Strong leadership and good clinical engagement are the essential qualities for turning around failing trusts, chief inspector of hospitals Sir Mike Richards has told HSJ.
In an interview to mark a year since the introduction of the special measures regime, Sir Mike said most of the first 11 organisations under the increased regulatory scrutiny had “made progress” over the past 12 months.
He said Medway Foundation Trust, which has had three chief executives in the past year, was the only one the Care Quality Commission had still “real concerns” about.
“Without stable and strong leadership it really is difficult to make progress… The ones that have made most rapid progress are the ones that have said ‘OK, let’s take this as a signal for action’ and responded positively to it,” he said.
The 11 trusts were placed into special measures following the Keogh review of trusts with high mortality ratios last year.
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Sir Mike told HSJ he believed the regime was a success, despite his advice that six of the 11 remain in special measures following inspections carried out in spring this year.
“Historically, what have we done when trusts are failing?” he asked.
“We’ve just got rid of one lot of management and replaced them… What I think is different about special measures is about saying we need to support this trust to become good and I think that’s a hugely different approach.”
The former Department of Health cancer tsar said some special measures trusts had made “very good use” of buddying arrangements, where they were partnered with a more successful organisation to help them improve. Such trusts had to be “prepared to respond” to the additional support on offer, he added.
Recent CQC inspections have identified a lack of clinical engagement as a common problem at many of the special measures trusts. Sir Mike said in “some places clinicians and managers have failed to move forwards together” and had “stayed back in the tail end of the 20th century”. However, he said there were many examples of the “exact opposite” situation at the best trusts.
“Several [special measures trusts] are really focusing on that engagement and alignment with their clinical staff and I think that bodes well for the future,” he said.
As HSJ reported last week, most of the Keogh trusts are forecasting deficits this year, with many blaming their poor financial position on the need to recruit additional staff.
However, Sir Mike said his role was to “say it as it is on quality”, not the financial positions of organisations.
“It is not my task to deal with the financial position because I think what the public want is a completely independent view of what the quality of care is. I’m very pleased that I don’t have to say they’re doing well considering their financial position.”
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