Calderdale and Huddersfield and East Lancashire Trusts in a group model

Two of UHS’ directors were respectively Chief Executive and Director of Finance at Calderdale and Huddersfield, a highly successful Trust whilst neighbouring East Lancashire was, at that time, under significant pressure on quality and finance. In conjunction with Regional colleagues it was agreed to manage both Trusts together, temporarily, under a shared leadership to enable quality and financial improvement.

As the first such arrangement in the country, there was a great deal of innovation and interest. The UHS directors ensured that the benefits realisation concerned not only this new model itself, but the improvement of quality and value for both organisations. Whilst there was high level innovation and benefit there was significant governance security built into the process. In particular, “taking the people with us” was a significant part of the work.

The benefits included stabilisation of East Lancashire NHS Trust, service quality improvement, progress with staff morale and engagement as well as improved finances. Both organisations benefitted from the cross fertilisation.

The work identified an inventive approach to organisational governance and intractable problems which has been repeated across the NHS and has become one of the repertoire of organisational solutions to clinical and financial viability challenges.

Mid Staffordshire NHS Foundation Trust

Two of the directors of UHS were involved in the dissolution of Mid Staffordhsire; one as a member of the Special Administration team and one supporting the executive team in the complex, highly visible and innovative task. The “bow wave” of political interest was a feature of the task as was the legal complexity of non-FTs becoming involved in the management of an FT’s services.

UHS Directors navigated the identification of solutions, their legal legitimacy, the risks associated with potential solutions, the interests of partner organisations and regulators as well as supporting the continued viability of services during a particularly turbulent period.

The evaluation of options resulted in a preferred solution which was novel and necessarily complex. UHS supported the health economy to see the benefits of the preferred solution and to get health economy members to play their part in implementing the solution and supporting the continued viability for the service to the population of Staffordshire.

Mid Staffordshire was successfully dissolved in Spring 2015 with a smooth transfer of services to other organisations.

North Cumbria University Hospitals NHS Trust

In February 2016 one of the UHS Directors was asked to join the Executive team at North Cumbria University Hospitals to work on the financial turnaround of the Trust and health economy, as the Trust’s Executive Finance Director. He has led the delivery of a stabilised and improving financial position as well as contributing to the Success Regime financial strategy.  The acute Trust had one of the largest proportional planned deficits (£69M) in England and finished 2016/17 with a deficit of £47.3M.

From 1 April 2017, the UHS Director has been supporting the West North and East Cumbria STP (advising the STP C.E.O.), ensuring that the health economy is well placed to deliver an accountable care system from mid-2017/18. The organisations have openly and transparently worked together to deliver each organisation’s 2016/17 control totals and put in place a risk agreement for 2017/18. The health economy expects to be at its combined control total of a £50M deficit in 2017/18 compared to an opening plan for 2016/17 of £82M. The Health Economy has a plan to be in recurrent balance by 2020/21, has a joint executive team between the acute and partnership Trusts and has a positive partnership with the County Council.

Nottingham and Sherwood Forest

One of the UHS Directors was appointed to Sherwood Forest Hospitals NHS Foundation Trust as interim Chief executive as a result of regulatory action by NHSI under Section 111 of the Health and Social Care Act. The director led the organisational recovery programme at Sherwood Forest (SFH), a Trust that had been in Special Measures for quality and safety for three years, and to prepare the Trust for a long-term partnership involving merger or acquisition.

In the course of the assignment, the UHS Director:

  • Embarked the Trust on a major programme to enhance the quality and safety of its services and address CQC concerns.
  • Transformed the governance, performance management arrangements, staff engagement and leadership arrangements to create a high–performing culture.
  • In conjunction with Monitor selected a long-term partner in Nottingham University Hospitals NHST.
  • Worked collaboratively with the leadership of NUH to prepare the Trusts for merger, engaging in all aspects of the M & A process including legal form; engagement with CMA; developing the clinical and leadership models; aligning clinical, divisional and departmental relationships; managing Governor relationships,  and engagement with external regulators and stakeholders,.
  • The merger process was progressed to practical completion within seven months, before the merger was terminated by NHSI due to growing concerns regarding NUH’s operational performance. SFH and NUH subsequently developed a successful collaborative long-term partnership to progress the excellent clinical collaboration that had been developed during the merger process and to explore other areas of mutual benefit.

The recovery programme the UHS Director led resulted in SFH:

  • Gaining a much improved CQC re-inspection report and moving from Inadequate on safety to Good and being removed from Special Measures;
  • Achieving recognition as one of the top trusts in the country for the management of sepsis and achieving excellent clinical outcomes in a number of areas.
  • The Trust was one of the top-performing Trusts in A & E and other operational performance;
  • Delivering a challenging CIP, significantly reducing agency costs and bettering the 2016/17 financial control total.
  • Improving staff engagement scores from well below national average to well above national average and significantly improving recruitment of doctors and trained nurses.
  • Becoming a CHKS Top40 Hospital and winning the HSJ Value in Healthcare award for Urgent, Emergency and Trauma care and being finalists in a number of other national award events.
  • Establishing an effective LTP with NUH to ensure the sustainability of clinical services.
  • Establishing a strong leadership team to continue its journey to becoming an outstanding Trust.

Southern Health NHS Foundation Trust

The Trust was required by NHSI to appoint the UHS Director as interim Chair following four unsuccessful tenures in the post. The Trust had suffered significant quality failures and huge reputational damage. The Chair’s task was to stabilise the organisation and make it organisationally effective, establish the clinical strategy for the Trust and develop an organisational change plan in four months. All of this was achieved and the UHS Director remained for a further four months to commence the implementation of the strategy and establish a new Board.

During the period the Trust was recognised by the CQC as having improved leadership , direction and safety. It had improved organisational and clinical governance, leadership and organisational development. Staff and service users and families were more engaged in the development of the strategy and that resulted in greater commitment and contribution to the way ahead.

Part of the plan was a redistribution of services amongst NHS providers resulting in greater emphasis on core business and quality and safety improvement. Shared governance arrangements were developed between the Trust and commissioners.