Executive summary

The review panel was thankful to the Placement Provider (PP) for accommodating this review. The review panel was pleased that Resident Doctors (RDs), Locally Employed Doctors (LEDs) and Dental Core Training (DCT) learners reported that the OMFS department offered a great training experience. It was noted that there was a wide variety of education opportunities and generally theatre time was sufficient to meet curriculum requirements. OMFS RDs and LEDs were particularly complimentary of the efforts of the new locum consultant who had assumed responsibility for education and training in the department. The review panel was also pleased to hear that the junior team in OMFS appeared to be working well and were supportive of each other at the different training levels. 

The review panel was very concerned to hear that there were some dental learners who did not feel safe to raise concerns and felt that as a result there were likely concerns which were not being shared with the senior leadership team. The review panel was also concerned that some of the consultant body no longer felt able to raise concerns as previous concerns had reportedly been handled inappropriately or no action had been taken.  

The review panel was informed about several instances of inappropriate behaviour by OMFS consultants which were not historic. It was reported to the review panel that some concerns raised about these instances had not been dealt with appropriately and in some examples, individuals had been told to not discuss the concerns.

The review panel noted a disparity in communication with OMFS RDs and LEDs, and other Dental specialties about the publication of The Sunday Times article. OMFS learners reported that they had been informed of the article prior to publication, however learners from other departments had not. Dental supervisors and learners reported that they had been instructed to not discuss the article by senior leadership in the days following the publication which they felt was inappropriate and unsupportive. They also noted a perceived lack of transparency around the PP’s response to the allegations made.

The review panel agreed that the NHS England’s Intensive Support Framework (ISF) rating of Oral and Maxillofacial Surgery at the Royal London Hospital is ISF 3. This report includes specific requirements for the PP to take forward, which will be reviewed by NHS England- London as part of the three-monthly action planning timeline.

Review overview

Background to the review

Following a report published in The Sunday Times newspaper detailing accusations of racism, bullying and toxic behaviour within the Oral and Maxillofacial Surgery (OMFS) department at the Royal London Hospital, NHS England-London required assurances from the Placement Provider (PP) that high quality education and training was being provided to all learners that operate within the department. As such NHS England-London conducted a multi-professional Urgent Risk Learner and Educator Review to speak to all available Resident Doctors, and Dental learners within the OMFS department, as well as their supervisors.

The content of the review report and its conclusions are based solely on feedback received from review attendees. The following evidence provided by the PP was used by the review panel to formulate the key lines of enquiry for the review:

• Breakdown of the number of Dental and OMFS educational and clinical supervisors within the department
• Breakdown of the number and type of all learner groups within the department
• Report from PP Review of Education and Training in Oral and Maxillofacial Surgery at The Royal London Hospital
• PP Dental Report with an overview of training at RLH and strengths and challenges for training
• Dental Teaching Attendance
• Freedom to Speak Up Guardian Board report 2023-2024
• Freedom to Speak Up Guardian Activity Report February 2025
• Dental Core Training Induction feedback September 2024
• Dental Core Training Local Faculty Group (LFG) Meeting Minutes- March 2024, July 2024, November 2024 and March 2025
• Orthodontic LFG Meeting Minutes- September 2024
• Paediatric Dentistry LFG Meeting Minutes- May 2024 and January 2025
• Restorative Dentistry LFG Meeting Minutes- February 2024, June 2024, December 2024 and March 2025
• Mid-Year Dental Learner Survey Results 2024-2025
• Medical Education Committee (MEC) Minutes- February 2024, May 2024, August 2024, December 2024 and February 2025 

Who we met with

Learners

• 13 Resident and Locally Employed Doctors as well as Dental Learners, working within the OMFS department or who directly interface with the department for clinical work.

