HEALTH chiefs in charge of five Greater Manchester hospitals have been savaged in an explosive independent report.

The report found a "lethal mixture" of suspect leadership styles and pressure to improve had soured relations between doctors and managers of the Pennine Acute Hospitals NHS Trust.

An investigation was launched into the board running the trust after medical staff passed a vote of no confidence in them.

The investigation was led by Professor Sir George Alberti - a former president of the Royal College of Physicians - who conducted an eight-week probe including interviews with 150 staff. The trust was formed in April 2002 to bring together management of five hospitals - North Manchester General, Rochdale Infirmary, Royal Oldham Hospital, Fairfield General in Bury and Birch Hill Hospital, Rochdale.

But senior medical staff at all the hospitals became increasingly concerned at major reforms and felt that patient care was suffering in the drive to meet targets.

Sir George's report singled out the trust's two top earners and chairman for specific criticism. He said the leadership style of chief executive Chris Appleby, who is paid a salary of £140,000, had "caused difficulties", while chairman Steven Price and medical director Dr Roger Glew had "not demonstrated their role as leaders".

Sir George wrote: "If they had exercised leadership then much of the dissatisfaction felt across the trust could and should have been addressed."

Mr Appleby and Mr Price are still in their posts while Dr Glew left his £120,000-a-year job with the trust earlier this year to take up a position with another health body.

The report, which made 25 recommendations for change, looked into a series of complaints raised by doctors and other staff.

Morale

Sir George found low morale among staff, questioned the widespread use of locums and agency workers and said he was "not confident" that clinical governance was "robust" across the trust.

Sir George, who said there was "no evidence" patient care had suffered, later told the M.E.N. that Mr Price and the board should resign if they were not able to carry out his recommendations.

He said: "If anyone cannot do the job they should get the hell out."

Mr Appleby said last night that he had no intention of resigning and said he accepted Sir George's findings.

He said: "Everyone at the trust was trying to do the same thing. There was often squabbling about the best way to do that. You can always do a better job and I am not saying my job was perfect but the values were sound."

Mr Appleby admitted he did not have the full confidence of all the trust's staff, but said he felt he was backed by "the majority".

Disappointed

Neil Goodwin, chief executive of the Strategic Health Authority, later gave Mr Appleby his backing but admitted he was "disappointed" the investigation had been necessary.

Medics welcomed the report but raised doubts whether the chief executive should remain in post.

"To say that management failures did not affect patient care is disingenuous," said Dr Ian Hartopp, vice chairman of the local negotiating committee which instigated the vote of no confidence. "Patients have had their scheduled operations cancelled so that emergency targets can be reached, and others have been rushed through without being properly worked up before an operation.

"Our members will be sceptical that the report suggests that Mr Appleby should remain. Clearly the Strategic Health Authority has decided to keep him, which will dismay many."

The Pennine Acute Hospitals NHS Trust was formed to centralise management of the five hospitals, which serve 800,000 people. Relations between bosses and staff gradually soured, and in June this year more than 210 of the 300 doctors voted for the board to resign.

The medics claimed they were not being consulted over major decisions and that patients were being put in inappropriate beds to meet waiting list targets.

Discomfort

In his investigation, Sir George wrote: "Some of the decisions made about structure (albeit for appropriate reasons), some of the leadership styles, and some of the behaviours of all parties have created considerable discomfort. Added to the tensions was the knowledge that further strategic change was required to maintain standards and develop even better forms of patient care and great frustration that, although this was the strong rationale for forming of the trust, the pace of change was slow.

"We do not feel that any one of these factors have of themselves actually caused the current situation but the chemistry of those issues within the history of the trust proved a lethal mixture."

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