Winner South Tees Hospitals Trust

In the space of a little over two years South Tees Hospitals trust has pulled itself back from the brink to become a dynamic and innovative centre of clinical and leadership excellence.

The exceptional work that took place to achieve such a turnaround has all been done in a climate of enormous change. Yet in spite of measures that delivered savings of£35m in 2005/06 and an 8 per cent increase in patient numbers, the trust was able to hit all the government’s key performance targets, gain Improving Working Lives Practice Plus accreditation and receive national recognition for the quality of its care.

Many of the initiatives that helped to balance the books over two consecutive years have come from the staff and go some way to demonstrate the particularly strong culture of clinical leadership and empowerment at South Tees and the management philosophy that supports it.

The management of accident and emergency patients and acute admissions, especially in an area with high indices of multiple deprivation, is considered exceptional. Introducing a consultant-led “see and treat” service has seen dramatically changed the four-hour waiting time target. Senior clinicians assess walk-in patients in a separate clinical area where they can be treated quickly. As a result more complicated cases can be passed through to the main unit.

Against a background of rising levels of attendance at A&E - up from more than 111,000 to nearly 118,000 - under this new system South Tees is consistently one of the best trusts at exceeding the 98 per cent target. A purpose built 24-bed assessment unit and rapid access clinic built in partnership with primary care has reduced medical bed days by five per cent in twelve months. The National institute for Innovation has cited this unit and the A&E department as areas of excellence.

The trust is also one of seven sites piloting a primary angioplasty service for acute heart attack patients. Survival rates are improved under this procedure, which effectively reduces damage to the heart muscle by re-establishing the blood supply. South Tees cares for some of the country’s sickest patients. However according to the Intensive Care National Audit and Research Centre mortality rates are well below those anticipated.

“Hospital @ Night”, an integrated wireless system that takes advantage of hand-held technology was jointly developed by clinical and management staff and has transformed how staff work out-of-hours and helped the trust become EWTD compliant long before the deadline. The system, a prime example of how South Tees embraces innovation and change to improve the quality of its healthcare, has since been bought by the NHS.

The Healthcare People Management Association gave the trust an award for what it described as the ‘inspirational partnership working’ of the staff side and management teams.

That so much of what South Tees has accomplished in the past two years should be replicable across other organisations is perhaps one of its most remarkable and enduring achievements. Consultation for Foundation trust status has now begun and much of the forward planning for the next five years will be concentrated on reaching this next milestone.

Highly Commended Heatherwood and Wexham Park Hospitals FT

It has been an era of accomplishments and landmarks at the Berks and Bucks trust. With 2006/07 already recognised as their best year ever – the organisation was awarded a score of “Excellent” for its quality of care by the Healthcare Commission and met all its national performance targets – Heatherwood and Wexham Park Hospitals then went on to achieve foundation trust status.

The financial surplus of£2.6m for 2006/07 was equally impressive, all the more so when that is considered against the£3.7m deficit of the previous year. Such a robust financial position, attained through rigorous planning and comprehensive monthly accounting processes, allows the organisation to enjoy its new position free from any further requirements or conditions that might have been imposed.

In late 2006 the trust introduced a systematic governance process with a balanced scorecard and assurance framework. This provides an integrated and risk-sensitive approach to corporate, financial, clinical and managerial accountability. The board get accurate performance management information and at one point, when the balanced score card indicated a potential risk, the trust was able to take the necessary pro-active steps to assure financial surplus and foundation status.

Furthermore, the sound footing has allowed Heatherwood and Wexham Park to invest and expand. More money sees cardiology services now offering angioplasty and implantable defibrillators while dermatology is available from a new and competitively tendered service based in a community hospital.

Partnerships with other members of the local health and social care economy are helping the trust develop joint service provision and build a secure future.

Calderdale andHuddersfieldFT

The culture of development at Calderdale and Huddersfield FT runs deep - from the Investors in People leadership and management centre and clinical director programme to its thriving OD network and status as an NVQ assessment centre.

It is a culture that breeds ambition and aspiration, enables engagement between managers and clinicians, develops strong relationships with the local community and membership and fosters a keen sense of corporate and environmental responsibility.

The trust is one of only ten to sign up to the Carbon Trust’s carbon management programme. Cost and energy savings have already been achieved through measures such as the installation of photovoltaic cells and the deployment of Green Champions across all areas of the organisation. Discounted travel has also been negotiated with local transport companies.

Partnership with the Regional Development Agency has led to the mainstreaming of an employability scheme and work experience placements from schools, colleges and the probation service.

The trust is currently undergoing significant reconfiguration as part of its integrated services strategy. Change has already been delivered in gynaecology and breast services in the bid to provide safe and high quality care as close to people’s homes as possible. Further work will reconfigure elective and major trauma surgery and see maternity services redeveloped during the summer of 2008.

