West Country Chronicle: Scandal-hit trusts show signs of progress

Board improvements

2021 marked the lowest point of the leadership travails that have dogged the Cornish health system for several years.

The year culminated with the departures of the county’s acute and community/mental health provider CEOs, who both left under a cloud of governance failures.

Such was the concern in NHS England at the problems in Cornwall that it intervened in a proposed merger between the two trusts, as well as imposing a range of regulatory enforcements.

The two trusts, Royal Cornwall Hospitals Trust and Cornwall Partnership Foundation Trust, have since attempted to clear up the mess, and some progress now appears to have been made.

The governance failures at RCHT were particularly scandalous and included “potential loss of funds”, “decisions made outside the authority of individuals”, and “decisions made in the interests of individuals, rather than in accordance with trust policy”.

As part of NHSE’s directions, the trust was told to brush up its governance processes and subsequently commission a fresh review of its leadership.

This review, carried out by Wakefield-based consultancy firm thevaluecircle in winter 2022, has now been published by the trust in its latest board papers – and its findings paint a picture of improvement.

The review found a “dramatic improvement” in RCHT’s board, including both “mechanics of operation” and “dynamics of relationships”.

It also reported “strong progress” on moving away from what was described as a “legacy of command-and-control leadership style”, and an improved culture of “openness, confidence and trust”.

The consultancy also described trust chair Mari McLean (who has been at the helm during the governance problems) as “well respected”, and said the appointment of new CEO Steve Williamson in January provided an “excellent platform for development and system thinking”.

All in all, the review concludes that there has been a “clear cultural shift” at the trust and that “positive progress” has been made with the “development of the trust’s corporate and quality governance”.

Trust more compliant

Progress also appears to have been made at CPFT, which was also subjected to regulatory requirements by NHSE last year following the governance issues which led to the defenestration of long-serving leader Phil Confue and chair Barbara Vann.

Under the leadership of interim CEO Matthew Patrick, and subsequently permanent CEO Debbie Richards – the trust has managed to demonstrate improvements in its governance and management to NHSE.

Three weeks ago, the regulator published an update to say that CPFT is now “compliant” with 11 of 13 “undertakings” imposed by NHSE last year.

These undertakings included commissioning a number of reviews into governance and culture, and strengthening CPFT’s board with an independent director and extra support for non-executive directors.

NHSE’s update means CPFT now needs to show compliance with the final two regulatory requirements.

These are:

• Implementing the recommendations of the reviews and providing evidence of this to NHSE; and
• commission an independent organisational cultural review and acting on its recommendations.

Merger news

There has been a flurry of provider mergers in the South West during the last couple of years, despite the small matter of a pandemic getting in the way.

Since covid-19 reached our shores there have been mergers between trusts in Bristol and Weston-super-Mare, and – more recently – Royal Devon and Exeter FT and Northern Devon Healthcare Trust.

The final planned merger in the region (for now) is Somerset FT and Yeovil District Hospital FT, which was initially hoped to be completed this autumn.

However, chiefs at the two trusts are now working to a new target of April 2023, amid the ongoing pressures of the pandemic and elective recovery work.

The new trust will still be called Somerset FT, and it will be the first trust in England to provide acute, community, mental health and primary care.