STRUCTURE: A major teaching hospital is to hive off its orthopaedic services into an ‘autonomous team’ within the trust as part of a pilot designed to improve staff performance and outcomes.

  • If trust’s “spin-out” pilot shows increases in staff performance and outcomes, other services will see decision making devolved
  • Discussions are ongoing on exactly how the clinical teams can be managed as a separate unit within the trust
  • “We are experimenting to see what benefits it brings,” says trust chief executive

University Hospitals of Leicester Trust will attempt to give staff a greater sense of ownership over their work by moving the elective orthopaedic, trauma, and theatre teams into their own “business unit”.

The initiative, designed to ape the structure of a social enterprise, is the first step of a long term process that could see the provider eventually become a “whole trust mutual” – outside of state ownership. However, the trust has identified significant barriers to mutualisation, including the VAT regime.

Image of John Adler

The trust is experimenting with ‘devolving as much power and decision making as possible’, John Adler said

Trust chief executive John Adler told HSJ that if the pilot improved performance, other services would also have decision making devolved to them.

Currently, the trust’s elective and trauma orthopaedics income is around £48m a year and direct costs for the provider’s musculoskeletal and specialist surgery clinical management group are nearly £28m a year.

In 2014-15 the trust had a total revenue of £834m, according to its most recent board report.

Mr Adler said: “We’re pursuing our autonomous team pilot – essentially an internal spin-out of orthopaedics but very much still within the trust.

“We are experimenting with devolving as much power and decision making as possible to the front line to see what benefits that brings.

“There’s another few months of development work to do on that before we go live but it will be an exciting pushing of the normal organisational boundaries.”

While the best way to create the autonomous team is yet to be decided, a report produced by trust as part of its involvement in the Mutuals in Health pathfinder scheme suggests two options.

First, the autonomous team could be created as a separate “business division” within the trust. Alternatively, another approach would involve setting the team up as a subcommittee of an existing board committee.

However, a trust spokeswoman said that the latter approach would not be necessary for the pilot to go ahead.

Trust managers have emphasised staff assigned to the team would see no changes to their terms, conditions or access to the NHS pension scheme.

Looking at possibilities beyond the pilot, Mr Adler said: “As far as the whole trust mutual idea goes, this very much depends on whether the new government decides to pursue it.

“If they do, we are still interested in considering this further, provided that the barriers that the pathfinder programme identified can be overcome. We appear to be the people most interested in it still.”