Educators

• 2 OMFS clinical and educational supervisors- Please note as there were less than 3 supervisors in attendance the contents of this session has not been included in the report to protect the anonymity of the attendees.
• 14 Dental clinical and educational supervisors who supervise learners working within the OMFS department or who directly interface with the department for clinical work

Education team

• Director of Medical Education
• Medical Education Manager
• Dental Education Manager
• Educational Lead for OMFS at Whipps Cross Hospital
• Deputy Director of Dental Education
• Freedom to Speak Up Guardian
• Head of Medical People Relations
• Medical Director
• Divisional/General Manager
• Associate General Manager
• Trust Dean
• Associate Director of Medical Education
• Postgraduate Lead for Medical & Dental Education
• Deputy Director Education Academy
• Undergraduate Lead for Medical & Dental Education
• Education Lead for Non-Medical Training

Review panel

• NHS England- London System Dean- North East London, Louise Schofield, Education Quality Review Lead
• NHS England- London Deputy Head of the London Specialty School of Surgery, Dominic Nielsen, Specialty Expert
• NHS England- London Regional Postgraduate Dental Dean (London & Kent, Surrey, Sussex), Sana Movahedi, Dental Specialty Expert 
• NHS England- London Regional Associate Postgraduate Dental Dean (London & Kent, Surrey and Sussex), Helen Tippett, Dental Specialty Expert 
• Dental Core Training Learner, Palna Panchasara, Learner Representative
• Robert Hawker, Lay Representative 
• NHS England- London Education Quality Coordinator, Rebecca Bennett, Education Quality Representative
• NHS England- London Education Quality Coordinator, Sahariyea Siddique, Observing for Training

Review findings

Culture and raising concerns

Placement Provider (PP) representatives advised that the Ibex Gale report which had been leaked to the press was part of a response by the trust to concerns about behaviours raised by members of the Oral and Maxillofacial Surgery (OMFS) department. PP representatives reported that the PP was reviewing how such investigations would be commissioned and shared in future, as the subsequent leaking of the report had impacted peoples’ confidence in raising concerns through fear that they would be identified and potentially named in the media.

PP representatives clarified that the issues of patient safety identified in The Sunday Times newspaper article had been investigated and were not substantiated. PP representatives also clarified that the Ibex Gale report did not identify any patient safety issues specifically but did agree that the cultural issues identified had the potential to lead to such issues if they were not resolved. PP representatives informed the review panel that an external safety audit of surgical outcomes was being conducted by an OMFS consultant who did not work at the PP, the results of which were due in May 2025. It was also noted by PP representatives that they had met with the General Medical Council (GMC) and the Care Quality Commission (CQC) to discuss issues raised. The review panel was informed by PP representatives that there were currently HR processes being conducted for 4 individuals in the department. PP representatives advised that there was also an internal report due in May 2025 which looked at learning from the situation and how issues had progressed to the extent they had. PP representatives also reported that they were actively seeking an independent company to conduct further OD work but were still in the process of negotiating terms.

PP representatives told the panel that issues relating to the culture and behaviours in the OMFS department, which had been described in reports submitted to NHS England in advance of the review, were historical and nothing of that nature was happening currently. This was being monitored by attendance at meetings such as Multi-Disciplinary Team Meetings (MDTs) and the Morbidity and Mortality (M&M) meeting. PP representatives advised they would continue to monitor this and informed the review panel of their intention to conduct focus groups in partnership with the Education Academy to continue to hear the experience of learners in the OMFS department.

The review panel asked whether similar feedback had been sought from other professions in the dental hospital or specialties which interact with the OMFS department. PP representatives reported that all feedback from people currently working with the OMFS department was positive. PP representatives reported that cultural issues had been identified more broadly across the dental hospital. PP representatives advised that they had identified a divide in the workforce between NHS staff and those who were employed by the university. It was noted that a piece of work had been started to address this and a review of the leadership of the dental hospital was planned. However, this information had not been shared with the Dental Education Leads. The review panel noted that the Dental Education Team should be involved in any work to address issues which impacted dental learners.

PP representatives reported that there had not been any concerns raised about culture from Dental Core Training (DCT) learners based in OMFS but that issues had been raised regarding equity of access to learning opportunities and experience in clinics.

Dental learners informed the review panel that they had not observed any behaviour which had directly impacted patient safety. However, some dental learners reported that they had witnessed some inappropriate disagreements between consultants that they felt should not have happened publicly. Some dental learners also described instances where people had been shouted at by an OMFS consultant and were now reluctant to approach the consultant if they needed to ask questions. It was also reported by the dental learners that they had been warned at induction to be careful of specific inappropriate behaviour of an OMFS consultant.

