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General Medical Council criticises head of Queen Elizabeth Hospital

The Chief Executive of Birmingham’s major hospital trust has been warned his conduct “does not meet with the standards required of a doctor” and “risks bringing the profession into disrepute” by the General Medical Council.

The ruling against Dr David Rosser comes after an employment tribunal found he gave evidence which was “inconsistent and unconvincing” and showed “apparent bias” against a surgeon who was unfairly dismissed.

Dr Rosser is Chief Executive of University Hospitals Birmingham NHS Foundation Trust (known as UHB), which runs the Queen Elizabeth Hospital, Good Hope Hospital and Heartlands Hospital in Birmingham, as well as Solihull Hospital and a number of smaller sites. The Trust treats more than 2.2 million people every year.

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But the Trust faces a series of problems. Earlier this year, the Care Quality Commission (CQC), the official health watchdog, conducted a series of surprise visits at a number of the Trust’s hospitals, after concerns were raised about issues such as staffing levels, infection control and allegations of staff bullying.

The CQC found that safety “requires improvement” at the Queen Elizabeth, Heartlands and Good Hope hospitals.

The Trust is also struggling to keep up with demand for services. NHS data shows patients face a long wait for cancer treatment, compared to other NHS hospitals across the country.

UHB’s chair since 2013 has been former Redditch MP Jacqui Smith, who served as Home Secretary. But she has announced she is standing down, and starts a new role on October 1 as chair of Barking, Havering and Redbridge University Hospitals NHS Trust and Barts Health group, which run hospitals in London.

A spokesperson for University Hospitals Birmingham NHS Foundation Trust said: “This tribunal case involved complex issues and the Trust, supported by its legal advisors, endeavoured to deliver its obligations in very difficult circumstances. The Trust takes its obligations in respect of disclosure and evidential accuracy very seriously, and will ensure that this is upheld in the future.

“The Trust has considered the warning by the GMC and concluded that there is no need for any disciplinary action to be taken against Dr Rosser. All of the Non-Executive Directors retain full confidence in Dr Rosser and his leadership of the Trust.”

Jacqui Smith, outgoing chair of University Hospitals Birmingham

Employment tribunal

A Birmingham employment tribunal ruled in 2018 that an eye surgeon working for the trust had been unfairly dismissed, following a disciplinary hearing chaired by Dr Rosser.

The Trust appealed, but the appeal was rejected by Naomi Ellenbogen, Deputy Judge of the High Court. Her judgment was critical of Dr Rosser and the evidence he gave to the tribunal.

The judge said Dr Rosser made comments to the General Medical Council about the surgeon which “had not been entirely accurate and, arguably, further confirmed Dr Rosser’s apparent bias against the Claimant.” And she said the evidence he gave to the tribunal “had been, to some degree, inconsistent and unconvincing”.

The original tribunal took the view there was “apparent bias and/or incompetence at a senior management level,” the judge said. She added: “Dr Rosser had not been sufficiently independent. There was a strong suspicion of bias, given his approval of the exclusion on grounds which he ought to have known were false.”

Another judge made further damning comments this week, as they explained why UHB had been ordered to pay £20,000 in costs to the surgeon.

The Health Service Journal reports that in a written judgement dated 28 June 2021, Judge Robin Broughton referred to “serious and material disclosure failings and evidential shortcomings” and continued: ‘’Whilst I stopped short of finding any deliberate dishonesty on the part of the respondent, or the key players involved, I could not rule that out.”

The General Medical Council

The General Medical Council (GMC), which oversees the medical profession, issued Dr Rosser with a formal warning after he referred the surgeon to it in June 2017. The surgeon had previously raised concerns with UHB managers about staff shortages, which he said were frustrating for surgeons and could eventually put patients in danger. However, Dr Rosser said in an email to the GMC that to the best of his knowledge, the surgeon had “not been involved in any whistleblowing episode or other attempt to raise concerns within the organisation”.

In its warning to Dr Rosser, the GMC stated: “You failed to take reasonable steps to ensure your … declaration to the GMC was correct.”

It said: “Your declaration at the end of your referral email to the GMC, was misleading, albeit unintentional, and incorrect. Your conduct as outlined above does not meet with the standards required of a doctor. It risks bringing the profession into disrepute and it must not be repeated.”

Concerns about safety

The Care Quality Commission (CQC), which inspects hospitals, carried out a series of surprise inspections on December 2 2020, when inspectors arrived at city hospitals unannounced.

In reports published February, it concluded that the Queen Elizabeth Hospital, Heartlands Hospital and Good Hope Hospital all “require improvement” regarding safety.

Setting out its findings for the Queen Elizabeth, the CQC said staff did not consistently update venous thromboembolism (VTE) risk assessments patients. This is a condition that can cause blood clots.

It also said the service “did not always have enough nursing staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.”

And it said senior managers “did not always operate effective governance processes, throughout the service.”

Inspectors identified a number of problems at Good Hope. This included a shortage of qualified nursing staff, and inspectors warned: “This resulted in some tasks being rushed, not enough staff to observe patients at high risks of falls, and some patients having to wait to be supported with eating meals.”

Staff shortages were also a problem at Heartlands Hospital, inspectors found. And they said: “The service did not always control infection risk well. Control measures to protect patients, themselves and others from infection were not always used. However, equipment and the premises were visibly clean.”

In a statement issued earlier this year, UHB said: “There are some issues raised in the reports, all of which we were aware of prior to the inspection, which we recognise as requiring further work and this is ongoing.

“At the time of the inspections...the Trust and our amazing staff were 10 months into a pandemic response with over 450 Covid inpatients on the days the inspections took place, rising to 1,054 Covid inpatients during January.

“Despite the enormous challenges faced by our staff, reassuringly there were no escalations related to individual patient safety at the time of inspection. The CQC recognised the complexity of the context and the Trust has provided further assurances related to ongoing work.”

Waiting times

While hospital trusts across the country face huge challenges, UHB seems to be struggling more than most.

For example, NHS figures show just 69% of cancer patients were treated within 31 days at UHB hospitals, in the three months up to April 2020. Across England as a whole, the figure is 94%.

UHB is one of the largest providers of treatment, but other large providers have a much better record. At York Teaching Hospitals NHS Foundation Trust, for example, 97% of cancer patients were treated within 31 days.

Birmingham MP says patients have expressed concern

Edgbaston MP Preet Kaur Gill (Lab) said she had been contacted by constituents who did not feel confident about the care provided by UHB hospitals, including the Queen Elizabeth in her constituency.

She said: “When we hear personal stories from people who have experienced cancellations and also have concerns about the treatment at hospital, you have to take that seriously.

“People should feel confident about the care they are getting.

“I’m sure the healthcare staff also are really worried about this. When I speak to doctors they tell me they want to give the best possible care and they are not able to do that.

“One question is, what is the government doing around supporting trusts and having a very clear plan around supporting trusts?

“An issue I have raised with Dr Rosser is the very high rate of sickness among medical staff. They are absolutely exhausted and feel they are being pulled to do various shifts constantly.

“Every trust where you have to put those measures in place will face concern from staff. But I think the issue is how does the senior management engage with staff in terms of really understanding the impact of what’s been going on and responding to that.”

She added: “There have to be lessons learnt from this unfair dismissal case. It’s important that the trust really looks at that and makes changes.”

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