An independent review into the senior leadership of Mersey Care NHS Foundation Trust has found that adversarial and mistrustful relationships between executives fostered a divisive and toxic culture, leaving staff fearful, anxious and unable to speak openly about their concerns.

The investigation, commissioned to examine executive relationships, board behaviour and organisational culture at the trust, points to a breakdown at the highest level of governance rather than an isolated dispute between individuals. Its findings describe friction between key decision makers that hardened over time into distrust, with the effect trickling down through the organisation until junior and mid-level staff felt unable to challenge decisions or flag problems without fear of professional consequence.

The specifics are stark. Reviewers discovered that at the executive level, psychological safety, the fundamental state in which employees feel free to have disagreements with leadership or acknowledge mistakes without facing consequences, had disintegrated. Communication between senior figures had fractured into what the review characterises as separate camps, each operating with limited trust in the other, a dynamic that made coherent decision making difficult and left staff uncertain about lines of accountability.

Mersey Care is one of the country's largest providers of mental health, addiction, learning disability and community services, serving more than a million people across the north west. A trust of that scale depends on functioning relationships between its chair, chief executive and board to hold operational pressures, workforce strain and financial constraint in balance. When that relationship curdles into mistrust, the consequences are not confined to the boardroom.

Given the trust's own past, the review's description of a scared and silent workforce is especially compelling. Mersey Care has previously invested in what it describes as a just and learning culture, an approach designed explicitly to encourage staff to report mistakes and raise concerns without fear of blame. A finding that senior staff now feel unable to speak openly sits uneasily against that stated ambition, and raises the question of how far cultural commitments made at policy level actually reach the executive suite itself.

This is not an isolated episode. Reviews of executive and board culture have become a recurring feature of NHS governance scrutiny this year, as trusts face sustained pressure on finances, workforce and delivery targets simultaneously. Where boards fracture under that strain, the usual mechanisms for surfacing problems, whistleblowing routes, staff surveys, non-executive challenge, tend to weaken precisely when they are most needed. A trust whose own leadership cannot model open disagreement is poorly placed to reassure a wider workforce that raising concerns is safe.

The report calls for structural reform and mediation between executives to restore functioning governance, alongside clearer mechanisms for accountability at board level. What form that will take at Mersey Care, and how quickly, remains to be confirmed. Trusts facing similar findings elsewhere have typically responded with a mix of interim leadership changes, external facilitation of board relationships and revised codes of conduct governing how executives are expected to engage with one another, though the specific remedial steps agreed by Mersey Care's board have not yet been made public.

For NHS leaders more broadly, the findings are a reminder that governance failure rarely announces itself through a single scandal. It tends to accumulate through smaller breakdowns in trust between the people meant to be running an organisation together, breakdowns that are harder to spot from outside and easier to dismiss internally until a review forces them into the open. Regulators and policymakers watching the pattern across multiple trusts this year will have to decide whether existing oversight arrangements are equipped to catch this kind of dysfunction earlier, before it reaches the point of an independent investigation and a public reckoning with what staff were too afraid to say.