Dental supervisors informed the review panel that they had witnessed and experienced some of the behaviour from OMFS consultants that was described in The Sunday Times article. Dental supervisors also reported behaviour in a joint clinic where dental learners were confronted about feedback they had given regarding the training within the clinic. The behaviour from the consultant was felt to be inappropriate and was subject to a Datix by nursing staff who witnessed it. As a result of the confrontation there is evidence that the feedback regarding the clinic was removed. The dental supervisors and nurses who raised the concerns have not been provided feedback about how this issue has been addressed.

Dental supervisors reported to the panel that when they have raised concerns previously regarding the behaviour of individuals, or have disagreed with them directly, it has adversely impacted their provision of services to patients and still demonstrated a culture of ‘cliques’. For example, resident dental learners had been told by an OMFS consultant not to refer to a particular dental clinic which was felt by learners and the dental consultants to lead to poorer outcomes for patients. As such dental supervisors reported that they no longer see any point in raising concerns to senior leaders. They also reported that they are concerned that there is a lack of transparent communication about processes.

The review panel was informed by OMFS Resident Doctors (RDs) and Locally Employed Doctors (LEDs) that they were not surprised by the contents of The Sunday Times article as they had heard stories from learners who were there at the time; however, they confirmed that they had not experienced any issues themselves. OMFS RDs and LEDs reported that they had heard about some learners who had experienced gender-based discriminatory behaviour, however the cohort the review panel met had not directly witnessed or experienced any of this kind of behaviour. OMFS RDs and LEDs informed the review panel that they had not observed any negative effects on patient care, or their training related to the contents of the article. Some OMFS RDs and LEDs reported that some of the consultants involved in the article had told them about their experiences with other consultants but the RDs and LEDs advised they had tried not to let this affect their own opinions or experience of other colleagues. OMFS RDs and LEDs informed the review panel that they had not experienced any repercussions or vindictive behaviour as a result of working with consultants named in the article.

OMFS RDs and LEDs reported that they had been made aware of The Sunday Times article prior to publication and had been reassured by the Clinical Director that it was no reflection on the work the learners were doing. However, dental learners and supervisors reported that this had not been their experience as they did not receive any communication from the trust until later in the week. Some dental learners and supervisors reported that there had been a meeting at the end of the following week with the executive team in which they were told not to discuss the article. Dental learners felt the communication from the executive team had not been appropriate or supportive and did not inform them of what the PP was doing to address the issues raised in the article. Dental supervisors reported they had provided feedback that the approach taken by the executive team was not appropriate. Dental learners and supervisors reported that transparency from the PP about the article and actions taken by the PP was needed to maintain confidence in the process for raising concerns. The review panel was informed that the OMFS education fellow had spoken to the DCT learners following the article’s publication and had been supportive.

The review panel asked about learners’ routes for raising concerns. PP representatives advised that OMFS learners reported that they would speak to their educational supervisors or Training Programme Director (TPD) to raise concerns. PP representatives advised that the TPD for the London OMFS training programme was based at the PP, therefore RDs had direct access. It was also noted by PP representatives that learners have been reminded about the Freedom to Speak Up (FTSU) service and routes for raising concerns within the PP Education Academy. The review panel enquired about the work the Director of Medical Education and Medical Director had done to obtain feedback from the RDs in OMFS. PP representatives acknowledged concern that the OMFS RDs did not want to provide feedback as a group and instead the PP had to conduct individual discussions, as requested by the OMFS RDs. PP representatives believed this may in part be due to the competitive nature of the specialty, which was reportedly the feedback from the RDs; however, the review panel noted that this had not been their experience in other similar specialties. PP representatives acknowledged that further work was needed to improve the culture and make learners feel comfortable to raise concerns in front of each other.

OMFS RDs and LEDs informed the review panel that they were aware they could raise concerns via the Clinical Director and Education Academy and felt requests for feedback were genuine. Some OMFS RDs and LEDs reported that they would feel comfortable raising concerns to the Clinical Leads in the department.

