• Surrey and Sussex moves from “good” to “outstanding”
  • Chief exec cites improvement focus and leadership stability
  • Also forecasting surplus, despite deficits elsewhere in the health economy
  • Trust also outstanding on “use of resources”

An acute trust in the south east has been rated “outstanding” by the Care Quality Commission, with its chief executive putting it down to quality improvement by clinicians and leadership stability.

The CQC published the new rating for Surrey and Sussex Healthcare Trust today, which was previously rated “good”.

It means two acute trusts in the Sussex sustainability and transformation programme area have the top CQC rating, while Brighton and Sussex University Hospitals Trust moved from “inadequate” to “good” earlier this month – there continue to be big financial gaps in the county’s NHS organisations.

SASH was praised by inspectors for its “exceptional culture of data driven continuous improvement and transformation” and making patient safety and experience the “dominant thread” running through its strategy and service delivery.

Executives were said to role model and set explicit expectations about behaviour, their relationships with services leads showing “warmth and respect” while being appropriately challenging.

The trust was rated “outstanding” in the caring, responsive and well led categories, with safety and effectiveness rated “good”.

The inspectors, who visited East Surrey Hospital, the trust’s main site, in October, identified particular improvements in outpatients, which had previously struggled with high demand.

SASH was also judged to be outstanding for “use of resources” – with the lowest total cost per weighted activity unit in England for 2016-17, and pay cost per WAU in the lowest quartile. The trust is expecting to record a surplus of £6.9m before provider sustainability funding in this financial year, despite being in one of the country’s most financially challenged health economies.

Its chief executive, Michael Wilson, told HSJ the trust had improved over the last eight years from being regarded as one of the worst, with both serious quality and financial problems.

He said many staff had worked at the trust throughout this period, and been empowered to make changes. “They have all come to work in the NHS to do a really good job,” he said. “We have to create the environment and conditions which allow them to do that. Staff morale is really important but you only get that by empowering people.

“Our philosophy is getting the people who do the clinical work to improve the outcomes, giving them the authority to make changes. We have encouraged staff to make improvements for themselves and for their patients.

“We don’t talk about cost improvement programmes, we talk about waste reduction programmes. If you present the clinical community with a cost improvement programme of £5m or £10m they don’t engage… if you talk about waste and reducing the time people wait, then they respond.”

The trust has been one of a small group in the UK working with the US based Virginia Mason Institute, which had given it a clear improvement methodology, which it refers to as “SASH+”. It has also benefited from consistent leadership with many long serving executives, said Mr Wilson, who joined in 2010.

CQC chief inspector of hospitals Ted Baker said: “The trust’s determination to develop a culture of continuous improvement has improved services for patients across the board – enough to ensure that the overall rating has moved to outstanding.

“Staff spoke positively about the patient journey and the striving for continual improvement. This was especially clear in medical care and maternity which we rated overall as outstanding and surgery which we rated as outstanding for both caring and well led, with staff working effectively as a team in a coordinated way for the patients’ best interests.”