The special measures regime for struggling hospitals has the potential to demoralise staff and hamper efforts to fill much needed vacancies, according to a high profile troubleshooter tasked with putting one trust back on track.

Manjit Obhrai, who was brought into Queen Elizabeth Hospital King’s Lynn Foundation Trust as interim chief executive when it was placed in special measures last year, also said Monitor appointed “improvement directors” were seen as “spies” by some cynical clinicians.

He told HSJ special measures had the potential to have a “detrimental effect, particularly with staff recruitment”.

Mr Obhrai said: “I think that’s something that we’ve got to avoid.

Manjit Obhrai

Some clinicians are cynical about ‘improvement directors’, Manjit Obhrai said

“The purpose is that it’s meant to be supportive with a timescale for improvement, but in some quarters it may be seen to be punitive.”

The appointment of improvement directors by Monitor to trusts placed under special measures had been met with “some cynicism among clinicians”, he added.

“[Clinicians have asked] is this somebody who is a Monitor spy - for want of a better word - or is this someone who is supporting the trust?”

Mr Obhrai said the relationship between chief executives and improvement directors was “critical”, and the latter role would become “more defined” over time.

He also pointed to pitfalls in “buddying” arrangements brokered by regulators between special measures and high performing trusts.

King’s Lynn has been buddied with Guy’s and St Thomas’ Foundation Trust.

Mr Obhrai, who was also appointed medical director of Mid Staffordshire Foundation Trust after care failings came to light there, said it was “good to have a successful trust to buddy with”, but that “some areas worked better than others”.

He said: “On the nursing front it worked particularly well. The buddying arrangement allowed for band 7 [and] 8 nursing staff to share experience across two sites.”

However, joint workshops between the trusts on business planning had been less successful because “the gulf was too big” between their circumstances.

“Guy’s and St Thomas’ are a hugely successful enterprise with profit that’s running into many millions, whereas the opposite is true [of King’s Lynn],” he said.

Mr Obhrai said he was “pretty confident” the trust would exit special measures in six months’ time, but he was unlikely to be in post by then.

Despite the Care Quality Commission rating the trust as “requires improvement” in an inspection report last month, the regulator did find “significant areas of improvement”, Mr Obhrai said.

King’s Lynn is holding interviews for a permanent chief executive this month.

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