'Dysfunctional' staff working relationships criticised in NHS trust report

A "dysfunctional" relationship between senior leaders, left staff feeling "fearful, anxious and unable to speak openly" at a major health trust, a review has revealed.

The review of Merseycare, which runs mental and community health services across Merseyside, was published late last year but has only been made public now after an investigation by the Health Service Journal.

The report, which has come to light now after a Freedom of Information request by the specialist Health Service Journal, found that the problems were so great, they were "seen to detract from patient care".

The trust says they have acted swiftly to improve the culture and are running an improvement programme to ensure staff feel safe to speak up and know they will be supported.

Merseycare Foundation Trust provides community and mental health services to over 1.4 million people across Merseyside and parts of Lancashire and Cheshire.

It has long been regarded as a success story – the government watchdog the Care Quality Commission rated it as good in its last inspection three years ago while its leadership was rated as outstanding.

But this report, commissioned by NHS England in June 2025, after the trust itself requested it, tells a different story.

It highlighted a "dysfunctional" relationship between board leaders leading to a "divisive and toxic culture" which was "significantly affecting staff well-being".

Some of those staff were described as "fearful, anxious, and unable to speak openly", while a staff survey carried out for the review revealed low morale with some describing the organisation as "toxic, anxious, divisive and fearful".

The report added that the focus on internal politics "is seen to detract from patient care, operational performance, and staff wellbeing".

Merseycare Foundation Trust itself asked NHS England to commission this report, which came out last November and was never made public.

Eight months on from the original findings, the trust says much has changed, including some changes at board level.

A spokesperson said they "acted swiftly to strengthen Board arrangements, enhance governance and decision-making and further embed the leadership behaviours and standards expected across the organisation".

They added: "Our senior leadership team is consistently engaging with staff through visible leadership, listening events, staff forums and open dialogue. This feedback is directly informing our improvement programme, with a continued focus on ensuring colleagues feel safe to speak up, know they are listened to and are treated with dignity and respect."

"Our focus remains on maintaining the highest standards of care, supporting our people and building an organisation that continues to learn, improve and deliver outstanding services."

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