Critical report on leading trust watered down ‘on an industrial scale’

As revealed in December, a draft review of a partnership between The Christie Foundation Trust and pharmaceutical giant Roche outlined multiple shortcomings in how the project was handled, as well as citing deeper cultural issues within the trust’s research and innovation department.

The review was written by Professor Andrew Hughes, chair of experimental cancer medicine at Manchester University. However, his most serious criticisms have not been included in his final report. HSJ has seen copies of both versions.

One section of the draft report which has been deleted from the final version had accused managers, executives and the trust board of an “underlying systemic failure” to implement recommendations from two previous reports, in 2012 and 2018, which would have improved the culture and practices in the research division.

Other key changes between the draft and final report include:

• A deleted section which said: “Discordant views were not actively solicited, captured in risk logs, managed and mitigated; rather a bullish stance was maintained throughout of ‘pushing-through’ an original concept despite weight of evidence to the contrary.”

• The draft report said the need for the review was an “indictment of the board of directors’ failure to implement previous recommendations from reviews of clinical research at The Christie”. But this was softened in the final version, which said the need for the review “raises questions as to why previous recommendations from reviews of clinical research at The Christie have not had their intended impact”.

• The draft report described senior leaders and decision makers as having “insufficient awareness/training of the complexities and challenges required to develop and launch (let alone maintain) strategic collaborations of this scale”. But this was changed in the final report to read: “There needs to be increased organisation awareness/training of the complexities and challenges required to develop and launch (let alone maintain) strategic collaborations of this scale.”

In his final report, dated 11 January, Professor Hughes said changes from his draft reflected: “amendments made by the author from comments received, having reviewed further evidence provided than at time of initial draft; and a final meeting with commissioners [The Christie].”

However, the changes, which also include dozens of other instances where language has been softened, have alarmed whistleblowers, who believe the amendments are aimed at minimising criticism of the trust’s leaders.

The report was commissioned by the trust in response to concerns from whistleblowers that the £20m project was being pushed through inappropriately by management. These included serious allegations about bullying and intimidation of those who raised issues internally.

But the fact the Hughes report was commissioned by The Christie, with limited terms of reference, meant whistleblowers also felt the need to persuade NHS England to commission a separate investigation last autumn. This is understood to be nearing completion.

Roger Kline, a former union official who has written extensively on leadership and workforce issues in the NHS, has been supporting the whistleblowers from the Christie. He told HSJ: “It is not unusual for a critical NHS report to be watered down by those who commissioned it, but this revised version is dilution on an industrial scale.

“When you get this many changes to a draft report, it either means the commissioners think the draft report is rubbish, or pressure has been put on to change it. In this case it feels like the latter, because the evidence the draft review was based on hasn’t changed, but the conclusions drawn from it have done.”

A response to the final review circulated within the trust, also seen by HSJ, acknowledges there are “lessons to be learned” from the review, and the “serious nature of the leadership, communication and governance issues”.

But the trust also described an “addendum” section – which contained the most striking criticisms in the draft report – as “not within the scope” of the review and that “Professor Hughes did not have access to other relevant information to inform this”. It said action plans were already in place last year to address these concerns.

Professor Hughes acknowledged the findings in the addendum “could be viewed as not directly within the main thrust and focus of the terms of reference”. But he added: “It is the view of the author that if these underlying challenges in the environment in which the… collaboration was conducted persist, that future strategic collaborations will equally face these headwinds.”

The trust did not wish to comment separately.

Last month, HSJ’s North by North West newsletter set out a list of key questions which the wider NHSE review will need to address.