New chief of struggling trust 'not shying away' from challenges

Mark Cubbon, the trust’s new chief executive, told HSJ the model would ensure more consultants work in the emergency department for a greater number of hours, to improve decision making during the patient pathway.

His comments come after the publication of a highly critical Care Quality Commission report, which said the trust was “not addressing the concerns regarding the acute medical pathway in a timely or effective way”.

The trust has long struggled with its performance against emergency waiting time targets, with the number of 12 hour trolley waits the highest at any trust in England this spring.

In May, the trust tried to implement a new acute model – which involved changes to doctors’ working hours – but the launch failed because some doctors refused to take part, the CQC’s report said.

Mr Cubbon said further discussions with specialists had taken place since May to “make sure the model is right” and the project has been subject to the trust’s HR process.

Focusing on the acute medical unit – where the CQC highlighted several failings – the model will see consultants supporting junior doctors for more hours to help assess and review patients, Mr Cubbon said.

It is hoped this will improve the patient flow through the emergency department.

The model will be implemented in September but Mr Cubbon said it was too early to predict when the trust would start achieving its agreed trajectory with NHS Improvement.

In June, Portsmouth’s four hour A&E performance was 81.57 per cent, against a target of 84 per cent as agreed with NHSI. There were nine breaches against the 12 hour standard, compared to 38 in May. The CQC said breaches of the emergency waiting time standards “appeared to be normalised”.

Mr Cubbon said the trust had been successful in recruiting further consultants to the emergency department and more multidisciplinary meetings were being held to bring staff closer together.

Mr Cubbon, who is four weeks into his first chief executive job in the NHS, said the 975 bed hospital was “full” and 76 escalation beds were in use – meaning some patients were being treated in other areas of the wards.

Stressing that he was not “passing the buck”, Mr Cubbon said elements of cross-organisation work in the local health system “were not right at the moment”.

But he added: “Everyone is committed to making it work.”

Asked about a “culture of specialism” within the trust that was highlighted by the CQC, Mr Cubbon said: “We are very clear in the trust that every patient counts and every patient who comes to the hospital should expect the very best standards of care…

“Some people have worked with their specialism for many years but it can’t come at the cost of general services provided to the local population.”

He pledged to publish the trust’s action plan, developed in response to the CQC report, and added: “We’re not shying away from what we need to do.”

Another priority will be to establish a new leadership team as several board positions are filled by interims after a high turnover of directors in recent years.

These include the chair, after Sir Ian Carruthers stepped down; chief operating officer; and chief nurse.

Mr Cubbon said he expected a new chair to be appointed by October and the trust is shortlisting candidates for other board level positions.