UPDATED: Downgraded trust’s CEO describes ‘hugely taxing’ effort to balance safety with collaboration

In an interview with HSJ, Robert Woolley – CEO of University Hospitals of Bristol and Weston Foundation Trust – said he still believed merging Bristol and Weston-super-Mare’s hospitals was the right decision, but he urged other trusts considering mergers to “think through the resources and skills you need and have secured”.

It comes as all acute NHS trusts have been told to form provider collaboratives as part of the new health reforms, with some trusts choosing to merge or adopt group models.

The £950m-income UHBW was created just after the pandemic broke out in the UK in April 2020 following a merger between the “outstanding”-rated University Hospitals Bristol FT and Weston Area Health Trust. 

However, the pandemic has disrupted UHBW’s ability to integrate services between the Bristol and Weston sites. Weston, in particular, has struggled with staff shortages, which were exacerbated last spring when Health Education England removed 10 junior doctors from the hospital over concerns they were being left without adequate supervision.

The CQC today downgraded Bristol Royal Infirmary from “outstanding” to “good” and rated Weston General Hospital “inadequate” amid concerns over staff shortages and a “disconnect” between managers and clinicians.

Mr Woolley, who twice led Bristol to “outstanding” ratings from CQC, said: “My advice to anyone contemplating a merger would be do it with your eyes open. Our problem was we didn’t have a crystal ball and anticipate the pandemic, but now it’s out there it can be factored into what you need by way of resources and skills capacity to make a success of the merger.

“Regulators are in a real bind – the bottom line is safety, no one is going to argue that and they can’t abandon any core standards on safety.

“The question is how do you take account of system working and provider collaboration - whether it’s mergers or groups – where leaders have to split themselves between all that internal governance control management of safety risks, but being drawn – quite rightly – into system working and collaboration and greater integration between providers and sectors?

“That is hugely taxing for leaders to balance both agendas”.

He added the new trust had always said it would take two years to realise the benefits of a merger – even without the pandemic – and the CQC had “acknowledged” they inspected the trust 14 months after the new organisation was formed.

‘Disconnect’ between managers and staff

According to the CQC, staff at Weston said UHBW’s senior leadership team were “perceived not to be present enough on the wards to understand the issues staff faced”.

Inspectors said senior managers had told them they recognised that “visibility” during the pandemic had been “an issue”, and that “some inroads had commenced to meet with staff”.

The CQC also reported that there appeared to be a “disconnect” between Weston’s senior management team and ward staff, who felt their concerns about workforce shortages were not being addressed.

Inspectors said they witnessed several shifts which were not covered, and that staff described staffing management as “reactive, not proactive”.

The CQC rated Weston General Hospital as “inadequate” in two of five domains (safe and well led), and “requires improvement” in the “effective” and “responsive” domains. Bristol Royal Infirmary was rated “outstanding” in the “caring” and “well-led” domains, and “good” overall.

Mr Woolley said he acknowledged that “we looked more distanced just when staff at Weston needed us” due to the pandemic, and he added that trust executives have “protected time” in their diaries to visit Weston as there is “no substitute for talking to people face to face”.

He also said he had “sympathy” with Weston’s new leadership team which was immediately dealing with a pandemic in a “new merged trust with strange systems and processes” which he said would have “taxed any leader”.

The trust has since appointed a managing director, medical director and deputy chief nurse at Weston to provide support to the divisional leadership teams.

But Mr Woolley warned staff shortages at the hospital – including a 20 per cent vacancy rate for registered nurses and nine of 12 consultants being locums – were symptomatic of a “national problem” which the trust was working hard to address.

Trust ’cannot’ improve alone

The trust was rated “outstanding” for caring. Inspectors also found the trust had maintained a “safe service” during the pandemic, and that overall risk-management was good. Last year, a review found 18 patients died at Weston General Hospital with hospital-acquired covid-19 where the infection contributed to their death.

Dr Nigel Acheson, CQC’s deputy chief inspector of hospitals, said: “As with all mergers, there are generally areas which a trust will need to address and we were disappointed to find a lack of awareness amongst the leadership team regarding medical care at Western General Hospital.

“It was also concerning that the team was not on top of some major concerns, including the supervision of junior doctors at Weston General Hospital which had triggered quality intervention visits from Health Education England and the General Medical Council.

“The trust cannot do this alone and support from the local healthcare community, including the local integrated care system, clinical commissioning group and NHS England and NHS Improvement is essential for the trust to succeed.”