well as taking “measurable action to address bullying across the organisation.”
The regulator has also said safety incidents must be reviewed and properly investigated with lessons learned when things go wrong.
It added: “All staff, including those with protected characteristics under the Equality Act, must be treated equally.”
Rupert Egginton, deputy chief executive at Nottingham University Hospitals Trust said: “We would like to assure patients and colleagues that we are working hard to address the serious concerns highlighted in the recent CQC report, focussing on standards of leadership within the trust.
“It’s important to note that the report does not criticise clinical services and recognises the care, dignity, compassion and kindness that our staff provide for our patients; but it’s our job as the leaders of the trust to ensure that the foundations of our organisation - our processes, governance, and learning from incidents - improve to allow our teams to provide safe, high quality care within a positive, open and supportive culture.”
Join our commenting forum
Join thought-provoking conversations, follow other Independent readers and see their replies