Cambridge University Hospitals Foundation Trust’s recently departed chief executive has warned he ‘does not know how the trust will cope’ this winter and that its problems could take years to address.

  • Cambridge’s recovery could take “two or three or more years”, says former chief executive
  • Keith McNeil says “relentless focus” on addressing its own problems means it cannot focus on “strategic aims” such as hospital chains
  • He calls the commissioner fining system “ludicrous” and a block on collaborative working
  • Questions the NHS leadership’s desire to have clinicians in senior positions

Keith McNeil, who stepped down last week ahead of the trust being placed in special measures, said he accepted the trust had significant problems but rejected the Care Quality Commission’s “inadequate” rating, calling it “galling”. He said “requires improvement” would have been a fair rating.

Dr McNeil told HSJ the trust was currently in a “critical internal incident”, meaning bed occupancy was dangerously high “at least for [my] last week”. He added: “And this is at the end of summer. I just don’t know how they are going to cope over winter. [The trust is not] going to get any more nurses anytime soon, so I don’t quite know what the system is going to do.”

Keith McNeil

The CQC rating of the FT was ‘galling’, Keith McNeil said

His comments follow Monitor placing the prestigious teaching trust in special measures and stating it had lost control of its finances earlier this week.

Monitor’s decision followed the CQC rating the trust “inadequate”. It cited “serious problems” posing a risk to patient safety, and a “disconnect” between senior managers and frontline staff. The inspectors’ report said the trust had lost its grip on a raft on operational targets.

Dr McNeil outlined in an interview with HSJ the implications of the trust’s problems for key NHS priorities such as setting up hospital chains and clinical leadership.  

Addenbrooke’s was like the “canary in the cage down the mine”, he said, and its issues were symptomatic of wider system problems, which were not being addressed quickly enough.

The trust would need a “relentless focus” on addressing its own problems, Dr McNeil said. This would stall it from participating in “pivotal” national projects, such as forming hospital chains as set out in the government commissioned Dalton review.

Dr McNeil continued: “It’s going to be very hard for the trust to think about positioning itself strategically now. It’s about recovery. That will take about two or three or more years in the current financial climate.

“It’s pivotal that the hospital is able to [progress projects like hospital chains] but… a relentless focus on improving things internally will inevitably mean less focus on trying to get the system piece together and working.”

The former chief executive said the system under which commissioners fine providers for missing targets, forcing hospitals to get government bailouts, was “ludicrous” and that it blocked collaborative working between NHS organisations.

He said: “[NHS leaders] are talking a lot. We have lots of plans, lots of vangards, but what are we actually doing to change the way we provide care to patients fundamentally at a whole of system level?”

He described the CQC’s decision to rate the trust as “inadequate” as “galling”. He said: “[Cambridge] gets outstanding results. We have one of the best safety records in the country and we get rated ‘inadequate’. How does that work?”

Dr McNeil also warned his depature would be a blow for NHS clinical leadership. “I’m really concerned that my departure is going to raise issues about clinical leadership and getting senior clinicians to put their hands up to do jobs like mine or any senior leadership roles. Maybe that’s what people want despite all the rhetoric. It’s going to send a bit of ripple through the system.

“The majority of the consultants at Addenbrooke’s don’t want me to go. How is the clinical leadership agenda going to be taken forward when situations like this arise?”

Asked whether he would consider a role in the NHS in future, Dr McNeil said that “if the right position came along I would be more than happy to take a look at it”. He said: “I love the NHS. It’s a great organisation. I’d defend it to the hilt; I just wish people would allow it to be as good as it can be.”

Addenbrooke's recovery could take 'years', warns McNeil