Whistleblowing in the NHS and the Capsticks report into Liverpool Community Trust

Liverpool Community Health NHS Trust delivers community health services to people in their homes and in health centres, walk-in centres, intermediate care bed based services and GP practices across Liverpool and Sefton. The Trust also delivers specialist dental healthcare, therapies, medicine management, nutrition and dietetic services. Until the beginning of 2015, the Trust had provided health care services to HMP Liverpool.

On 22 March 2016 the specialist health and social care law firm Capsticks published the report of their independent review into significant service and governance failures at Liverpool Community Trust. The review had been commissioned by the new management team at Liverpool Community Health Trust, to understand why the problems highlighted by the Care Quality Commission and others in 2014 had taken place, and assess how much progress has been made since then.

The review was conducted in two distinct phases. The first phase looked at governance issues within the Trust from its creation in 2010 until the appointment of a new leadership team in the middle of 2014. It found a number of failures had led to critical reports by the Care Quality Commission (CQC) and the dispute resolution organisation ACAS in 2014. These included:

• Problems in the way the Trust went about trying to deliver savings over several years which led to a shortage of clinical staff – something which the CQC identified in its critical inspection reports in early 2014.

• Failures to investigate concerns properly, including a serious assault on a clinician by a patient’s family member in 2013.

• Several years in which the Trust failed to exercise proper oversight of offender health services – problems which were identified by the organisation’s new leadership team, and led to the decision to enable a different NHS organisation to provide offender health services from January 2015.

• Failure to properly oversee the Trust’s in-patient services, which led to the serving of two CQC warning notices in January 2014, saying the organisation needed to support staff better and have better quality checking systems to manage risk and learn from clinical incidents.

• An oppressive, top-down culture which the reports finds had its seeds several years before a report by ACAS in 2014.

The second phase of the Capsticks report looks at the Trust today and found that substantial progress has been made since the appointment of a new leadership team at the Trust in April 2014. The report identified several areas for further improvement, these include changes to some of the Trust’s committee structures, further improvements to governance arrangements, and reducing the length of board papers. The report is being made available to the CQC, the Nursing & Midwifery Council and other regulators, as well as NHS commissioners.

A panel of experts interviewed 43 current and former members of staff, and reviewed nearly 900 documents and minutes dating back to 2010. The review report and appendices cover 285 pages and the review cost £160,000.

To read the Capsticks Report please click here: Capsticks Report

The CQC carried out a further inspection of the Trust in February 2016 and still rated it as “Requires Improvement”. Inspectors were satisfied that the trust had sought to address the findings of the May 2014 inspection, and that improvements had been made. However, progress to make the necessary changes was often slow and some services still required further improvement. The full CQC report is available here.