• New trust chair says turnover in its executive team is the main cause of patient safety failings

Senior team instability is the biggest factor to blame for high profile care quality failings at a Midlands acute trust, its chair has told HSJ.

Caragh Merrick became chair of Worcestershire Acute Hospitals Trust in September. The trust has experienced severe capacity and quality problems in recent months and been the subject of media attention over patient deaths during amid extreme emergency care pressures over the New Year bank holiday.

A warning letter from the Care Quality Commission this week cited problems with governance and oversight of safety; emergency department capacity; and poor care being provided to patients on trolleys on corridors.

The letter gave it six weeks to address serious concerns around patient safety and the quality of services.

Addressing this Ms Merrick said: “Of course this letter is a concern, it is a concern for our staff it has not been good reading.”

However she added: “I am confident by the 10 March we will be able to demonstrate to the CQC’s satisfaction that we have a comprehensive plan, we have implemented it, we have achieved improvement in a number of areas and we’ve made substantive progress in others.”

Speaking about the source of the problems, Mr Merrick said: “The major factor in where we’ve got to with this [CQC] letter was a long period of temporary and changing executive leadership.”

She said: “This trust has had a succession of chief medical officers, chief nurses, some on secondment, some interim.

”This is not to say these individuals came here and did a bad job but when you’re only here six months you have no commitment to the long term, and consequently difficult things you don’t really deal with. Even if you put a plan together you won’t be here to implement it or really drive it.

”Equally you’re not prepared to make investment in things where you’ll only see a benefit in the long term like staff development.” She said it had also affected the ability to hire medical consultants.

Ms Merrick announced the appointment of a new permanent chief executive, Michelle McKay, in early December, and HSJ understands it is due to announce a new chief medical officer, chief nurse and chief finance officer in the near future.

The chair also said clinical recruitment had been hampered by uncertainty over its service strategy. Its Future of Acute Hospital Services in Worcestershire has been running for nearly nine years before proposals were published for public consultation on 6 January.

She indicated this certainty would be helpful, although she also said the programme was now “out of date” as further plans were being developed under the area’s sustainability and transformation plan.

She added: “That doesn’t mean to say we will be unpicking what we’ve already done but [now] we have opportunities to work very collaboratively, to work with other providers to come up with much better solutions.”

The programme has already seen a number of changes implemented including the transfer of emergency paediatric and maternity services from the Alexandra Hospital in Redditch to Worcestershire Royal Hospital.

Asked whether the trust would have the capacity to maintain the services transferred to Worcestershire Royal, the trust chair said that, because these moves had taken place “under emergency measures… we were not able to secure the capital funding to deal with the estate…. [to] enable those changes to be effective.”

She indicated that formal approval of the plans under consultation will lead to approval of the required capital, of £29m, and to the building work taking place.