Hos­pi­tals are on the mend now, says chief

Rochdale Observer - - LITERATURE AND IDEAS FESTIVAL - Jennifer.wil­liams@men-news.co.uk @jen­williams­men

IT was an un­en­vi­able task. More than a decade of prob­lems at Pen­nine Acute NHS Trust – and the four Greater Manch­ester hos­pi­tals it runs – cul­mi­nated last year in a damn­ing Care Qual­ity Com­mis­sion (CQC) re­port and rev­e­la­tions about longterm fail­ures in its ma­ter­nity department.

The trou­bled trust ur­gently needed new lead­er­ship and it was Sir David Dal­ton, chief ex­ec­u­tive of next-door Sal­ford Royal hos­pi­tal, who picked up the gaunt­let.

It was a ‘dif­fi­cult pe­riod’ at first, he ad­mits, and in some re­spects the job re­mains a strug­gle.

But a year on, as CQC in­spec­tors carry out their lat­est visit, he is cau­tiously op­ti­mistic.

A whole range of wor­ry­ing trends at the trust – which runs North Manch­ester Gen­eral Hos­pi­tal, the Royal Old­ham, Fair­field Gen­eral and Rochdale In­fir­mary – have re­cently started to re­verse.

Twelve-hour trol­ley waits, which had num­bered 137 in March alone, were down to two in July. C-Diff cases, which were even crop­ping up on the trust’s in­fec­tious dis­eases ward ear­lier this year – and, Sal­ford’s chief nurse Elaine In­glesby-Burke ad­mits, were ‘run­ning away with them­selves’ over the sum­mer – are now fall­ing.

Com­plaints have halved and are be­ing dealt with faster. Coroners’ warn­ings have re­duced. Hun­dreds of new nurses, mid­wives and sup­port staff have been hired.

Be­reave­ment cen­tres have been opened on each of the hos­pi­tal sites, the num­ber of falls and pres­sure ul­cers have dropped and staff are grad­u­ally giv­ing more up­beat feed­back.

“We gen­er­ally feel we have made a pos­i­tive dif­fer­ence for pa­tients and for staff in the 12 months that we’ve been mak­ing im­prove­ment,” says Sir David, speak­ing in his of­fice at Sal­ford Royal.

“There’s still years to come to keep on at this, but I’m do­ing this be­cause it’s worth­while – and to be able to see staff say­ing it feels bet­ter, that the data we col­lect sees it mov­ing in the right di­rec­tion, it feels good.”

When Sir David took on the ail­ing trust, one of his first tasks was to over­haul man­age­ment and place proper lead­er­ship teams on each of the hos­pi­tal sites, in­stead of leav­ing them to be run re­motely from head of­fice in Crump­sall.

He then looked at what could be copied from Sal­ford, which has been rated out­stand­ing by the CQC for many years.

Elaine In­glesby-Burke says cer­tain ba­sics were sim­ply not be­ing prop­erly car­ried out in the hos­pi­tals run by Pen­nine, such as au­to­matic hourly rounds by nurses.

“Call buzzers at Sal­ford aren’t a fea­ture, re­ally, be­cause we go to ev­ery pa­tient ev­ery hour to say ‘are you com­fort­able, have you got any pain, do you need the loo, do you need a drink,’” she says.

“So you don’t hear a lot of call buzzers at Sal­ford be­cause you’ve al­ready been in and sorted it.

“In Pen­nine a sim­i­lar sys­tem was al­ready im­ple­mented when we got there, but it wasn’t work­ing prop­erly. It’s now much, much bet­ter.

“So I think pa­tients would now recog­nise that. If you need a nurse she’s nor­mally there be­fore you need her be­cause she’s com­ing round proac­tively, rather than re­act­ing to a buzzer when they might be busy.”

More than 125 nurses – and mid­wives, a key area of con­cern for the CQC – have also been re­cruited af­ter the new lead­er­ship found there were too few on Pen­nine’s wards. An­other 300 are in the process of be­ing taken on.

A new hot­line has also been set up for friends and fam­ily to call if they feel they’re get­ting nowhere with staff on their ward.

Nev­er­the­less, as Sir David looks to the next phase of the trust – which, to­gether with Sal­ford, is now be­ing re-branded the North­ern Care Al­liance Group – he ad­mits not ev­ery­thing has been sorted.

De­layed trans­fers – some­times known as ‘bed­block­ing’ – at North Manch­ester Gen­eral were run­ning at seven times the hos­pi­tal’s tar­get ear­lier this month, al­though Sir David in­sists that is due to de­lays within so­cial care at Manch­ester and Bury coun­cils.

“It’s far less about what we do, the NHS, it’s far more about what our col­leagues in so­cial ser­vices do and the abil­ity they have to make the as­sess­ment of a pa­tient so they’re suit­able for trans­fer,” he says.

“We don’t do that. They do that - and if they don’t do it quickly enough then we get the bot­tle­neck.”

Nev­er­the­less as it stands - in com­mon with much of the rest of the re­gion - A&E waits are way off tar­get at North Manch­ester.

Nearly 80 peo­ple also waited over two hours in am­bu­lance queues at the hos­pi­tal be­tween July and Septem­ber due to han­dover de­lays.

And while can­cer treat­ment times are im­prov­ing, they re­main be­low tar­get, which Sir David says is due to dif­fi­culty hir­ing en­doscopy spe­cial­ists to do the scans.

In­deed, he says re­cruit­ment is by far the big­gest block­age to faster im­prove­ment. De­spite ef­forts, there are fewer medics work­ing at the trust than there were in Jan­uary 2016, with Sir David point­ing to a lin­ger­ing im­age prob­lem.

“Al­though I can say for the very first time ‘look, North Manch­ester has re­cruited two new per­ma­nent A&E con­sul­tants, that’s fan­tas­tic’ – and it is, we’re de­lighted – we still strug­gle.

“And we’ve got to cre­ate the com­pelling pic­ture that this is now a set of or­gan­i­sa­tions that have got their heads held high, it’s a good place to work.

“It’s been hard postCQC, post some of the sto­ries you’ve brought to the at­ten­tion of the pub­lic, to be able to say ‘look, come and work here.’”

Sir David hopes that will now change as he moves his chain of hos­pi­tals into its ‘next phase,’ in­clud­ing tak­ing on a new name.

All five hos­pi­tals have – as of this month – been grouped to­gether into the North­ern Care Al­liance Group ahead of them of­fi­cially merg­ing, bar North Manch­ester Gen­eral, by spring 2019. By then North Manch­ester should have moved into Manch­ester Health Trust – and Pen­nine Acute will be no more.

In the mean­time, Sir David awaits the CQC’s cur­rent in­spec­tion of the Pen­nine hos­pi­tals. It is a time of some ‘anx­i­ety,’ he ad­mits, for while he is clear he has ev­i­dence of im­prove­ment, whether that can be demon­strated re­li­ably across ev­ery department, ev­ery ward, ev­ery day, re­mains to be seen.

But he in­sists that what­ever hap­pens, he in­tends to stick with it and turn around the hos­pi­tals for good.

“We’re in this for the long term,” he says. “We want to work along­side staff and build their con­fi­dence. We’re be­gin­ning to do that – there’s a long way to go, but we’re be­gin­ning to do that.”

●●Rochdale In­fir­mary

●●North Manch­ester Gen­eral Hos­pi­tal

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