Throughout the development and implementation of this process strong leadership and effective communication has maintained a sense of ownership and kept motivation high. Calderdale andHuddersfieldreceived the highest Improving Working Lives Practice Plus assessment in the country.

Lutonand Dunstable Hospitals FT

Luton and Dunstable is widely acclaimed for its leading work on patient safety and was an exemplar site for the Health Foundation sponsored Safer Patient Initiative.

The drive for excellence however is far from limited to one domain and can be seen in its clinical leadership and partnership working, its patient participation in service design, an emphasis on staff development and its plans for the future.

In each directorate at Luton and Dunstable a clinical director and general manager work closely together, leading from the front to improve performance and implement change. The success of this structure has already seen its stroke services – which score highly on length of stay and communication with carers - featured in the NHS Institute for Innovation ‘Focus on Acute Stroke’ national best practice documentation.

There is a high value placed on leadership at all levels. A trust initiative for implementing NICE guidance and new interventions supports clinical engagement and a ‘be the change you want to see’ ethos. A rapid improvement event in the imaging department has contributed to a reduction in waits for MRI from 40 to 12 weeks. The acute pain team won a National Pain Symposium award for their work on enabling non-anaesthetic staff to administer nerve blocks to patients with fractured hips.

Patients and staff have been put at the centre of an ongoing redesign of head and neck cancer services that highlights the importance of the experience of care and care giving for everyone involved.

Luton and Dunstable is now set to create strategic business units with financial and managerial responsibility devolved to clinical directorates.

Harrogateand District FT

For a trust with a small hospital, Harrogate certainly packs a punch. It was the only acute provider to be awarded a double excellent rating for its quality of services and use of resources, it got top marks for its PEAT inspection, achieves a consistent Monitor risk rating of 4 – and won the SAGA award for the best hospital for the over 50’s.

The trust also impresses with its access achievements. Average waits for outpatient appointments run at five weeks, elective admissions at eight weeks and for a diagnostic test the figure stands at four weeks.

Demand management tools that were established following proactive waiting list reporting have helped reduce emergency and repeat admission rates, as have the analytical skills of a dedicated information team.

The introduction of devolved clinical business units and management arrangements has brought with it a significant focus on leadership and development skills. Personal coaching and workshop sessions are helping senior clinical staff hone the skills they need to flourish in this new organisational culture.

Harrogate can be particularly proud of its public engagement. Alongside a membership that represents roughly ten per cent of the patch’s adult population – a figure few can better – the trust has 800 volunteers and focus groups, committees and working groups looking at areas such as maternity services, cancer care and quality of patient experience and all with lay representation.

The trust also takes it corporate citizenship responsibilities seriously, being one of the first hospitals to secure central funding for a combined heat and power system that has reduced its carbon emissions by seven per cent.

Reflections on judging the HSJ Award

The media headlines might lead you think otherwise but there are lots of organisations delivering excellent quality services in the NHS. The HSJ awards recognise this achievement and I found it immensely rewarding to be involved and to be able to visit five high performing organisations.

There are three steps involved in the awards. First the organisation makes an application (it may be obvious but if you don’t apply you can’t win). Second a shortlist of five is compiled and final stage is a visit by a team of judges. Each individual visit lasts three hours and the structure is left entirely to the trust’s discretion – the aim is to showcase as much of the organisation as possible.

This leads to a wide range of approaches – no one of which is right. Most involve walking a mile or two around the site and always meeting lots of different people. One trust this year achieved a special note for having a programme so full of people and presentations that none of the judges thought it would be delivered – but they managed it.

Our award is for the Acute Healthcare Organisation of the Year. Good entries need to show how the organisation is functioning in total rather than showcasing one or two areas of merit. This year the topics covered ranged from the (predictable but necessary) management of A&E and emergency admissions through to (very definitely doing things differently) a fashion show put on by patients with cancer.

Inspirational leadership was on display time and time again – not just from the senior management but throughout the organisations we visited. There was a genuine commitment to wanting to provide the best service possible to patients and improving services. As a judge, I thought the whole process was invigorating – of course everyone wanted to focus on the positive and ignore the problems and difficulties (which all five organisations surely have).

I would like to think that the effort put into organising the judging visits in itself contributes something to the trust by making it think about how to tell the positive story, and then sharing it on the day.

Of course, at the end comes the hard bit - choosing the winner. All the entries had great attributes. Finding the right balance takes some good and healthy debate but consensus was eventually reached – the one sadness is that there is only one award. I would like to re-iterate my thanks to all the people who put effort into the visits and say how much they proved that the NHS is a great service.

Paul Robinson is head of market intelligence at CHKS.

probinson@chks.co.uk