Moves to tackle performance problems at Cambridge University Hospitals

What’s the problem? Cambridge University Hospitals Foundation Trust is one of England’s best known trusts, featuring the mighty Addenbrooke’s Hospital and possessing a strong reputation for research. But recently it has been failing many key standards, including the 62-day cancer referral to treatment target. This has led to it being red rated by Monitor which is considering whether it is in significant breach of its authorisation.

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Anything else? It has had eight never events in the last year - several involving swabs being left in patients after procedures - and the CQC has raised concerns. And it is struggling with the 18-week target, has missed the accident and emergency four-hour standard on occasions, and has a significant number of cancelled operations. Oh, and its top team of Gareth Goodier, the long serving and visionary chief executive, and chair Dame Mary Archer are moving on. Dr Goodier left in June and Dame Mary hands over to a new chair in the next few days.

What’s causing the problems? A variety of issues, many of which are not the trust’s fault but are indicative of problems for the whole health economy. Top of the list for causing disruption to the functioning of the trust has to be delayed transfers of care. On some occasions more than 80 beds at the trust - which has 600-700 “normal” adult beds - have been occupied by patients who could be better cared for elsewhere. That’s one of the worst figures in the country. Another issue has been late transfers of cancer patients which has affected the trust’s 62 days performance: a new agreement across the area has improved this. However, it is also being affected by a sudden and unexplained increase in urology cancer patients: it has been recruiting more specialists to tackle delays with these but this will take time to work through the system.

What’s being done to tackle delayed transfers of care? A lot. There is some real evidence of close working across the health economy and between health and social care. Cambridge is working with a private company to support some people in their own homes as an alternative to staying in hospital, and Cambridgeshire County Council is focusing on reablement and trying to increase the number of discharged patients who are helped to recover their independence.

And some of the other problems? A&E performance is improving as building work on a major regional trauma centre progresses. Financially, the trust hopes to make a surplus this year after a small loss last year. And it hopes it is overcoming issues around never events. In the longer term it has very ambitious plans to expand. It is seeking a partner to develop a private hospital, education and conference centre and hotel on land it owns. The partner would put up the cash for the development and Cambridge would provide the land - plus the draw of its name. This could come to fruition within three years. Looking even further ahead it would like to develop a children’s hospital.

What happens next? Next month Monitor is expected to decide if it is in significant breach. Given signs of improvement on some measures and a plausible explanation of how the cancer waiting time problems came about, the trust may well escape censure. It should have a new chair in place and an announcement is expected on the crucial chief executive role, although it may still be some months before the role is filled permanently if there is an outside appointment. But the real test may be how it copes with winter pressures: a bad winter and continuing delays in transfers of care could affect targets again and damage the trust’s reputation.