Four more directors exit struggling FT’s board

Besides those subject to the big public inquiries, there can’t be many NHS organisations that had a more torturous last decade than Stockport Foundation Trust.

The first half of the 2010s was dominated by the case of Victorino Chua, a nurse convicted in 2015 of murdering two patients and poisoning 20 others at Stepping Hill Hospital.

After a short period of calm in the middle of the decade, the trust’s performance started to rapidly decline on the two most important indicators in the eyes of regulators – finance and emergency care.

Performance on the four-hour target was particularly poor, with the trust routinely posting percentage figures in the 60s or 70s over the last few years, against the 95 per cent standard.

This has prompted lots of external attention and intervention, including a turnaround director from NHS Improvement, close oversight from Greater Manchester’s devolution team, and multiple external reviews of the trust’s management, quality and safety.

Meanwhile, an ambitious “vanguard” project to create a new type of organisation also ran into multiple problems and had to be significantly scaled back as relationships with the council and local commissioners turned sour.

Following the departure of Ann Barnes in late 2017, the trust spent 2018 under an interim chief executive, Helen Thompson, before substantively appointing Louise Robson in January 2019, who joined from Newcastle Hospitals FT.

Gradual improvements were expected, but accident and emergency waiting times kept getting worse (in every quarter of 2019-20 performance was around 5 percentage points worse than the corresponding quarter in 2018-19), and an inspection by the Care Quality Commission in early 2020 concluded the quality of services has worsened as well.

The rating for urgent and emergency care fell from “requires improvement” to “inadequate”, with some serious criticisms around staff morale and a lack of support and awareness from leaders. The overall trust remained at “requires improvement”.

When explaining the A&E problems, the trust points to high demand and continued difficulties with delayed discharges (pressures which the vanguard was supposed to ease), but concedes that the CQC judgement was “hugely disappointing”.

It says part of the strategy to tackle the “long standing and deep seated” issues has been to strengthen the leadership team in A&E, and on the trust board. Alongside Ms Robson, new directors of finance, workforce and corporate affairs were appointed last year, as well as a new role, of director of quality governance and risk assurance.

Further changes are also imminent, HSJ has learned, with the trust preparing to recruit a substantive chief nurse after Alison Lynch agreed a secondment deal to work in a pan-Greater Manchester role.

Joint medical directors Colin Wasson and Gill Burrows, who have shared the role for five years, have also said they will step down and return to full time clinical duties by the end of the year.

And Hugh Mullen, deputy chief executive and director of strategy, retired at the start of the summer and has been replaced in the latter role by Simon Bennett, who joins from NHS England/Improvement. The trust said the four departures were not linked to the CQC report or A&E difficulties.

Reset

As well as some expected benefits from new leadership, the trust is also hopeful that coronavirus can offer a clean slate.

It says its services now “bear little resemblance” to the organisation visited by the CQC in February — as, like all NHS hospitals, it has rapidly transformed its wards, working practices, and strategies to meet the demands of the pandemic.

With attendances and admissions dramatically reduced in May, it met the four-hour A&E target for the first time in several years. This was not an inevitability, because England as a whole only reported 93 per cent (against the 95 per cent standard).

Stockport’s performance dropped back to 89 per cent in June (the England average stayed at 93 per cent), with attendances and admissions still 10-15 per cent lower than the previous June. But it means the trust has now had two consecutive months without reporting the worst performance in Greater Manchester, which will feel like something to build on.

Key to the next few months will be the extent to which it can successfully limit demand and divert patients away from A&E. This will include a new urgent treatment centre model with pre-bookable appointments and a ‘call before you walk’ ethos and communications strategy, which is likely to be deployed across Greater Manchester.

With A&E leaders across the country preparing for what could be their most difficult ever winter – if a covid peak coincides with flu and other pressures – Stepping Hill will be among the most closely watched hospitals.