• Making staff “bothered” about four hour “quality measure” was key to turnaround, says trust boss
  • Transforming Colchester A&E performance was a “little bit of changing systems, but largely hearts and minds”
  • Hospital’s A&E performance up from 81 per cent in July 2017 to 98 per cent last month

Making staff “bothered” about the four hour metric and recognising it was a “quality standard not a performance target” was the main driver behind a struggling hospital’s accident and emergency performance recovery, a senior trust chief has told HSJ.

Nick Hulme, chief of the newly created East Suffolk and North Essex Foundation Trust, said turning around Colchester Hospital’s woeful A&E performance had required a “little bit of [changing] systems, but was largely hearts and minds”.

Mr Hulme said: “A locum registrar who has worked in 50 A&E departments up and down the country and I really respect [told me] if [the staff] are bothered about and committed to the four hour standard then you deliver it, and if they’re not, you don’t.

“So I had a series of one-to-one meetings with senior staff and consultants and said ‘you need to be bothered’.

“People are now genuinely committed to the standard because they recognise it’s a quality standard and not a performance target. That took hours and hours of meetings.”

Colchester’s A&E performance has transformed over the last year. Its overall A&E performance was 80.7 per cent in July 2017, with its type one performance at 69.2 per cent. 

But it met the 95 per cent target overall by March 2018, despite the system still being under significant pressure from a brutal winter. By May its type one hit 96.2 per cent, and the hospital has remained on target on both categories since.

He said the trust had implemented “Project Ivy”, inspired by a patient treated at the hospital after spending nine hours left on the floor in her own urine waiting for an ambulance, many of which were backed up at hospitals handing on other patients.

The former Croydon hospital chief added: “The Ivy story [supported by pictures and family testimony] is really powerful. We changed the conversation from…a bloke in a suit with a clipboard telling staff to hit 95 per cent target…to what can we do to get Ivy off the floor?”

ESNEFT was created by the merger of Colchester and Ipswich hospital trusts in July. It is now one of the largest providers in the East of England with a turnover of around £670m.

Mr Hulme is also the accountable officer for the East Suffolk and North Essex sustainability and transformation partnership, one of 10 integrated care system pilot areas announced earlier this year.

He said he had “challenged” all the involved organisations to makes decisions which were “advantageous to the system even if there is a risk to their organisation”.

He said Ipswich trust’s hospital board had set an example by taking the decision to “effectively fall on their sword in terms of saying ‘we know it’s best for the system if Ipswich and Colchester merge’”, even though it put their jobs at risk.

The long standing chief executive also backed calls last week for NHS England to drop its policy – described as “perverse in the extreme” – to withhold money from a £200m of cancer transformation fund from areas breaching the 62 day target.

“It is perhaps ironic that you can only access the full amount of money if you deliver the 62 days rather than recognising you need the full allocation in order to hit the target. There needs to be an ongoing discussion about this,” he said.