Avon and Wiltshire Partnership Trust

Troubled mental health trust had ‘centralist’ culture

NHS South of England commissioned the review of management and governance arrangements at the trust in the wake of critical reports of the care provided to two patients who went on to kill people within months of each other in 2007.

The review team found a severe lack of clinical engagement and discovered the Swindon crisis team that had been responsible for both patients was still “seriously deficient” five years later.

The report said too many of the findings of the two previous inquiries, which were published last November, still had resonance, despite the trust board noting “excellent progress” at its meeting that month.

“We observed the trust culture to be centralist, top down, and target driven, bureaucratic and controlling… The trust should not proceed with its Foundation Trust application until such time as it has achieved a culture where the quality of patient care is the primary concern of all staff,” the report said.

Trust chair Felicity Longshaw and chief executive Laura McMurtrie both left the trust in April. The reviewers found Ms McMurtrie was faced with a “disparate” organisation failing a number of required standards when she joined in 2006.

However, it criticised the excessive use of targets which were often not clinically relevant and interfered with the ability of staff to deliver good patient care.

Ms McMurtrie, who was described to the review team by some colleagues as having an unduly “command and control” management style, restructured the organisation from a locality based organisation to five strategic business units. The review found this restructure was still not embedded and warned the trust did not appear to have the “culture, capability and capacity” to achieve its latest programme of service redesign while maintaining safe services.

The trust serves a population of 1.6 million across six primary care trust areas. The move away from the locality structure has not been supported by commissioners and is one of the factors in the decisions of NHS Bristol and the Bath, North East Somerset and Wiltshire PCT cluster to look at retendering the services.

The review was completed in January this year. Tony Gallagher, who has been a non-executive director at the trust for the past four years and was recently appointed as chair, told HSJ the board accepted the findings of the report.

However, he said the trust was not planning to return to a locality structure and anticipated pressing ahead with its foundation trust application, although success would be a “residual” achievement rather than the trust’s main focus. He said the trust had made a “significant amount of progress” since the change in leadership, improving engagement with clinicians and reducing the number of targets.

He added: “Some of the culture and leadership issues have been a hurdle to us progressing along the foundation trust journey. The change in leadership that has taken place has given us an opportunity to change the culture.”