East Kent Hospitals: Six Chief Executives, Nine Chairs and 15 Years of Failed Leadership

East Kent Hospitals has spent 15 years changing the cast while leaving much of the script intact. A new review says staff can still regard speaking up as pointless or dangerous, serious concerns can be kept below Board level and non-executive directors struggle through hundreds of pages searching for the warning nobody has clearly stated. The Trust now stands 127th out of 134 acute trusts in England. This isn’t a temporary wobble. It’s a pattern.

In June 2019, investigators carrying “grave concerns” about maternity safety arrived for a meeting with East Kent Hospitals’ senior leaders. They were left sitting in a corridor for 45 minutes. When they were finally admitted, the welcome was described as “incredibly aggressive”. One Trust representative reportedly demanded: “I don’t know why you are here.” The investigators’ recommendations, they were told, were “not needed”.

They were from the Healthcare Safety Investigation Branch, or HSIB. They knew exactly why they were there.

East Kent’s maternity services had emerged as an outlier. Investigators kept finding the same hazards: failures to escalate deteriorating patients, unsupported junior doctors, poorly supervised locums, fetal-monitoring errors and problems with neonatal resuscitation. In August 2019, HSIB took the unusual step of writing to the chief executive about a possible “serious continuing risk to safety”. East Kent’s referral rate was 50 per cent above that of the other trusts HSIB was dealing with.

That wasn’t simply an awkward meeting handled badly. It was a glimpse of an organisation’s reflex when somebody arrived bearing news it didn’t want to hear.

Seven years later, the warning has changed department but not shape.

Helen Buckingham’s independent review of how East Kent handles concerns was presented to East Kent Hospitals’ Board on 28 July 2026. It had been triggered after consultants in Critical Care, Anaesthetics and Surgery went around the normal machinery and wrote directly to the Trust’s Chair in October 2025. The Trust’s dashboards, committees and reporting channels hadn’t revealed the pattern to the Board. The consultants had to carry it there themselves.

Buckingham completed her report in February. It took five months to reach the public Board.

Her review was limited. She interviewed a very small proportion of East Kent’s thousands of employees and accepts that their views might not represent everyone. But their accounts were consistent with each other and with staff surveys and wider engagement evidence. Her prose is careful and measured. What it describes is neither.

Staff told her that the Trust’s routes for raising concerns were “fragile and inconsistent”. Some believed speaking up was “at best pointless” and, worse, unsafe. They feared being “targeted” through closer examination of annual leave or job plans, disadvantage on rotas, lost development opportunities or referral to the General Medical Council. Two interviewees separately said consultants who raised concerns were subsequently investigated. Another said “Trust values” had been used as a threat.

Buckingham doesn’t conclude that those investigations were retaliatory or improper. That distinction matters.

But fear doesn’t wait for a tribunal judgment. Once staff believe a safety concern may be answered with an inquiry into their own conduct, silence starts to look like the sensible career choice. In a hospital, that’s not office politics. It’s a patient-safety risk.

The formal safety net had already come apart. East Kent’s internal Freedom to Speak Up operation “effectively collapsed” in early 2024. For about three weeks there was nobody from the team at work. The Trust recorded no Freedom to Speak Up cases at all during 2024. In an organisation this large, zero concerns weren’t a clean bill of health. Somebody had disconnected the alarm.

The formal safety net had already torn. East Kent’s internal Freedom to Speak Up service “effectively collapsed” in early 2024. For roughly three weeks that summer nobody from the team was at work, and the Trust recorded no Freedom to Speak Up cases during the whole year. Zero reports weren’t a clean bill of health. The alarm had stopped working.

An external service began in March 2025 and received 81 contacts within six months. That surge doesn’t prove the Trust suddenly became more troubled. It suggests people had finally found a door that opened. Buckingham says it was too early to know whether confidence had genuinely been rebuilt.

Her review also describes an HR function that was historically “fairly poor”, risk-averse handling of employee relations and a failure to give the Board regular reports on grievances, disciplinary cases and other workforce disputes until March 2025. Without that information, directors couldn’t properly identify clusters, recurring personalities or departments where the temperature kept rising.

Some interviewees described a “nepotistic” culture where opportunities depended on “fitting in” and having the right patron. Managers were sometimes said to be complicit. Buckingham found too little visible evidence that bullying, harassment or racism produced consequences, while previous leaders had allegedly moved troublesome people elsewhere or simply waited for the row to die down.

Bad behaviour, in other words, could and did acquire tenure.

Then there’s the Board.

Its meeting packs can run to 400 or 500 pages. Buckingham found that papers often delivered great slabs of detail without extracting the issues directors needed to examine. Important themes could be “buried deep” rather than hauled into the summary. Board members admitted they couldn’t always read everything with sufficient discernment and depended on the Director sponsoring each report to tell them what mattered.

That’s more than a problem with wordy reports. It allows the people being scrutinised to control the lens through which scrutiny takes place; and hide their failings while retaining their well paid salary.

A warning doesn’t have to be deleted to disappear. It can be divided among different committees, expressed as an unexplained total, stripped of comparison, labelled operational rather than strategic, or submerged beneath enough graphs to tranquilise a herd of rhinoceros.

Buckingham found a cultural view that non-executive directors didn’t need to know about operational matters, “even when they have governance implications”. Directors reportedly treated the anaesthetics concerns as separate pieces of day-to-day business instead of escalating the developing pattern. The acting chief executive had received information through different channels, but the links were made largely in hindsight.

