Long-challenged trust lifted out of special measures

The Care Quality Commission said Queen Elizabeth Hospital King’s Lynn Foundation Trust’s overall rating had also been upgraded from “inadequate” to “requires improvement”.

It leaves only a single trust, the Shrewsbury and Telford Hospital Trust, now rated “inadequate” overall by the CQC.

The regulator took the relatively unusual step of lifting the QEH’s rating in two categories from “inadequate” to “good”, for the well led and effective domains. It also lifted the trust’s rating for the caring domain from “requires improvement” to “good”.

The trust will be one of the first two trusts, alongside United Lincolnshire Hospitals Trust, to be “transitioned” out of segment 4, the bottom group of the new systems oversight framework which is equivalent to “special measures”, up to segment three. 

The report marks a significant achievement for a trust which had been rated “inadequate” since 2018, when it was put into special measures, and remained in the regulatory regime after an inspection in 2020.

The trust has long struggled with financial and performance challenges. A high turnover of CEOs and senior managers in recent years, prior to the current leadership, led by Caroline Shaw who was appointed chief executive in 2018, had in part also led to the trust’s well led rating being cut to “inadequate” and inspectors viewing it as a very troubled organisation.

The trust has, however, previously been removed from special measures, after a spell in the regulatory regime between 2013 and 2015, only to fall back in again in 2018, so maintaining and building on the improvements could remain a challenge.

Fiona Allinson, CQC deputy chief inspector for hospitals, said: “I am pleased to see significant improvements have been made right across the trust in the care given to patients, resulting in a number of its services being rated good.”

Trust chief ‘confident’ trust could be rated ‘good’ after full inspection

Trust chief Ms Shaw told HSJ she was delighted with the progress and praised staff, not least because “we’ve done this during a pandemic, and with all the other challenges of recovery and restoration, so I’m really proud”.

“This report shows how far QEH has come in the last three years, and that this trust is well on the way to becoming the outstanding organisation that we all know it can become,” she added in a statement.

But she also claimed the overall rating could have been even better had there been a full inspection, rather a risk-based approach of only a few core services, as carried out by the inspectors in line with the CQC’s current regime.

Ms Shaw said: “The overall rating [won’t be higher than requires improvement] because [the CQC did] not inspect enough core services. But I’m very confident if they had done, we would have been ‘good’ overall… We were good on all the services they assessed.”

The former chief executive of The Christie Foundation Trust however warned the hospital’s long-term sustainability could only be secured by completely re-building the site, which has a structurally deficient roof which needs to be held up by 476 temporary props.

“I strongly believe it does need an absolute rebuild. Without a rebuild [running a sustainable hospital] will be hugely challenging,” she said.

The trust is expecting to hear imminently on whether either of its two expressions of interest submitted for capital funding have been successful. Its preferred option is for a complete rebuild, with a new hospital in place by 2029-30, but it has also submitted a proposal for a modular piecemeal rebuild.

Former Christie boss urges more senior leaders to join struggling trusts

Ms Shaw has also written a comment piece for HSJ in which she urges other senior leaders to take on a challenged general hospital, rather than just focusing on landing a job at a big teaching trust.

She writes: “If you genuinely come into the health service to make a difference to patients, I promise you that by turning round a difficult hospital you’ll get real pleasure and personal satisfaction from it. It should be something every aspiring leader and CEO aims for. Challenged trusts deserve our brightest and our best.”

Ms Shaw made the argument having herself spent nearly 10 years at The Christie, the prestigious cancer specialist provider in Manchester, where she was one of the youngest female CEOs in the NHS.

However, she resigned following a lengthy suspension in 2014 from her CEO role, after anti-fraud body NHS Protect launched an investigation into invoices submitted to the trust by the Young President’s Organization, a networking organisation which she was a member of, and had recently taken a business trip to Ibiza with.

Ms Shaw always maintained she had acted properly. In October 2014 NHS Protect said it would “not be taking the matter further”, and the trust said the matter had been “resolved to its satisfaction”.

She told HSJ she had “a difficult time after The Christie”, but speaking about her career since, she said: “I think what it shows is that with resilience you can do a lot. I’ve got a lot of good friends in the NHS who have supported me. [After The Christie] there were a couple of people who said ‘come on, you need to get back on the horse’.

“I think what I’d like to do in the future is support people who have gone through difficult challenges like that.”

She added that she “would never say never” to opportunities at big trusts but that “what I’ve learned to do is enjoy what I’ve got I’m doing. I’m really pleased with what the whole team has achieved [at QEHKL].”