"Bullying, harassment and sexualised behaviour" at SECAmb exposed in damning CQC report

Whistle-blowers who raised their concerns with the Care Quality Commission were praised today for being "brave enough to come forward."

Southeast Coast Ambulance Service NHS Foundation Trust

"High levels of bullying and harassment and inappropriate sexualised behaviour" became normal at Southeast Coast Ambulance Service NHS Foundation Trust because leaders did not act, a damning report from a watchdog has found.

The report from the Care Quality Commission has searing criticism of the trust. Inspectors were called in after a "high number of whistleblowing concerns" from staff. Workers asked to describe the culture to inspectors often used the word 'toxic' said the report.

The shocking findings exposed a culture in which staff were scared to speak out because they feared reprisals. And those who alerted the Care Quality Commission were praised on June 12th for being "brave enough to come forward".

While frontline staff were described as "doing their utmost to provide safe and effective care" for patients across Kent, Sussex, and Surrey, it was the leaders who inspectors described as "out of touch" and not constantly aware of the challenges their staff faced.

The Care Quality Commission said: "The inspection was undertaken after Care Quality Commission received a high number of whistleblowing concerns relating to culture and leadership, including inappropriate sexualised behaviour, bullying and harassment, leaving staff feeling scared to speak out, and a failure by the trust leadership team to address concerns raised.

"But while staff were doing their absolute best to provide safe care to patients, leaders often appeared out of touch with what was happening on the front line and were not always aware of the challenges staff faced. Staff described feeling unable to raise concerns without fear of reprisal - and when concerns were raised, these were not acted on. This meant that some negative aspects of the organisational culture, including bullying and harassment and inappropriate sexualised behaviour, were not addressed and became normalised behaviours."

The findings mean the trust will receive the "highest level of support" to improve its leadership. It has been given an action plan it must conduct to make improvements. Inspectors in this latest visit have rated the emergency operation centre and NHS 111 as "good overall".

The Care Quality Commission has suspended the trust's overall ratings while conducting further checks. The last inspection in July 2019 rated the trust well in all five areas.

Amanda Williams, Care Quality Commission's director of integrated care, said: "We conducted this inspection of Southeast Coast Ambulance Service NHS Foundation Trust in response to concerns raised with us around culture and leadership.

"Our inspectors found that staff on the front line were doing their utmost to supply safe and effective care and treatment of patients across Kent, Surrey, and Sussex. They were doing a decent job, especially considering the added pressures on the service caused by the COVID-19 pandemic.

"But while staff were doing their absolute best to provide safe care to patients, leaders often appeared out of touch with what was happening on the front line and were not always aware of the challenges staff faced. Staff described feeling unable to raise concerns without fear of reprisal - and when concerns were raised, these were not acted on.

"This meant that some negative aspects of the organisational culture, including bullying and harassment and inappropriate sexualised behaviour, were not addressed and became normalised behaviours. I want to praise those staff who were brave enough to come forward, as speaking up in these circumstances is difficult, but it must happen.

"There was a plain disconnect between leaders and staff, leading to poor and unsupportive culture. As a result, the leadership of the trust has been rated inadequate, while the emergency operation centre, and NHS 111, were rated as good overall.

"It is clear the trust needs help to ensure significant improvements in leadership are put in place to give hardworking staff the support they need and deserve to deliver diligent care. Therefore, I recommend to NHS England and Improvement that Southeast Coast Ambulance Service NHS Foundation Trust be placed in segment four of the system oversight framework and receive more support via the recovery support programme.

"This is the highest level of support offered and should give the trust the extra support needed to make the required improvements in leadership. We will continue watching and reviewing progress to ensure sufficient improvements are made."

The trust has been given a list of actions it must take to improve:

• The trust must ensure all complete staff mandatory, safeguarding and any added role-specific training in line with the trust target.

• The trust must improve the culture and ensure all staff are actively encouraged to raise concerns and enhance the quality of care.

• The trust must ensure it takes staff's concerns seriously and takes demonstrable action to address them.

• The trust must ensure that all incident investigations are completed promptly to allow the opportunity for action on learning to be shared and action is taken swiftly.

• The trust must ensure it works collaboratively with system partners to improve category two, three and four response times.

• The trust must ensure the governance and risk processes are fit for purpose and ensure the ongoing assessment, monitoring and improve the quality and safety of the services provided.

• The trust must ensure it looks for and acts on feedback from relevant persons and other persons on the services supplied to evaluate and improve services continually.

• The trust must collect and analyse the End-of-Life calls and share the analysis with Integrated Care Systems stakeholders to reduce the need for unanticipated End of Life calls by emergency and urgent care services.