The executive directors must therefore answer for what they escalated and what they choose not to escalate, how they framed it and what they left below the Boardroom waterline.

Non-executives directors aren’t off the hook. Their role isn’t to sit politely while an executive director reads out the reassuring bits. If a 500-page pack conceals the point, send it back. If figures are presented without workforce rates or useful comparisons, demand them. If repeated operational incidents form a governance pattern, drag that pattern into daylight.

Dr Bill Kirkup had already described almost exactly this failure in his 2022 investigation into East Kent maternity services and neonatal services

He found that maternity concerns became “diluted” as they moved through the organisation and lost their significance through repeated summaries. Board papers could be late, incomplete or inaccurate. Directors became lost in detail instead of standing back and asking what the information meant. One Board member said the Trust’s governance was like moving a car’s gear lever and finding that “nothing happens”.

The consequences weren’t confined to a meeting room. Of 202 maternity cases examined, Kirkup concluded that different care might have changed the outcome in 97. Of 65 baby deaths, the outcome might have been different in 45. He placed accountability on “the successive Trust Boards and the successive Chief Executives and Chairs”. They had the warnings and the authority to act but failed to do so. “They were wrong.”

Six people have occupied the chief executive’s office during roughly the past 15 years. The last, Tracy Fletcher earned £247,500 for overseeing the shambles set in Buckingham’s report

Stuart Bain was chief executive when an internal maternity review in 2010 found suboptimal care in 40 per cent of 91 cases. He remained in post as commissioners raised concerns and through the Trust’s inadequate CQC rating in 2014. Chris Bown followed as interim chief executive during the period when a Head of Midwifery who investigated bullying lost the Trust’s backing and resigned. The bullying, Kirkup found, wasn’t addressed.

Matthew Kershaw arrived later in 2015. During his tenure, the Royal College of Obstetricians and Gynaecologists reported weak investigations, repeated incident reporting without effective action and consultants failing to attend when required. Kirkup also recorded evidence that Kershaw’s departure in 2017 was “catastrophic”, indicating that some emerging improvement was again disrupted by leadership churn.

Susan Acott took over in October 2017. Her tenure encompassed Harry Richford’s death, the confrontations with HSIB and the commissioning of Kirkup’s investigation. Tracey Fletcher arrived in April 2022. Both maternity units were subsequently rated good, an achievement that shouldn’t be airbrushed away, but the broader Trust remained under formal regulatory action. Fletcher announced her departure in May 2026. Dr Des Holden is now acting chief executive and has inherited Buckingham’s review

It would be lazy to claim that every chief executive achieved nothing. It would be dafter still to call five completed tenures a successful turnaround.

Some departments improved. Buildings received investment. Plans were written, programmes launched and structures rearranged. Yet the same organisational weaknesses — poor escalation, defensive leadership, cultural fear and false reassurance — continued to turn up in independent reviews like an unpaid bill.

Over the same 15-year period, nine people have occupied the Chair’s position, including interim and acting appointments. Kirkup found that this repeated turnover damaged confidence, broke momentum and encouraged the fantasy that each new leader would finally sort everything out. Another chief, another chair, another action plan. Same stubborn wiring underneath.

East Kent has been remarkably good at changing nameplates.

The directors around the table can’t shelter behind “collective responsibility”, either. Collective responsibility has too easily become collective anonymity: everybody owns the failure in theory, which means nobody carries the can in practice. Kirkup’s judgment applied to whole Boards — executive and non-executive directors — not merely whichever chief executive happened to be holding the pager.

Private Eye’s Shoot the Messenger supplies the wider NHS context. It documented staff who raised safety concerns being investigated, suspended, reported to professional regulators, financially ruined or forced out. It doesn’t prove every fear described at East Kent. It explains why staff know that telling the truth can become a highly effective way of damaging your own career.

There is no need to exaggerate East Kent’s present standing. The verified position is bad enough. NHS England’s latest table ranks it 127th out of 134 acute trusts: eighth from bottom, in the lowest-performing segment and subject to a financial override.

NHS England’s July 2026 enforcement undertaking say earlier improvement work hasn’t produced sustained or demonstrable progress in organisational culture, leadership effectiveness or governance. They record that not all staff feel able to raise concerns without fear and identify the Trust’s largest negative staff-survey deviations around advocacy, compassionate culture, raising concerns and engagement.

Most damningly, the regulator has ordered East Kent not to rely merely on the existence of governance processes as proof that it complies. NHS England now wants Board papers showing real scrutiny, challenge, escalation, decisions and follow-up. It has effectively told the Trust: stop pointing at the machine and prove the thing works.

Buckingham says an action plan has been drawn up. It wasn’t published with the review, even though directors were asked to approve the findings and next steps. The public can see the diagnosis, but not who owns each remedy, whether they’ll remain in post long enough to deliver it, when it must be completed or what happens when progress stalls.

After 15 years of action plans, that omission isn’t administrative housekeeping.

It’s the story.

East Kent has been warned by its staff, patients, bereaved families, commissioners, the CQC, professional colleges, HSIB, NHS England, a coroner and independent investigators. It hasn’t lacked chiefs, chairs, directors, dashboards, committees or paper.

What it has lacked is a reliable route by which an unwelcome truth can travel from ward to Board without being softened, separated, buried or turned back on the person who raised it.

In 2019, the warning was left waiting in a corridor.

In 2026, it’s sitting on the Board table.

Nobody around it can say they didn’t see it.

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