Published: 15/08/2002, Volume III, No. 5818 Page 4

A Commission for Health Improvement review of one of England's 'supertrusts' says the 3000-bed Leeds Teaching Hospitals trust is guilty of a lack of co-operation across the organisation.

The two-star trust, formed from a merger four years ago, is 'still aligning its working protocols and developing systems to promote effective cross-site working'. The report described a fragmented organisation where 'achieving a corporate overview is difficult'.

'At corporate level, the trust has focused on performance targets and its financial deficit. Clinical governance needs to take higher priority and be fully integrated with business and service planning', CHI found. The trust has a forecast deficit of£15m for 2002-03.

The CHI report adds: 'The layout of the site and the divisional structures can hinder patientfocused care.'

The trust's organisational structure prevented effective risk management, while implementation of evidence-based practice was 'patchy'.

The review identified particular problems in clinical information.

There were 'three separate, incompatible and outdated patient information systems and two separate accident and emergency systems'. Some patients had up to nine separate folders of paper notes. But CHI said there was 'good progress' in clinical governance 'at division and specialty level because of committed individuals'.

Trust chief executive Neil McKay, a former acting chief executive of the NHS, who took up his post in April, acknowledged the merger had caused the trust problems 'getting to grips' with its priorities. There was 'some excellent work being done by excellent staff ', he said. 'Drawing that together into an integrated whole is something CHI has quite properly told us to do.We accept that.'

The trust was consulting on reorganisation plans to put doctors and nurses at the centre of decision making, while a cultural change was needed 'to give clinical quality as much priority as money and activity', he said.

The report also recommends that scheduling of trauma operations be reviewed urgently, while A&E security arrangements, children's A&E services and children's day-case chemotherapy should also be reviewed.

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