'Blame culture' and unsafe staff levels at NHS trust

An NHS trust at the centre of a breast cancer care scandal had unsafe staffing levels and a "blame culture", inspectors have found.

County Durham and Darlington NHS Foundation Trust (CDDNFT) was told it "must make immediate improvements" by the Care Quality Commission (CQC), following a series of inspections late last year.

The watchdog found "standards of care had deteriorated" and staff said they were "actively discouraged from speaking up about concerns".

The trust accepted the findings and said "significant work" had already been done to strengthen patient safety, improve services and support staff.

Durham Police was already investigating whether any criminal offences had been committed before the report, after multiple failings in breast cancer services at the trust, including missed cancers and unnecessary mastectomies.

CQC inspectors identified "significant and serious safety concerns" at surgery services at University Hospital North Durham, Darlington Memorial Hospital and Bishop Auckland Hospital in October.

These related to safe staffing, escalation when patient health was deteriorating, record-keeping, and learning from incidents.

The trust was issued with a warning notice, and all three sites were given an overall rating of 'requires improvement'.

Meanwhile, the trust's "well-led" rating was downgraded from 'good' to 'inadequate', following an inspection in December.

CQC deputy director of hospitals in the North East, Chris Storton, said it was concerning staff "didn't feel listened to and had to repeatedly raise the same issues".

"For example, the absence of a call-bell system in theatre was added to the risk register in June 2023.

"Funding was agreed in December 2024, following a serious incident. However the system wasn't installed until almost a year later, leaving people at risk during that time."

The CQC said trust leaders did not always inform relevant organisations about serious incidents, including the issues with its breast cancer service.

It said on "several occasions" it had become aware of serious incidents through the media, or parliamentary contacts, rather than being notified directly by the trust, which they were required to do.

However, a further inspection of the trust's community health services for adults saw it re-rated as 'good'.

CDDNFT chief executive Steve Russell said: "We fully accept the findings of these reports and apologise where we have fallen short of the standards our patients, communities and colleagues rightly expect.

"I know some of the findings in these reports will be difficult to read and may understandably cause concern."

He went on to say a "tremendous amount of work" had taken place to drive forward improvement.

For example, 106 of 119 actions linked to the Surgical Section 29A Warning Notice had been completed, the trust said.

It added it had "completely redesigned its risk management process", with clearer ownership of risks at specialty level, defined escalation thresholds, and new training for leaders.

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