Daily Insight: Outstanding

A glowing report

It’s not often HSJ gets to report on such a glowing Care Quality Commission report as the one delivered on Surrey and Sussex Healthcare Trust.

The trust – plagued by problems including massive debts and a rapid turnover of chief executives a decade ago – was elevated from “good” to “outstanding”. The report was fulsome in its praise for staff and the executive team, including a number of vignettes of how staff interacted positively and respectfully with both colleagues and patients.

As chief executive Michael Wilson is quick to point out, many of those staff have not changed in the last few years – it’s the environment they work in which has enabled them to shine. A focus on clinical leadership, continuous improvement and empowerment of staff is what he thinks has made the difference. The trust is also heading for a generous surplus this year.

The sustainability and transformation partnership area now has two outstanding trusts – SASH and Western Sussex Hospitals Foundation Trust – and Brighton and Sussex University Hospitals Trust has recently moved from “inadequate” to “good”. Its quality problems appear to be receding rapidly.

But what of the finances? Although SASH and Western Sussex FT look stable, the other two large acute trusts in the county – BSUH and East Sussex Healthcare Trust – are heading for large deficits this year, as are the clinical commissioning groups (though this will partly be masked by commissioner sustainability funding).

None of that should detract from SASH’s achievements, which included an “outstanding” rating for use of resources. Yet at some point the health economy will have to live within its means and that will impact on all organisations within it. 

Backlogged

Reviewing, and learning from, patient deaths is an important part of any good improvement process within the NHS. But, given the pressures of day-to-day activity, it is perhaps predictable that these processes are not always in the forefront of commissioners’ and providers’ minds.

HSJ has recently revealed just how much the local systems are struggling to keep up with reviews for a particular cohort of patients – those with learning disabilities.

The Learning Disabilities Mortality Review Programme aims to ensure local areas are learning from the unexpected deaths of patients with learning disabilities. Readers will remember the tragic case of Connor Sparrowhawk, a teenager with learning disabilities and epilepsy who drowned in a bath at a unit operated by Southern Health Foundation Trust in 2013 following a seizure.

Under this programme, CCGs are responsible for making sure providers review all deaths they are notified of. But recent figures published by several CCGs show areas are struggling to keep up with demand.

The most common problems quoted were a lack of reviewers to carry out the work and lack of capacity for those already reviewing. One expert suggested that, if NHS England is really committed to this review programme, it will need to up the ante on funding and staff doing the reviews, potentially doubling or trebling the resources available.

It’s also important to remember it’s not just learning that suffers when reviews are delayed. Sarah Fletcher, chief executive officer of Healthwatch Lincolnshire, pointed out there was a “significant impact” on bereaved families when reviews cannot be completed “in a timely manner”.