An NHS trust in South West London, responsible for services at St George's Hospital in Tooting and Queen Mary's Hospital in Roehampton, has been told it must improve after numerous staff raised concerns about racism, bullying, and harassment within the organisation. Following a Care Quality Commission (CQC) inspection in February, the trust’s leadership was rated as “requires improvement,” signalling significant challenges still to be addressed.
Feedback from staff painted a troubling picture of what some described as a "toxic culture" marked by "distressing experiences," including discriminatory and abusive behaviour. Many employees reported feeling fearful of raising concerns about patient safety due to potential retribution. Moreover, there was a perception among some that the trust did not fully understand or support the experiences of people from black and minority ethnic backgrounds, contributing to a culture seen as exclusive rather than inclusive. Issues raised included persistent racism, bullying, harassment, and concerns that race and gender acted as barriers to being heard. Some staff cited a blame culture that was at times unprofessional and lacking accountability, consistent with poorly embedded values and leadership cohesion.
The CQC’s report underlined that measures aimed at tackling discrimination in recruitment and career progression have so far been ineffective, with gaps in leadership oversight hampering swift action on safety risks. While the trust published a group strategy in May 2023 aiming to enhance service quality, it was evident that not all staff understood their role within this framework. This disconnect was further complicated by difficulties in merging the culture and leadership between St George’s and the recently integrated Epsom and St Helier University Hospitals NHS Trust, which share an executive team. The CQC noted missed opportunities for collaborative learning and highlighted tensions between executive leaders and front-line managers, which have slowed improvements, particularly in maternity services.
Despite these concerns, the watchdog recognised some positive developments. The trust partnered with others to open a new orthopaedic centre, reducing hospital stays for patients. Additionally, it maintains a dedicated research and innovation team involved in over 300 clinical trials aimed at advancing healthcare. Improvements in specialties such as urology and community care projects designed to support frail individuals were also noted as examples of good partnership working.
Antoinette Smith, deputy director of operations at the CQC London office, emphasised the need for urgent action on cultural issues. Speaking about the inspection findings, she said, “It’s absolutely critical that the trust tackle this as a priority. Everyone should feel respected, and able to speak up and be listened to. Staff have important information to share that can keep people safe.” She acknowledged the trust’s commitment to improvement but warned that the cultural change necessary remains a significant challenge.
In response, St George’s University Hospitals NHS Foundation Trust acknowledged that any staff member feeling unheard or unsupported was one too many. A trust spokesperson stated, “We fully accept this rating is not where we want to be for our staff and local communities.” The trust asserted it has already taken immediate steps to bolster support for staff and strengthen oversight of quality and safety across its services, while committing to further efforts to listen to colleagues and enhance the diversity of leadership teams.
The issues uncovered at St George’s fit within a broader national context where concerns over bullying, racism, and toxic culture have been reported across several NHS trusts. Independent investigations into other trusts, like University Hospitals Birmingham and Leeds Teaching Hospitals, have revealed similarly high levels of staff bullying and harassment, with leadership often criticised for failing to respond adequately. The CQC’s increasing focus on leadership and culture ratings reflects a systemic push to address these deep-rooted problems, highlighting that the safety and wellbeing of both staff and patients are closely intertwined with organisational culture.
St George’s ongoing challenges underline the complexity of changing entrenched behaviours and attitudes within large healthcare organisations, especially during periods of structural change and leadership reconfiguration. However, the trust’s engagement with partnerships, research initiatives, and community projects shows a commitment to improvement alongside the necessary cultural reforms. The CQC will continue to monitor progress through upcoming inspections to ensure that these improvements result in a safer, more inclusive working environment and higher-quality care for the population of approximately 1.3 million people served by the trust.
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Source: Noah Wire Services