Dental learners advised that they would feel comfortable approaching their dental educational supervisors (ESs) if they had concerns. Some commented that it was easier to raise concerns with their ESs as they were more removed from the OMFS department. Dental learners also advised that the cohort of dental learners was very supportive, and they would feel comfortable discussing concerns with them. Some dental learners informed the review panel that they would be very mindful about the consequences of raising concerns as they felt that there would be implications on their future career. Some dental learners told the review panel that it made them reluctant to speak up even during the review, as they had seen other previous learners have difficulties. Dental learners advised they felt less confident that instances of poor behaviour would be addressed if they reported it, and this made them reluctant to speak up in the future. Dental supervisors echoed these concerns and noted that learners were more likely to discuss concerns with supervisors who were more removed from the OMFS department. Dental supervisors reported that some dental learners had said they were more reluctant to raise concerns as they had seen that previous concerns raised by dental supervisors had reportedly been handled inappropriately or no action had been taken. 

PP representatives reported that other professions had accessed the FTSU service to raise concerns about culture in the department; however it was noted that many reported they did not have confidence in the ability of the PP to make changes as management processes were slow. It was reported that other departments were not assured that if similar issues were to arise in their departments that it would be dealt with by the PP.

The review panel noted that significant and sustainable changes to culture could take a long time to implement and enquired about the PP plans for the OMFS department in the interim particularly for ensuring appropriate behaviour at M&M and Local Faculty Group (LFG) meetings. PP representatives reported that there had not been any recent adversarial behaviour in OMFS M&M meetings but noted the team had not been complete. PP representatives reported that when bringing the OMFS team back to full staffing they would not allow the previous inappropriate environment and dynamic to re-establish. OMFS RDs and LEDs noted that there had not been many M&M meetings but confirmed that all behaviour they had witnessed had been appropriate. OMFS RDs and LEDs also felt behaviour in theatres had been collegiate and appropriate in their experience.

PP representatives acknowledged that changes would take time to embed and advised they intended to establish standards of acceptable behaviour and reiterate the behaviours that the PP would not tolerate. PP representatives also advised that work was needed generally to manage expectations around what can be shared about Human Resources (HR) cases and to ensure staff were aware of the confidentiality requirements for HR processes.

Educational governance

PP representatives advised that previously there was a regular OMFS LFG meeting, although it was not documented and did not follow the standard agenda for LFG meetings. PP representatives reported that the Education Academy would support the OMFS department to re-establish formal LFG meetings which would be documented.

PP representatives informed the review panel that the various dental training specialties had regular, documented and well-established formal LFG meetings. PP representatives reported that feedback was sought from dental learners in advance of these meetings via surveys and Learner Representatives. It was noted that the Dental Department assured learners that their feedback would not affect their training in any way. Dental supervisors confirmed that the process and record keeping for education appraisals was exemplary and reported that time for LFG meetings was protected.

PP representatives reported that a new locum OMFS consultant had taken the lead for education and was the Assigned Educational Supervisor (AES). OMFS RDs and LEDs reported that the locum consultant was very good and was an engaged clinical supervisor and AES. OMFS RDs and LEDs also reported that the TPD was a good trainer and was supportive of LEDs. OMFS RDs and LEDs felt they benefited for having the TPD based at the PP.

Dental supervisors commended the work and support offered by the Dental Education Lead. Dental supervisors informed the review panel that the Dental Education Lead ensured that all supervisors were appropriately trained for their supervision role. It was also noted that some dental supervisors had sufficient time in their job plans for education responsibilities for NHS training posts, but not all supervisors did. Some dental supervisors reported issues with having sufficient time in their job plans to accommodate supervision of learners in university training posts.

It was noted that the appraisal process for OMFS LEDs was not consistent, LEDs in OMFS advised that not all LEDs had annual appraisals.

Learning environment

OMFS RDs and LEDs reported that they had enjoyed their time in the OMFS department and the learning environment and overall training experience had been excellent. OMFS LEDs confirmed that they felt well supported and had access to good training. It was noted that their timetable was similar to the RDs with access to similar opportunities, but was less formal and more self-directed than the RDs.

