Daily Insight: Wake-up call

Multiple corporate governance problems and ‘deep seated’ cultural issues have been identified at one of England’s highest-profile mental health trusts, according to an external review.

Tavistock and Portman Foundation Trust, which provides a national service for gender dysphoria alongside local mental health services, commissioned an external firm to look into its leadership amid a period of intense public scrutiny in the latter half of 2021. 

In that time, the trust fought a safeguarding employment tribunal brought by a whistleblower and overturned an appeal on puberty-blocking drugs.

Findings of the governance report were published in the trust’s board papers for January 2022.

Concerns were raised about staff’s ability to speak up, while reviewers also found workers from minority ethnic groups did not feel consistently supported, respected or valued.

The report did find that the board was cohesive and had displayed a “consistent focus on delivery of high-quality care”.

It added: “We also strongly believe that the trust board has all the constituent elements to be effective and is serious about board leadership, board processes and effective governance.”

Yet the spotlight fell on NEDs, whom reviewers said demonstrated a lack of effective scrutiny towards trust leaders.

CEO Paul Jenkins said the trust accepts the report’s recommendations, adding that it presents a “unique opportunity to further renew and reinvigorate” governance arrangements.

Going the wrong way

Before the omicron wave last December, NHS England told trusts they had to dramatically reduce their numbers of delayed discharges – by at least half – to free up much-needed beds and staff.

But new figures seen by HSJ reveal that not only are trusts not meeting that target, but levels of discharges are actually getting worse.

There were an average of 12,819 patients in NHS hospitals who no longer met the ‘criteria to reside’ in the week to 23 January.

That was up from an average of 10,500 ‘medically fit’ patients before the Christmas period and the latest covid wave.

The proportion of NHS patients who are ‘fit’ to leave hospital – but can’t due to workforce shortages in social care, among other issues – is also increasing.

In an effort to get on top of the growing problem, NHS England and the government have formed a joint national taskforce “to provide strategic oversight of hospital discharge initiatives”.