The Care Quality Commission (CQC) has today published a damning report into ongoing and deep-seated issues at the East of England Ambulance Service Trust (EEAST).
Following information from sources, including whistleblowers, an inspection of the Trust took place between 25 June and 15 July 2020, about the safeguarding of patients and staff from sexual abuse, inappropriate behaviour and harassment.
The report states that the Trust has not addressed long-standing concerns around culture, leadership and governance, despite flagging them up over a year ago and the introduction of a new leadership team.
Following the inspection, England’s chief inspector of hospitals recommended that the trust enters special measures.
This means it will be inspected again in line with CQC’s regulatory processes. If insufficient improvement has been made at that stage, CQC will use its enforcement powers further.
The inspection found that the trust’s leadership did not cultivate a transparent culture, with some senior leaders adopting a combative and defensive approach when facing reasonable challenge.
It said EEAST staff were undervalued, not empowered to raise concerns and treated disrespectfully when they spoke out about problems.
A statement from the CQC stated, “Some of the trust’s leaders lacked adequate skills, knowledge and experience for their roles. 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 one of its workplaces, including after recommendations were made in an independent report.
“Leaders also failed to act decisively when staff faced allegations of predatory sexual behaviour towards patients.”
In a press statement, the Trust’s executive team said, “[We] absolutely recognise the seriousness of the concerns raised by the CQC, and have set out to improve the organisation’s culture, strengthen safeguarding, and tackle inappropriate behaviour, as urgent priorities.”
Following the inspection, the Trust says that it has:
- updated safeguarding policies; now using new procedures to record, manage and audit concerns
- increased support and mentoring for staff raising concerns and clearer routes for mental health support identified;
- introduced more robust complaints procedures to ensure effective investigations and lessons are learned systematically.
The Chair of the East of England Ambulance Service, Nicola Scrivings 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.
“The trust aims to provide outstanding quality of care and performance for patients and be an exceptional place to work, volunteer and learn.
“In a message to staff today, the executive team has again reinforced its commitment to listen to and support anyone who raises concerns.
“It is clear from the CQC staff survey that the majority of staff at the Trust are proud to work for EEAST.
“The role of the leaders is to make sure every member of the team feels that pride, with the support and culture they deserve.
“I shall continue to work with MPs of all parties to assist the CQC and the Trust in tackling the very deep seated issues that have so adversely affected the operations of our ambulance service.”
Bedford MPs met with the Secretary of State for Work and Pensions, Thérèse Coffey, last week to urgently discuss the situation.
Commenting on today’s report, Richard Fuller, MP for North East Bedfordshire, said: “During last year’s election, I highlighted the need for the East of England Ambulance Service Trust to investigate thoroughly the pressures under which staff operated and the wellbeing support systems that were in place.
“It is therefore concerning that the CQC found that ‘leaders across the trust did not consistently promote a positive culture that supported and valued staff’ and found that ‘reports of cases we reviewed demonstrated that the trust had missed opportunities to support staff with mental health illness due to disjointed occupational health provision and poor staff welfare mechanisms.'”
Bedford and Kempston MP, Mohammad Yasin, added: “Six million people potentially rely on these emergency services at the most crucial time in their lives so it’s truly alarming to see that after all of the interventions last year and a new leadership team that the Trust is still failing its staff and the public to such a serious degree.
“12 breaches of legal requirements and such appalling allegations relating to what appears to be a toxic working culture across the Trust can only lead to patient needs not being met.
“This is very worrying as we enter what is expected to be an extremely difficult and demanding winter.
“Following a meeting last week to discuss the report, the CQC, working with NHS Improvement and the EEAST have already implemented conditions and support.
“This is a welcome first step and I am committed to working with the CQC to address the failings to ensure that staff and patients are safe.”
The report comes as no surprise to union officials.
Eastern regional organiser Sam Older said, “UNISON has been consistently raising issues around the culture at EEAST…and we’ve been working hard with the Trust to resolve them.
“We’ve been pushing for greater action on governance and employee relations and hope that this CQC report will hammer home the message that things still need to get better.
“EEAST must make clear it values and supports its staff, not only for the sake of the the thousands of ambulance workers in the East of England who have given their all during lockdown, but for the millions across the region who rely on a fully funded, fully staffed ambulance service.”
NHS England and NHS Improvement (NHS E/I) has already begun to put a package of support measures in place to help the trust address the serious concerns raised.
CQC has told the trust it must make several improvements, including:
- Implementing effective systems to identify and assess safeguarding issues, and monitor staff Disclosure and Barring Service renewals
- Reviewing policies to deal with allegations made against staff
- Undertaking adequate pre-employment checks
- Ensuring the safety and effectiveness of subcontracted private ambulance services and their staff
- Actioning the findings of its review into inappropriate behaviours and implementing effective processes to manage concerns, grievances and disciplinaries
- Ensuring all required oversight and governance arrangements are in place
- Addressing long-standing concerns regarding bullying and harassment within the organisation.
CQC has also referred the trust to the Equality and Human Rights Commission (EHRC), due to a potential breach of the Equality Act 2010.