More than half of staff at a hospital trust that has been under fire for its “toxic culture” have said they felt bullied or harassed.
The findings come from an independent review commissioned by University Hospitals Birmingham (UHB) NHS Trust.
It has been at the centre of NHS scrutiny after a culture of fear was uncovered in a BBC Newsnight investigation.
UHB has apologised for “unacceptable behaviours”.
It added it was committed to changing the working environment.
The trust is one of the largest of its kind in England, responsible for the Queen Elizabeth (QE), Heartlands, Good Hope and Solihull hospitals, as well as some community services.
Of 2,884 respondents to a staff survey, 53% said they had felt bullied or harassed at work, while only 16% believed their concerns would be taken up by their employer.
Many said they were fearful to complain “as they believed it could worsen the situation,” the review team found.
The details make stark reading, with most staff blaming their immediate line managers or colleagues for the bullying.
As many as 30% said they did not always feel safe at work, citing a lack of managerial support over violence and intimidation from patients.
UHB’s Independent Organisational Culture report follows a separate review for local NHS bosses by Prof Mike Bewick after whistleblowers told the BBC they had been punished for raising safety concerns.
One insider had previously described the trust in an interview as “a bit like the mafia”.
Richard Burden, chair of Healthwatch in Birmingham and Solihull, which represents patients, said it was imperative to address “dangerous practices” and bring individuals responsible to account.
“This culture of fear, coupled with the perception of a board and management that is, at best, disinterested and, at worst, actively hostile to staff raising concerns, clearly has serious ramifications for patient safety,” he said.
In Prof Bewick’s reports, published earlier this year, he wrote of a “historical coercive bullying culture where fear and threats were used as a management tool”.
The latest of those two reports, however, identified that improvements had been made.
UHB’s survey, published on Wednesday, suggests the trust’s problems remain widespread.
The second Bewick report, published in June, highlighted for the first time the issue of sexual harassment and the latest survey backs that up, with the review team saying that not enough was being done to “ensure the sexual safety of staff”.
Reviewers analysed documents and spoke to about 4,000 staff members in various departments over four months from April, including non-medical, board and senior leader team members.
Their report highlighted how unacceptable behaviours and working practices had developed, leading to staff feeling isolated, discriminated against, unsafe and undervalued.
The review team also heard less than half (48%) of respondents felt respected by their employer, with many reporting feeling like “just a number”.
Tolerance of poor behaviour had led to staff becoming de-sensitised, the report found, resulting in many feeling pushed beyond their capacity and a significant impact on mental health.
The report also set out key recommendations, including greater transparency by managers, a shift to valuing staff and measures to ensure a safe working environment.
In one sense we haven’t really learned all that much from this 54-page report that we didn’t already know.
Anyone who’s been following Newsnight’s year-long investigation into what we were told was a “toxic” and “mafia-like” working environment at one of England’s biggest and worst performing trusts would have been familiar with its findings.
Staff who felt bullied into silence, who feared their careers would be harmed if they spoke up and a management seemingly more concerned with reputational damage than patient safety.
But what this review does is provide official confirmation and, vitally for the patients and staff at UHB, a roadmap towards a more healthy, inclusive and safer culture.
Although several senior managers who presided over the trust in the past have since departed, the current CEO Jonathan Brotherton is not exactly a new broom. He has been at UHB for nearly a decade and was Chief Operating Officer from 2014 until his promotion earlier this year.
Many staff have told us they are going to need convincing that the leadership style of UHB has really and permanently changed.
In August, whistleblowers wrote they feared little would change following the appointment of new chief executive Jonathan Brotherton from within the trust and little change at board level.
At the time, the trust declined to comment on the letter, sent to a cross-party reference group on the hospital trust.
While the latest independent review observed the trust was taking steps to respond to challenges, it underlined the need for “a fundamental shift in approach, attitude and understanding”.
In response, UHB said it fully accepted the report’s core recommendations.
“We are very sorry for the unacceptable behaviours and working practices that the culture review highlights and welcome the recommendations, which we fully commit to implementing,” Jonathan Brotherton, UHB chief executive, said.
“Whist the review makes very difficult reading, it resonates with what we have heard directly from staff,” he added.
Mr Brotherton said the trust had already begun to make changes to its infrastructure and leadership and would do everything possible to become “the best possible place to work”.
Mr Burden said a new culture and inclusion board at the trust would be “a crucial test of UHB’s commitment to facing up to past failings”.
“We are clear that self-reflection by the trust leadership is essential to building confidence among staff,” the Healthwatch chair added.
NHS Ombudsman Rob Behrens said the trust must now listen to staff and patients, “accept accountability and learn from its mistakes”.
“[The trust] has made a start, but there is much work to do to before we see real change and a shift in the culture of fear that has been instilled at University Hospitals Birmingham Trust,” he said.
“Staff deserve to work in a safe environment, where they are treated fairly, feel valued and are confident that when they raise concerns, those concerns are addressed.”
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