‘Culture of fear’ at Sussex hospitals, Royal College of Surgeons reports

Bosses at hospitals where police are investigating dozens of deaths have been criticized for ‘bullying’ and promoting a ‘culture of fear’ among staff in a scathing review by the Royal College of Surgeons.

The review focused on concerns about patient safety and dysfunctional working practices in the general surgery departments of the Royal Sussex County Hospital in Brighton and the Princess Royal Hospital in nearby Haywards Heath.

But reviewers were so alarmed by reports of harassment, intimidation and abuse of whistleblowers that they suggested executives at University Hospital Sussex Trust may need to be replaced.

They concluded: “The suitability, professionalism and effectiveness of the current management team should be taken into account given the worrying reports of bullying.”

The report comes as Sussex Police continues to investigate allegations of medical negligence and cover-up in the department of general surgery and neurosurgery, involving more than 100 patients between 2015 and 2021, including at least 40 deaths.

The investigation was prompted by concerns raised by a general surgeon, Krishna Singh, and a neurosurgeon, Mansoor Foroughi, who lost their jobs at the trust after blowing the whistle on patient safety.

The findings of the study, which was conducted last year and published in the board papers of the trustsuggest that problems in the hospital have continued beyond the time frame of the study. They will add to whistleblowers’ concerns that treatment at the trust remains unsafe.

The reviewers were “particularly concerned” about the “culture of fear… among staff when it came to the executive leadership team.” They added: “There were disturbing reports of bullying by members of the executive leadership team, with examples of confrontational encounters with individual consultant surgeons where they were told to ‘sit down, shut up and listen’.”

The review found that staff felt “intimidated” and were reluctant to raise their concerns for fear of reprisals. It recommended support for whistleblowers “so that they feel psychologically safe in raising their concerns”.

“Staff reported that they were reluctant to put any concerns in writing as they would worry that they would be victimized, referred for regulatory action and/or dismissed, as they believed this was happening to colleagues had happened,” the review said.

“Some said this ‘culture of fear’ existed in association with a number of CEOs, where their ‘tactic’ was to single out someone in the department who spoke out and then fire them.”

The current chief executive, George Findlay, and his predecessor, Marianne Griffiths, who retired in 2022, were praised by former Health Secretary Jeremy Hunt for building “the best learning culture I have seen anywhere in the NHS”.

The review found reports of bullying in the surgical department, including two trainees who were “physically assaulted by a consultant surgeon in the operating room during surgery”. It called on the trust to “address the broken relationships within the department to restore unity”.

The report highlighted a range of concerns about patient welfare, including high cancellation rates and long wait times that could be dangerous.

It turned out that cancellations often occurred on the day of surgery “after patients had waited up to seven hours, after preparing for the operation, for example by not eating and/or drinking”.

The emergency admission rate for patients with colorectal cancer was 54%, well above the national average of 20%. Mortality rates for abdominal surgery were also higher than the national average, posing a “threat to patient safety.”

The reviewers were alarmed by the high number of patient complaints, with 45 outstanding complaints at the time of the review. But it found improvements in the way the trust learned from past mistakes and found staff were “extremely committed, open and helpful”.

Findlay pointed out that he ordered the review to address “major challenges” in the department of surgery.

In a statement, he added: “Long-term issues cannot be solved overnight, but significant progress is being made now. We all want to further improve patient care, so building a stronger structure around the team and stronger relationships remains an absolute priority.”