Daily Insight: Humiliating accusations

A hospital boss has warned colleagues of “significant behavioural concerns” reported by junior doctors at a major trust’s cardiology department, including “undermining by public humiliation”.

Matthew Metcalfe was recently appointed hospital executive director for Queen Elizabeth Hospital at University Hospitals Birmingham Foundation Trust. In an internal email, seen by HSJ, he expressed concerns about feedback received from an NHS England visit to the cardiology department.

He wrote that the regulator had raised “significant behavioural concerns within cardiology, including undermining by public humiliation.”

His email said doctors had reported being “fearful of negative feedback” which had made them scared about contacting consultants out of hours, which he said “clearly [has] very serious patient safety implications”. 

The new director, who came to UHB from Northamptonshire Integrated Care Board where he was medical director, warned that such feedback had led to his dismay, adding that “behaviours such as those described have no place at Queen Elizabeth Hospital”.

It comes as junior doctors in UHB’s haematology and obstetrics and gynaecology departments are currently receiving intensive support from regulators following concerns over quality of training and lack of consultant support. UHB said it was “working hard” to reduce unwarranted variation in teaching and learning opportunities.

Handovers and smacked wrists

The latest attempt to crack down on ambulance handover delays has involved five trusts being summoned to see the secretary of state, and new protocols aimed at avoiding the longest delays.

NHSE leaders have told local chiefs about patients being held in the back of ambulances for more than 10 hours, with some trusts holding ambulances as a “management strategy” to ease pressures inside their hospitals.

They outlined a new escalation process to be triggered when a patient has been waiting in an ambulance for eight hours, saying national teams should be contacted at this point so they can step in to help resolve the situation.

Official data has shown a steep rise in ambulance handover delays this month, reaching similar levels to last December, when delays were far worse than previous years, drawing widespread media coverage and political pressure.

There are serious concerns about the NHS’s ability to cope with the high demand which normally comes from patients in early January, particularly as junior doctors are due to strike over this period, and flu infections have not yet peaked.

Ambulance chiefs will welcome the step up in action being taken nationally on this issue, although it’s come very late in the day. The fact the bar has been set as high as eight hours is also a depressing indictment of the scale of the emergency care crisis.