• Review by consultants said trust had “cohesive leadership [and a] clear vision”
  • Review contrasts with CQC report which raised concerns about how well led the trust was
  • Report identified “high levels of disaffection” among staff but said trust was “heading in appropriate direction”

An external review of the East of England Ambulance Services Trust’s leadership concluded bosses showed “cohesive leadership” and had a “clear vision” just weeks after the Care Quality Commission raised concerns about how well led it was.

The Deloitte review, released by the trust last week, also said the trust’s chief executive Robert Morton had been described by some staff as “visionary, supportive and compassionate”.

The review, which cost around £50,000, did identify cultural problems. Other staff “described an ‘us and them’ culture between staff and senior leadership” and felt “a sense of being voiceless and disempowered”.

It said “the trust is heading in the appropriate direction” but it would take time to address the concerns. In the meantime “high levels of disaffection across the organisation” remain, it said. 

The conclusions followed a CQC inspection earlier this month, which rated the trust “requires improvement” overall and “requires improvement” for the “well led” domain.

Inspectors raised concerns in the “well led” section that “temporary management roles had contributed to a lack of leadership, openness, and staff engagement”.

The “well led” section also said there was a “culture of low morale, late shift finishes, and disengagement between front line staff and the senior management team” at the trust.

The Deloitte review also comes a week after senior MPs called for leadership change and official data showed the trust’s performance was the worst of the 10 mainland English NHS ambulance trusts in May and June for the most urgent “category 1” calls (see box).

The trust told HSJ comparisons between the two reports were “misleading, particularly when the CQC field work took place in the middle of one of the worst winters on record and the Deloitte field work concluded some months later”.

“We note the selective comparison HSJ approached us with as a small number of statements extracted from both reports, which are taken out of context. The findings of both reports are focused on different areas, hence comparisons are misleading,” a spokeswoman said.

The Deloitte report rated the trust against the NHS Improvement’s “well led” framework. The CQC used its own “well led” framework. NHS Improvement says its “well led” guidance, updated in 2017, “underpins” the CQC’s well led domain.

It says: “In support of our commitment to working more closely with our regulatory partners, the structure of our framework (key lines of enquiries and the characteristics) is wholly [NHSI emphasis] shared with the CQC and underpins CQC’s regular regulatory assessments of the well led question. This means that information prepared for regulation can also be used for development, and vice versa. 

The CQC’s well led guidance on its website supports this. It says NHS Improvement’s guidance is a “good practice reference” for their inspectors and trusts (see box below).

The trust issued a further statement following publication of the story. It said: “Both the CQC and Deliotte have undertaken their reviews using the NHSI well led framework and have asked searching questions.

”We recognise that while both reviews used the same framework, the focus was different, e.g. the CQC examined the trust’s processes in detail, while Deloitte focussed on engaging a substantial number of stakeholders both internally and externally. The diverse perspective of both reports adds to the rich picture of improvement we continue to develop.

“The trust continues to focus on our ambition to move to good and beyond but recognises the challenges associated with changing a culture across a large regional provider organisation. The material from both reports will continue to inform our work.”

The review, East of England Ambulance Service NHS Trust Review of Leadership and Governance, said: “Our overall view is that the trust board has all the necessary foundations in place to become a high performing board and well governed trust… The trust has a clear vision which is underpinned by its strategic objectives and priorities as well as a number of enabling strategies.”

It also dismissed “the ongoing criticism being levelled at trust senior leadership” as unjustified. The trust should “maintain an internal focus going forward”.

The CQC had not seen the Deloitte report prior to publishing its inspection, both organisations said, although the regulator said it had been aware the Deloitte review was on going.

A CQC spokesperson said: “Our inspection of [the trust] found that progress had been made in some areas, but it also identified a number of concerns in relation to patient safety, disengagement between front line staff and the senior management team, and low staff morale.

“We are pleased to see that the independent review by Deloitte has also made a number of recommendations for the trust, particularly in regard to improving staff engagement and enhancing the visibility of board members.

“We welcome the recommendations made by Deloitte which reiterate the action needed to improve leadership and culture across the organisation. Our inspection has made clear to the trust where their focus needs to be in terms of quality and safety improvements and we will be monitoring their progress closely.”

The Deloitte review was carried out in line with NHS Improvement’s well led framework, which states it is good practice to carry out such a review every three to five years. It is expected to cost £50,000, the trust said.

A trust spokeswoman added: “Deloitte spoke to almost 1,000 internal and external stakeholders; we do not know how many stakeholders CQC spoke to during their field work.

“Rather than focusing on selective comparisons, we are more focused on using the opportunities the reports provide to celebrate what we do well and continue to work hard on those areas identified for further improvement for the benefit of our staff and patients.”

NHS Improvement’s well led guidance, updated in 2017, says: “In a change from previous frameworks, and in support of our commitment to working more closely with our regulatory partners, the structure of our framework (key lines of enquiries and the characteristics) is wholly shared with the CQC and underpins CQC’s regular regulatory assessments of the well led question. This means that information prepared for regulation can also be used for development, and vice versa.

NHS Improvement says on its website: “As part of our commitment to simplifying our regulatory approaches, we’ve worked closely with the CQC to bring together our respective approaches resulting a fully joint well led framework structured around eight key lines of enquiry.” 

The CQC’s well led guidance on its website says NHS Improvement’s guidance is a “good practice reference” for their inspectors and trusts. It says: “Well led: the leadership, management and governance of the organisation make sure it’s providing high quality care that’s based around your individual needs, that it encourages learning and innovation, and that it promotes an open and fair culture.”

The NHS Improvement’s eight lines of inquiry are:

KLOE 1. Is there the leadership capacity and capability to deliver high quality, sustainable care?

KLOE 2: Is there a clear vision and a credible strategy to deliver high quality, sustainable care to people, and robust plans to deliver?

KLOE 3 Is there a culture of high quality, sustainable care?

KLOE 4. Are there clear responsibilities, roles and systems of accountability to support good governance and management?

KLOE 5. Are there clear and effective processes for managing risks, issues and performance?

KLOE 6. Is appropriate and accurate information being effectively processed, challenged and acted on?

KLOE 7 Are the people who use services, the public, staff and external partners engaged and involved to support high quality sustainable services

KLOE 8: Are there robust systems and processes for learning, continuous improvement and innovation?

Trust’s performance struggles in recent months

C1 East of England performance 2018

NHS England data published this month showed the trust’s performance has deteriorated each month between April, May and June, and that performance had not improved since the risk summit in February for category 1 calls. C1 is the most urgent call category. It has a 7 minute mean response time target (See chart).

The official data shows the trust recorded the worst performance of the 10 mainland English NHS ambulance trusts in May and June and the third worst in April for C1 calls.

*UPDATED: This story was updated at 16:05 on 23rd July after the ambulance trust provided a second statement.