Supported by CHKS


  • Dr Helen Bevan, director of service transformation, NHS Institute for Innovation and Improvement
  • Matthew Swindells, special adviser to the health secretary
  • Sue Slipman, director, Foundation Trust Network
  • Frank Burns, former chief executive, Wirral Hospital trust
  • James Coles, director of research, CHKS

Winner Heart of England Foundation Trust

Those who know life is tough at the top do not always know how hard it can be at the other end of the spectrum. But in the NHS's most financially healthy organisation, this was never going to be a problem

Not only is Heart of England foundation trust the strongest financial organisation in the NHS (last year it was£5.4m in the black and after only the first three months of 2006-07 was at a surplus position of£4.1m) it is in the throes of trying to get clearance from the health secretary to be the first foundation trust to 'acquire' another - nearby Good Hope Hospital trust.

Heart of England has been managing its neighbour for over a year and turned it round from financial failure to at least break-even ahead of schedule. The fact that it has been able to improve its own performance and learn from good practice at Good Hope, and the organisational development experience from turning round a troubled trust, is ample evidence of how a vision created five years ago by chief executive Dr Mark Goldman has become reality.

'We are very ambitious,' says Dr Goldman. 'Sometimes we are a little embarrassed about displaying it but it's not about the chief executive trying to build big thinking. It's about how we play our part in the renewal of a health system that needs fresh legs. In the health economy we live in we have a powerful vision for that and try to build unstoppable momentum towards that vision.'

Dr Goldman says the fundamental premise of the trust's vision is quality, making patient care the vehicle for change and development. And it works.

In 2005-06 it not only achieved the biggest financial surplus in the health service, but met and exceeded all national key performance targets.

To exceed national targets for a reduction in MRSA rates it launched an enhanced infection control strategy, which introduced 'six golden rules' for hand-washing.

To improve inpatient care the trust created a strategy that led to the introduction of a group of patient representatives, called Redcoats, whose job is to ensure they get the best possible service and care. After an outpatient consultation, instead of writing to a patient's GP and copying the letter to the patient, the directorate writes to patients and sends a copy to the GP.

The trust has many examples of excellence and ambition, from its clinical structure to create strength and accountability at the top of the organisation to performance measurement being rolled out below directorate level to individual teams.

HSJ judge and NHS Institute for Innovation and Improvement service transformation director Helen Bevan says: 'George Bernard Shaw once wrote about choosing to be a victim or a force of nature. A lot of trusts see themselves as victims. Heart of England sees itself as a force of nature. In that sense it's a role model of what an acute hospital might be in the future.'

Judges' reflections

Buzzwords or brilliance?

Our most significant impression of judging for these awards was how privileged we were. How often do you get three hours of people trying to show off a whole organisation to you?

The requirement for this category was that the trust showed excellent performance across the board, not just in a few projects.

This meant that a few good or charismatic leaders were not sufficient - their leadership must have become embedded in the culture, so the vast majority of staff are striving to achieve excellence.

The challenge as judges was telling whether what we were being shown was truly embedded or just the pockets of excellence that can be found in most organisations. Had the staff been taught how to use all the latest buzzwords or could they show evidence of true delivery?

Undoubtedly the NHS has many excellent staff but the real difference was when they showed examples of thinking beyond the basics of care delivery and more about the whole system they were working in.

Often the best examples were not complicated but challenged the assumption that things would be done right simply because everyone would want to. For example, simple systems to check that communication took place rather than the assumption that everyone knew what the other team member expected.

The range of perspectives of the many professions required to create good services can give rise to many different explanations of the same service - when you listen to a medical director, capital planning director and marketing director talking about the same service, sometimes it really doesn't sound like they are talking about the same thing at all.

Similarly, the judges all have different backgrounds so tend to get a slightly different view of what they are shown. Despite all this, it was good to find that we all had comparatively similar views on the relative position of the shortlisted trusts, and the decision was made reasonably easily.

We would like to repeat our congratulations to all the shortlisted organisations and their staff - their enthusiasm and motivation to provide good-quality healthcare was a joy to experience.

Paul Robinson is director of marketing and James Coles is director of research at information company CHKS.

