Hospitals are on the mend now, says chief
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.”
●●North Manchester General Hospital