CQC flags bullying, discrimination concerns and uneven leadership at Epsom and St Helier
The Care Quality Commission has rated leadership at Epsom and St Helier University Hospitals NHS Trust as requires improvement after inspectors heard repeated concerns about workplace culture, recruitment practices and the pace of change inside the organisation. Staff described bullying, harassment and fear of reprisal, with some also raising concerns about racism and perceived unfair treatment during the May inspection.
The picture inside the trust was not uniformly bleak. Inspectors also found areas where staff described a supportive environment and where diversity was embraced, particularly in parts of the organisation with stronger local leadership. But the overall assessment was shaped by inconsistency: good practice in some divisions sat beside slower management action, uneven strategic focus and complaints from staff who felt unable to speak up safely.
The most consequential problem is cultural. When employees believe concerns may trigger retaliation, poor practice tends to persist longer, recruitment suffers and clinical teams lose the frank internal challenge needed to protect patients. In a hospital group already under pressure from ageing buildings and service demand, a fractured workplace culture can quickly become a safety issue rather than an abstract management problem.
Staff accounts described fear, delay and unequal progression
Inspectors heard about “poor cultural practices” and said managers were slow to act. Reports of bullying and harassment were most prominent in pharmacy and surgery, alongside a wider fear of reprisal when speaking up. Black and minority ethnic staff were over-represented in lower pay bands and under-represented at senior levels, an imbalance that points to more than isolated grievances and suggests structural problems in hiring, promotion and career progression.
Those findings matter because leadership quality shapes everything from rota stability to the speed with which concerns reach senior decision-makers. If staff think complaints will be ignored or punished, problems are more likely to stay underground until they affect patient care. In that sense, the inspection findings describe not only a workforce morale issue but a governance failure with direct clinical consequences.
A supportive culture appeared in pockets, which gives the trust a practical starting point for reform. Strong teams can set local standards for respectful behaviour, whistleblowing and fair recruitment, but those gains need to spread across the organisation if they are to change the overall rating. The CQC said there was strong leadership in some areas, yet it was not consistent across the trust.
Safety concerns extended beyond leadership into the hospital estate
The CQC also described the trust’s estates as a significant risk because of the age and condition of some buildings. In urgent and emergency care in particular, inspectors found that the state of the facilities affected patient safety, privacy, dignity and care. Crumbling infrastructure does more than create inconvenience; it can interfere with infection control, patient flow, confidentiality and the basic ability of teams to work efficiently under pressure.
Those building concerns echo a previous inspection in 2024 that also pointed to deteriorating facilities. The trust later secured £57m of government funding in June to redevelop St Helier Hospital’s emergency department, a major capital commitment that reflects how serious the estate problem has become. Even so, capital money does not fix the immediate operational strain caused by overcrowded, outdated and poorly configured clinical spaces.
A striking feature of the inspection was how closely physical and organisational weakness overlapped. The CQC said there had been a lack of stability on the board, though permanent appointments were made shortly after the May assessment. It also found that engagement with clinical sustainability initiatives and workshops was not consistent across all divisions. In practical terms, a hospital system cannot repair frontline standards quickly if senior leadership turns over too often and improvement work reaches some departments while bypassing others.
Trust leaders say strengths were found, but consistency remains the test
Chief executive Chinyama Okunuga said inspectors repeatedly heard that patients felt listened to, respected and well cared for, often in difficult circumstances. He said inspectors identified many strengths, including capable leaders, clear strategies, stronger complaints handling and partnership working. That response is important because it suggests the trust is not starting from zero; there are functioning parts of the organisation that can be used as a model for wider reform.
Yet the CQC’s central criticism remains unchanged: the trust needs a more consistent standard of care and a more coherent strategic focus. Antoinette Smith, the watchdog’s deputy director of hospitals in London, said the inspection found shortfalls in safety management and in ensuring a consistent standard of care and strategic focus. She added that the regulator has shared its concerns with the trust’s leadership, which now understands the improvements required.
For patients, the message is straightforward. A hospital can have dedicated staff, decent complaints handling and pockets of strong leadership while still falling short on culture and safety if the system around them is too uneven. For staff, the more urgent issue is whether complaints about bullying, discrimination and unfair treatment are met with visible action rather than internal drift.
The next phase will be judged not by statements of intent but by whether the trust can make leadership expectations uniform, protect people who raise concerns and turn capital investment into a safer working environment. The inspection leaves the trust with a clear mandate: fix the culture, stabilise the leadership structure and reduce the risk created by buildings that are already affecting patient care.