Brighton hospital trust accused of being institutionally racist

The main hospital trust serving Brighton and Hove has been accused of being institutionally racist by a support group for black and minority ethnic (BME) staff and patients.

Nine of the BME staff – including two medical consultants – who volunteered to help the trust tackle its problems with race relations now face disciplinary action after they raised a grievance.

Their case has been highlighted by the trust’s BME Network. It spoke out after a report by the Care Quality Commission (CQC) – the government’s official care watchdog – flagged up similar concerns last week.

The CQC described the Royal Sussex County Hospital, in Brighton, and the trust that run it, the Brighton and Sussex University Hospitals NHS Trust, as inadequate.

The trust was placed in special measures and some expect the interim chief executive Gillian Fairfield, who is on leave until Monday 5 September, to leave her job. Her previous trust, Pennine Acute Hospitals, has also been rated inadequate by the CQC.

In its report on the Brighton trust the CQC said: “Staff from BME backgrounds and other groups with protected characteristics reported that bullying, harassment and discrimination were rife in the organisation.

“Staff complained that inconsistent application of human resource policies and advice contributed to inequality – but the board had been slow to address longstanding cultural issues within the trust.”

Professor Edward Baker, the deputy chief inspector of hospitals, said: “It is clear that the problems we have found on this inspection go right through Brighton and Sussex University Hospitals NHS Trust.

“It is a matter of some concern that we found there was a distinct disconnect between the trust board and staff working in clinical areas.”

The BME Network said: “The BME Network for BSUH has for many years both privately and publicly raised concerns about the institutional racism that exists within the organisation.

“The CQC report highlights that staff from BME backgrounds reported that bullying, harassment and discrimination were rife in the organisation and that BME staff felt there was a culture of fear and of doing the wrong thing.

“In addition BME staff also described reporting concerns only to be threatened with disciplinary action.

“The CQC report also acknowledges that the trust board has been slow to address longstanding cultural issues and that the inconsistent application of human resource policies and advice has not only contributed to the inequality that exists on the grounds of race but has also served to further embed many of the negative aspects of the trust’s culture and proved divisive in the management of equality.

“(The) CQC has recommended that the trust undertakes a review of the HR (human resources) functions in the organisations and develop and implement a people strategy that leads to cultural change.

“However, CQC has also acknowledged that ‘in 2015 the trust initiated a race equality workforce engagement strategy. This race equality programme was jointly chaired by the chief executive and the associate director of transformation, who is also chair of the BME Network (Vivienne Lyfar-Cissé).

“‘The strategy has an innovative structure that afforded ownership of eight work streams between BME leads and senior managers and clinicians.

“‘A structure of meetings was initiated and a series of workforce analysis exercises completed.

“‘Unfortunately, this strategy has now fallen into disarray amid a culture of disciplinary action and grievance placing any progress at significant risk.

“‘This risk does not appear to have been acknowledged by the board.’

“It is the position of the BME Network that the race equality workforce engagement strategy provides an effective and efficient process by which the trust board can address the institutional racism that exists.

“As the beneficiaries of the ‘race equality duty’, the BME Network calls on the trust board to take on board the BME Network’s position.

“However, this will first require the fair and just resolution of the disciplinary matters facing the associate director of transformation (and chair of the BME Network) and eight BME staff who are leads for the race equality workforce engagement strategy.

“It is noteworthy that the Workforce Race Equality Standard (WRES) report from August 2015 shows comparative data that indicated that over the last two years the likelihood of white staff entering a disciplinary process had decreased while it had increased for BME staff. The relative likelihood had increased from 1.1 to 2.3 times more likely.

“Eight of the BME leads for the race equality workforce engagement strategy are currently facing disciplinary action due to the findings of Henrietta Hill QC that although their concerns raised by way of a collective grievance was done in good faith the act of raising a grievance itself constituted victimisation.

“However, the CQC report (page 4) states that: ‘Ward managers and senior staff reported that they received little support from the trust’s HR department in managing difficult consultants or with staff disciplinary and capability issues. They told us that HR advised staff to put in a grievance as a first step in resolving any issue.’

“It is acknowledged by CQC that the trust has produced a detailed programme of improvement in response to a warning following the inspection in April 2016.

“However, despite repeated contact with the chief executive Dr Gillian Fairfield, the BME Network has neither been invited to work in partnership with the trust nor given any information on how the trust intends to address the longstanding institutional racism that exists and is highlighted by the CQC report.

“It is also of concern that the trust’s response to the CQC report by way of an email to staff, a media statement and a list of improvement actions since April 2016 does not include any mention of the race equality issues.

“The BME Network calls upon NHS Improvement to work in partnership with the BME Network to bring about the improvements necessary to ensure the trust delivers on its statutory obligations concerning race equality.”

The trust said: “We recognise we have much to do as a trust to tackle the longstanding issues we face towards creating a culture of equality and fairness for all our staff.

“Over the coming weeks and months we will be working hard to address all the issues identified in the CQC report and will be involving our staff, networks and unions to help us to shape the significant journey we must embark on together.”

The trust added that it was already planning to make a number of improvements and actions, including

• Engaging everyone in a refresh of our values and behaviours and the associated processes to ensure they are effective in helping us create a culture of equality, fairness and accountability.
• A review of all of our people policies and practices in partnership with our trade unions colleagues and equality experts.
• Engagement of our existing 250 values and behaviours champions and our equality network/forums.
• Launching our new Equality Hub Toolkit and the development of our BSUH Equality and Inclusion Forum.
• Advertising the Freedom to Speak Up Guardian role to independently support staff.
• Training and developing a team of workplace mediators nominated by staff across the trust.
• Ensuring our trade union colleagues have dedicated time to support the various change projects including the implementation of our wellbeing plan.
• Developing comprehensive leadership training, focusing on fairness, equality and tackling poor performance for all line managers and supervisors.
• Implementation of compulsory training for all recruiting managers and review of our recruitment processes.

In a parliamentary written question on Tuesday 1 December last year Lord Hunt of King’s Heath, also known as Philip Hunt, asked the government: “What assessment they have made of whether the Brighton and Sussex University Hospitals NHS Trust followed its own procedures correctly in appointing the chairman of the trust to hear a right of appeal from nine BME members of staff against the decision of Henrietta Hill QC.”

The question was answered by Lord Prior of Brampton on Wednesday 9 December. Lord Prior, also known as David Prior, had previously visited the Royal Sussex – in January 2014 – when he was chairman of the CQC specifically to find out more about race problems among staff.

He said: “The NHS Trust Development Authority (TDA) is monitoring and working closely with Brighton and Sussex University Hospitals NHS Trust to support the trust to address these issues.

“We are advised by the TDA that the trust’s Race Equality Workforce Engagement Strategy involves multiple work streams led by area-specific engagement groups to address specific issues and challenges across all areas and levels of the trust.

“It was launched at the joint Black and Minority Ethnic (BME) Network and trust conference in October 2014.

“A programme board was established and the first meeting was in February 2015. Programme board meetings are co-chaired by the chief executive and the chair of the BME Network in order to provide oversight, performance management and governance of the race equality action plans developed by the various engagement groups.

“We are assured by the TDA that the trust followed procedures correctly in appointing the chairman of the trust (Julian Lee) to hear a right of appeal from nine BME members of staff against the decision of Henrietta Hill QC.”

Five months after the parliamentary answer and just over a month after the CQC inspection Mr Lee resigned as chairman of the trust. No permanent successor has been appointed yet. Tony Kildare, one of the non-executive directors, has stepped in as interim chairman.

The trust website lists 10 board members. Seven are men and three women. They are all white.