Whistleblowers claim an inner circle around the leadership, fear of speaking out and 'bullying culture' go to the heart of problems at the region's biggest hospital.
An 'inner circle' dominates the leadership of Norfolk's main hospital, according to whistleblowers.
Health watchdog the Care Quality Commission (CQC) last week slammed the leadership of the Norfolk and Norwich University Hospital (NNUH), as it became one of only eight hospitals in England to be rated 'inadequate' overall.
The CQC inspected from last October to this March after 19 whistleblowers came forward raising a range of concerns including about patient safety, bullying and leadership.
The watchdog rated the hospital 'inadequate' for safety and leadership, but 'good' for caring.
Today we report on the leadership issues and tomorrow we will look at the safety concerns.
Inspectors' findings on leadership included:
-Six of the 19 whistleblowers felt bullied by members of the executive leadership team.
-A 'culture of fear and reprisal' among some staff
-A perceived 'inner circle' had developed at the top
-Senior nurses felt 'publicly humiliated' if they raised concerns
-Board oversight of the leadership was not effective
Chief executive Mark Davies, who has led the hospital since 2015, said the culture of the hospital was changing and he was staying in his post.
When asked why the hospital still believed Mr Davies was the best person to lead the NNUH forward, chairman John Fry said: 'We accept the findings of the CQC, we have taken them on the chin, and the senior leadership team is committed to get the Trust out of special measures as soon as possible.'
The CQC findings are backed up by a former member of the hospital's executive leadership team who recently quit, they said, because of the way the hospital was managed.
'I was not afraid to speak up and to challenge,' they said. 'I would be shouted at across the table in front of people.
'If around the executive team you feel you are not getting listened to, what is it like for nurses?'
They called on the chairman, Mr Fry, and chief executive to 'show some leadership' and resign.
'The CQC report is relatively fair,' they added. 'I'm not sure the hospital is unsafe but it is definitely led inadequately.
'The management style at the hospital is very formal and old fashioned. It is 1970s, blue-eyed boy management.'
The former senior manager supported claims made to the CQC by whistleblowers about an 'inner circle' around the chief executive.
But the hospital said it 'strongly refuted' the claims.
It said health think-tank the King's Fund had found that the chief executive's style was 'overwhelmingly positive' as well as 'inclusive and open'.
The CQC, meanwhile, uncovered a lack of oversight of the leadership by the board and chairman.
They found the appraisal section was empty in the files of the chief executive, chief finance officer and the trust secretary. The last time the trust secretary had been given appraisal objectives was in 2012.
They also found evidence the hospital's secretary had re-written reports on behalf of other board members, without their knowledge, which led to 'tension' amongst the senior team.
And when the CQC asked the hospital for a job description for the trust secretary the hospital could not provide one.
'The executive team was not functioning effectively or cohesively,' the CQC said.
The head of finance and director of nursing left the hospital this year.
In response, an NNUH spokesman said: 'Changes have already happened within the leadership of the Trust and the executive team is committed and determined to address all the concerns raised by the CQC.'
Like the rest of the NHS, the hospital faces unprecedented levels of demand which its budget has not kept up with.
But the former member of the executive team, who praised the hard working front-line staff, said: 'Funding is not the main issue. You could give the hospital another £100m a year, but with the same leadership team it wouldn't change.
'They are in deficit but most hospitals are and most hospitals are not inadequate for safety and leadership.'
In a survey of 750 readers on this newspaper's website, respondents said their biggest concern of all the CQC's findings was the leadership being rated 'inadequate'.
Two thirds of respondents also said the chief executive should resign.
•Whistleblowers 'disgruntled' nurses
More whistleblowers came forward to the national watchdog about the NNUH than from any other hospital in the country bar one at the end of 2017.
But hospital chief executive Mark Davies described them as 'disgruntled' nurses to the CQC.
Former health minister and North Norfolk MP Norman Lamb said it was crucial for NHS trusts to listen to whistleblowers.
Mr Lamb helped lead the campaign to expose hundreds of deaths at the Gosport Memorial Hospital caused by administering dangerous amounts of painkillers.
He said: 'People should never be dismissed as disgruntled in my view.
'There should be a willingness to explore why they are disgruntled as sometimes there are underlying issues which need to be addressed.
'The Trust really must ask itself profound questions about why people feel unable to challenge issues within the hospital.'
•What about the board?
The board of the hospital once again came in for criticism from the CQC last week.
In 2014 the watchdog said it was concerned about the 'effectiveness' of the board.
This time it said: 'The trust must improve the level of oversight, scrutiny and challenge from the chair and non-executive directors.'
The chairman since 2013 has been John Fry.
A former executive leader at the hospital said: 'The chairman is rarely there apart from at board meetings.'
But the NNUH denied that.
The hospital said independent think-tank, The King's Fund, which reviewed the NNUH in April this year praised the chairman.
They described him as 'highly valued and supportive' and the non-executive directors as 'high-calibre, capable individuals with a broad skill-set.'
The board is made up of six non-executive directors and five executive directors.
•What the hospital says
The hospital said it was changing its culture and was tackling bullying.
It has introduced a phone line which staff can call in confidence.
It has also brought in 'Freedom to Speak Up Guardians' who support whistleblowers.
The hospital also has a values programme called PRIDE (People-focused, Respect, Integrity, Dedication, Excellence).
A spokesman said the programme was based around listening, learning and establishing principles of behaviour for its staff.
'Everyone on the board is committed to addressing all the points raised in the CQC report,' the spokesman added.
Chief executive Mark Davies said he found 'significant deep rooted issues' when he joined the hospital in 2015.
'We are talking about them and exposing them and it is a good thing that staff of all professions, backgrounds and levels are speaking up.
'However, major cultural change takes time. We recognise that there's more to be done.'
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