OMFS RDs and LEDs described a good dynamic between the different training levels in the department. It was noted that less experienced learners were comfortable approaching LEDs and RDs for help. OMFS RDs and LEDs also reported that there was a good working relationship with the dental specialties.

Dental learners reported that their interactions with the OMFS junior team had been positive and generally they were approachable. Dental learners advised that the junior team worked very well with other specialties. DCT learners reported that their training had been very good and the OMFS supervisors had been encouraging of participation in projects. DCT learners advised that all the OMFS RDs and LEDs were very supportive and approachable. Dental supervisors also reported that they had not received any negative feedback from DCT learners about their learning experience in OMFS.

Despite previously stating that they had not experienced difficulties with the environment, the OMFS RDs and LEDs stated that there had been significant improvement in the last 6 months. Some OMFS RDs and LEDs reported that they would consider a consultant post at the PP if the current environment and changes were sustained. DCT learners reported that they would recommend their posts to colleagues.

Teaching and curriculum coverage

The review panel was informed by OMFS RDs and LEDs that training had been limited with absences in the department but noted this had improved since the appointment of a new locum consultant.   

OMFS RDs and LEDs reported that they had good access to various MDTs. It was noted that relationships with the other departments were good and the MDTs offered good educational opportunities. OMFS RDs and LEDs advised they were treated with respect and felt comfortable to raise concerns and ask questions in that forum. It was advised that discussion around management plans was encouraged.

OMFS RDs reported that they were able to meet the curriculum requirements for theatre time across the time they were in the department. It was reported that there were 2-3 theatre lists per week which increased to 6 sessions whilst in a trauma post, therefore the numbers balanced out across the rotations. OMFS RDs and LEDs confirmed that they were satisfied with this arrangement. OMFS RDs and LEDs also noted that there were additional opportunities on-call as well. OMFS RDs and LEDs reported that more training opportunities with certain theatre lists would be helpful. It was reported that the OMFS RDs and LEDs were hopeful that the consultant gaps would be filled soon to enable more theatre experience and filled with individuals who were enthusiastic about training. OMFS RDs and LEDs advised there was sufficient clinic experience to meet curriculum requirements and confirmed that the clinics were well supervised.

OMFS DCT learners reported that surgical experience was not always consistent across the rotation which made keeping track more challenging. Dental learners reported that there was sometimes a disparity in access to learning opportunities between those in NHS England training posts and those in university training posts, particularly for DCT learners’ access to oral surgery opportunities. Some learners felt they had de-skilled in this area throughout their post due to the limited access.  

OMFS RDs and LEDs informed the review panel that there was teaching scheduled every week and confirmed that the quality and variety of teaching was good. It was also noted that there had not been any issues accessing study leave and consultants were supportive of learners taking study leave.

Dental supervisors reported that dental teaching was scheduled regularly, and attendance records were kept with support from the Education Academy.

Rota

DCT learners reported that sometimes OMFS clinic preparation had to be done out of hours as they only received their timetable the week before the scheduled work. It was noted this also made theatre preparation more challenging.

Supervision

OMFS RDs and LEDs informed the review panel that there were no issues with supervision on-call and advised that consultants were accessible. It was noted that the on-call role was also very well supported by various specialties.

Dental learners advised that supervision had been good, and supervisors had been supportive.

Induction

OMFS RDs and LEDs advised that their induction had been thorough and there were no issues. Dental learners also advised that generally their induction had been good; however some DCT learners reported that the DCT induction was not very relevant to OMFS and felt it was designed more for other dental specialties. Some learners also reported that the on-call handbook did not always translate well into practice.

Areas that are working well

Areas for improvement

Immediate mandatory requirements

N/A

Mandatory requirements

Recommendations

Report approval

Report completed by: Rebecca Bennett, Education Quality Coordinator, NHS England-London
Review lead: Louise Schofield, System Dean- North East London, NHS England-London
Date approved by review lead: 20 May 2025

NHS England authorised signature: Elizabeth Carty, Postgraduate Dean, NHS England- London
Date authorised: 10 June 2025

Final report submitted to organisation: 10 June 2025