Highly commended Luton and Dunstable Hospital Foundation Trust

Luton and Dunstable Hospital Foundation trust is committed to financial stability, and far from being a hindrance, the trust has shown that running a tight ship can be force for positive change

Debt free for seven years, Luton and Dunstable Hospital foundation trust has used stable finances as the starting point for a culture of continuous improvement driven by an appetite to be at the forefront of patient care and initiatives designed to deliver better outcomes.

'Financial balance is an important prerequisite to doing new and better things,' says chief executive Stephen Ramsden. 'We have good, strong financial control.

'It's not always popular with people but the finance director runs a tight ship and it gives us freedom to improve patient safety by going beyond targets.'

Luton and Dunstable is involved in the Institute of Healthcare Improvement's Pursuing Perfection programme and was chosen in 2004 as the English trust in the Health Foundation's Safer Patients Initiative.

Hospital-standardised mortality rates have improved from 11 per cent worse than the national average to 5 per cent better in two years.

It is also a national pilot for cancer waiting times (100 per cent of all Luton and Dunstable's urgent cancer patients start treatment with 62 days of referral and diagnostic waits have been cut from 44 weeks to 12 weeks earlier this year) and one of the eight pilots to help prepare the NHS for meeting the challenge of the 18-week target from GP referral to hospital treatment.

Finalist Cambridge University Hospitals Foundation Trust

The trust's strength lies in its diversity, and the breadth and variety of services it provides mark it out as far from your average district general hospital

While Cambridge University Hospitals foundation trust has a strong accent on training and research, there are other elements in its 2020 Vision long-term development plan that show it still takes pride in conventional focus on better care for patients. This year, for example, the trust opened its emergency assessment unit, centralising and redesigning emergency treatment.

The trust is also working closely with managers in primary care to reduce delayed transfers of care, look at admissions avoidance, develop an early discharge policy, develop treatment in the community and obtain greater shared understanding of the demand for complex discharge.

The judges were impressed by the level of clinical engagement in the organisation and some good work on managing patient flows.

'The place oozed quality,' said judge Helen Bevan. 'If I was going to be ill with a serious disease, take me there, please.'

Finalist Salisbury Foundation Trust

Cruising through this year's raft of targets, this new foundation trust has had a year to remember Salisbury foundation trust achieved foundation trust status this year, moved into a new hospital wing, met targets and pioneered several projects in the NHS.

The trust met all of the key access targets, including cancer, and progress is in hand to meet the 18-week target. Financial duties were met for the 12th year running while delivering a 6.5 per cent cost improvement programme. The trust has an excellent record for infection control, with a position in the top 20 hospitals for low MRSA bacteraemia.

Salisbury was rated ninth best acute trust in the staff survey, as ranked by HSJ, and targets for Agenda for Change and the knowledge and skills framework were met. The trust opened the second phase of the hospital in May. This PFI scheme was shaped by staff and members of the public who were recruited through a radio and newspaper campaign. As a result, most patient rooms have views across the countryside, all rooms are ensuite, and 40 per cent are single occupancy.

The trust developed its five-year business strategy for the foundation trust application with engagement of every specialty and department. The application was successful and the organisation became a foundation trust on 1 June.

Salisbury is the first NHS organisation to be approved by the Treasury to establish an NHS trading company. Odstock Medical Limited promotes functional electrical stimulation devices that have been developed by trust scientists. The products have been approved for sale in the US and a contract has been agreed with an American firm to be the local agent. In another UK first, Salisbury is introducing a bed tracking system which flags up expected discharges in advance to ensure they take place.

Finalist King's College Hospital Trust

Part of a major cultural and service improvement revolution at this south London trust, the First Choice programme was designed to achieve fundamental change through clinical service transformation and trust-wide improvement projects

Improvement projects will develop the organisational infrastructure and support continuous improvement in performance management, activity-based costing, patient experience and staff capability building at King's College Hospital trust. The programme will establish clinical staff as key drivers of change.

With a steering group overseeing the programme, external management consultants give input to all projects. Projects initiated with support from the consultants are increasingly run by trust staff. Industry methods have been adapted and the trust is developing the management infrastructure to drive improvement.

Clinical service transformations began with a pilot in general medicine, where a long average length of stay and high number of medical outliers were preventing elective admissions and affecting A&E performance. A year later, the care group had reduced average length of stay by 20 per cent and outliers by 59 per cent and achieved financial balance.