A report published by NHS England has outlined its suspicions that failings in governance may have occurred at the Royal Cornwall Hospitals Trust (RCHT).

As a result, the Trust has updated a list of agreed 'undertakings', which was first published in April 2019 and now revised this month, in June 2021. 

In it the Trust and NHS Improvement, a non-departmental body responsible for overseeing the National Health Service's foundation trusts and NHS trusts, has agreed revised wording to add extra points to the ‘Issues and need for action’ section. 

The list was first put together in 2019 after NHS Improvement found "reasonable grounds to suspect that the Trust has provided, and is providing, health services for the purposes of the health service in England while failing to comply with conditions of the licence." 

As a result, the trust agreed at that time to take a series of undertakings, including to ensure financial sustainability, a strengthened workforce and improved waiting times. The full list can be found here.  

The latest revisions come after an independent report in relation to governance within the Trust stated that there are "reasonable grounds to suspect that there may have been decisions made inappropriately outside of agreed governance processes and structures."

In simplest terms, governance means the proper functioning of institutions, including the structures and processes that are designed to ensure accountability and transparency.

The report also claims that it has suspicions that decisions were made "in the interests of individuals identified in the report, rather than in accordance with Trust policy" as well as outside of the authority of individuals.

The revised wording accepted by the Trust goes on to add that, in September 2020, the Trust hired interim consultancy support at a senior level without prior reference to NHS England and NHS Improvement, the Department of Health and Social Care and HM Treasury guidance.

According to the document signed by Dr Mairi McLean, chairwoman of the Trust, and Mark Cooke, director of strategy and transformation at NHS Improvement: "The Trust will follow up the findings of the Freedom to Speak Up Report and ensure further investigation is undertaken and appropriate action is taken in accordance with the Trust’s internal policies and procedures.

"This will include, if necessary, the commissioning of a fit and proper persons review of the individuals cited in the report."

The suspected failings, as listed in the amendment to undertakings, are as follows:

  • Decisions made inappropriately outside of agreed governance processes and structures
  • Decisions made in the interests of individuals identified in the report rather than in accordance with Trust policy
  • Decisions made being potentially ultra vires - 'ultra vires' is a legal term used to describe an act which requires legal authority to be done, but is done without said authority.
  • Potential loss of funds.
  • Decisions made outside of the authority of individuals.

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The Trust has agreed to a number of undertakings as part of the investigation, including following up on the findings of the report as well as ensuring that any breaches of policy or procedure is dealt with following the trust's processes.

In a statement given to the Packet, a spokesperson for the Royal Cornwall Hospitals Trust said: "The undertakings were the board’s decision and it is committed to meeting them in full."

The trust came under fire back in February after three Cornish hospitals were told to make improvements after a series of surgical errors.

The warning came from the Care Quality Commission (CQC) which told the Royal Cornwall Hospital NHS Trust (RCHT) it needed to improve in order to prevent further ‘never events’ from occurring.

A never event is classified as a serious patient safety incident that is "entirely preventable" and should not happen if healthcare providers follow national guidance on how to avoid them.

At the time, RCHT chief executive Kate Shields apologised to patients for "the shortcomings in their care."

In April last year the Trust was taken out of the 'special measures' that were imposed by the Care Quality Commission in 2017, after it went on to show "tangible signs of improvement" in a report from the governing body. 

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