Shropshire Live’s Rowan Hall looks into the findings of NHS Improvement’s review into the way that Shrewsbury and Telford NHS Trust handled a 2018 report into its Maternity Services.
The review by NHS Improvement’s, with independent advice from Heather Tierney-Moore, executive summary concludes that when the outcome of the report by the Royal College of Obstetricians and Gynaecologists was less favourable than it had hoped for, “…the primary trust focus seemed to shift towards the perceived public reaction to the report, rather than getting the right internal assurance and scrutiny to ensure the improvement of services.”
Much of the review focuses on whether the report was withheld from the trust’s board. The review’s executive summary says that the report was not withheld from the board, but that it should have gone to it and the Quality and Safety Committee sooner than it did. It also says that an addendum, which was produced before it went to the trust board, but not before it went to the Quality and Safety Committee, reduced the impact of the initial report.
What does the review cover?
Over two years ago, in July 2018, a report, with an addendum, by the Royal College of Obstetricians and Gynaecologists into maternity services at The Shrewsbury and Telford Hospital NHS Trust was published. It was written following a visit in July 2017.
However, in November 2019, a letter of complaint was sent to the National Medical Director by some of the families affected by the issues covered in the report.
According to the review, the letter alleged that the 2018 report was withheld from the trust board for a year and that the trust management sought to ‘water down’ the report by requesting that an additional document, an addendum, be produced by the Royal College of Obstetricians and Genealogists acknowledging that improvements had apparently been made, which was then added to the report when it was presented to the trust board.
And so, this review was set up, in order to determine whether members of trust management acted in accordance with accepted standards of governance.
What does the review say?
The executive summary first reads: “The process of getting agreement to the revised report and subsequent follow-up visit took up a significant further proportion of the overall timescale.”
It explains that a draft version of the report was first received by trust staff three months after the initial July 2017 visit and that trust staff were unhappy with it, feeling that it was an inaccurate representation of the service. It says that, following a response of this nature, the Royal College of Obstetricians and Gynaecologists made only minor changes and, at this stage, in December 2017, Simon Wright, Chief Executive, partly guided by staff feedback, initially wouldn’t accept the report.
The review goes on to say: “While we believe there were some genuinely held concerns about the report’s accuracy, it seems that the trust’s response at this stage was driven primarily by concerns about the impact of publishing the report in its current form.” Particularly, it explains that the trust was worried about potential public and media reaction and the knock-on effect of this on staff morale and public confidence.
The review’s executive summary goes on: following discussions, the trust accepted the report in January 2018, but concerns remained about its tone and context, particularly in relation to the executive summary. It says that the trust proposed that the Royal College of Obstetricians and Gynaecologists addresses this and agree to a follow up exercise to evidence improvements that the trust had felt it had made. It explains that the Royal College of Obstetricians and Gynaecologists refused to make further changes to the report, but did agree to a follow up exercise.
It evaluates: “Our view is that it was reasonable for the trust to request a follow up if it genuinely believed improvements had been made; it was appropriate to seek external assurance about the changes made and right that the public should get the most accurate and up to date account of the service.”
The review goes on: the action plan prepared in response to the report “…seemed to support the assertion that changes had been made in an attempt to address the concerns raised, although it was focussed more on process than outcomes. However, a single off-site meeting could only ever provide a limited degree of assurance, particularly in relation to issues of culture which cannot easily be assessed from a distance.”
It says: “Again, our view is that the primary purpose of the follow up exercise from the trust’s perspective was to mitigate the perceived adverse impact of publishing the initial report”, and it says that it understands why the trust was motivated to do this, seeing how some staff had been affected by intense media and public scrutiny.
The review’s executive summary goes on to explain that an addendum was produced by the Royal College of Obstetricians and Gynaecologists summarising the findings of the follow up exercise. The review shows that the follow up visit took place in April 2018 and the addendum, first in draft form, was received in June 2018.
Summarising the addendum, the it says: “It is fair to say that the addendum, and particularly the covering paper prepared by management for the board, does reduce the impact of the initial report. This in itself is not of concern if the improvements were evidenced. However, as above, the degree of assurance from a single remote meeting could only be limited, and no such caveats were highlighted to the board or public. The covering paper to the board was overwhelmingly positive in tone, with its twelve-point summary reflecting only the most complimentary aspects of the addendum itself. The overall result was a document that gave the impression that issues in the maternity service had been largely resolved, when in fact there was significant further work to do.”
However, the executive summary goes on to introduce the next paragraph with the short sentence: “The report was not withheld from the board.” It says that the board first saw the report in July 2018.
It explains that the review went in full to the Quality and Safety Committee before the addendum was produced. But “…our view is that the report should have gone to both forums sooner than it did. The trust wanted to wait for the addendum before publishing, but this should not have delayed internal scrutiny; QSC and the board should have had an earlier opportunity to scrutinise the actions being taken by the care group.”
It says: “We can understand why the trust wanted to publish the report alongside assurances of improvements made, but it would have been more transparent to publish sooner, along with a clear statement of how the issues would be addressed.”
It also notes that “All board members were kept informed of the report’s progress and could have challenged the approach or timelines, but did not.”
The review’s executive summary mentions two more things: “Governance arrangements at the service and care group level were not operating effectively in relation to the report and associated action plan…” and “Although a lot of work was initially done to implement actions and keep the action plan updated, there has been very limited ongoing scrutiny of the plan by local or corporate governance forums. This is concerning given the severity of some of the issues identified in RCOG’s report.”
The executive summary concludes by acknowledging that the trust was not obligated to commission the report, but chose to and to publish the results, but “…when the outcome was less favourable than hoped for, the primary trust focus seemed to shift towards the perceived public reaction to the report, rather than getting the right internal assurance and scrutiny to ensure the improvement of services.”
What’s been the reaction to the review?
Ben Reid, Shrewsbury and Telford Hospital NHS Trust Chair, has said: “I accept the findings of the report of the investigation into SaTH’s handling of the Trust-commissioned Royal College of Obstetricians and Gynaecologists (RCOG) report and will act on all of the recommendations.”
He has also said: “We, as a Trust, and I personally, have learnt a valuable lesson as to how we handle such reports in the future. I consider it my responsibility to take these lessons forward and ensure they are applied across the organisation.”
Dr Edward Morris, Royal College of Obstetricians and Gynaecologists President, has said: “We welcome this thorough investigation by NHS Improvement which confirms that our invited review remained materially unchanged from when it was originally submitted to the Trust in October 2017.”
He has followed this up by saying: “While any decision around the dissemination of an invited review report remains the responsibility of a hospital Trust or Board, this NHSI investigation demonstrates that these reports should be shared promptly to ensure openness and transparency.”