Agenda item

This report seeks to provide an update on the leadership arrangements at Medway NHS Foundation Trust and the recent reinspection of the Trust’s urgent and emergency care services.

Discussion:

The Interim Chief Executive (CE) of Medway NHS Foundation Trust (MFT) introduced the report which provided an update on the leadership arrangements at MFT and the recent reinspection of the Trust’s Urgent and Emergency Care Service. He explained that the Kent and Medway Integrated Care Board (ICB) had commissioned a review of both MFT and Dartford and Gravesham NHS Foundation Trust (DGFT), at which he was also CE, to explore any benefits and synergies of greater collaboration between the two organisations.

Members then raised a number of questions and comments, which included:

• Merger – concern of the prospect of a full scale merger of both acute trusts was raised. In response, the interim CE explained that although the review was ongoing, he considered this to be an unlikely outcome, with a group model being more likely. A group model would see a shared leadership team, where appropriate, but with high demand, closure of services was unlikely unless clear clinical benefits were established. It was also confirmed that no further trusts were being explored as part of this review.
• Challenge of the role – in response to a question about the impact of merging the CE role for DGFT and MFT and the challenges that brought, the interim CE explained this was inevitably a challenge and therefore a priority had been embedding the right support in the executive teams beneath him in both organisations and a full time Deputy Chief Executive for MFT had started in post the previous week. In response to a follow up question, he did agree that the role of CE of acute trusts generally had changed in recent years and was now far more externally focussed with partnership working being a key part.
• Staff morale – in response to a question about staff morale and how arrangements had impacted that, the interim CE reported that morale was moving positively but was still mixed across the organisation. He explained that the organisation’s culture generally needed to improve, which would in turn impact positively on morale. A Cultural Transformation Programme had been commissioned by the Trust, led by specialists outside the organisation. Its purpose had been to identify issues and make recommendations to address the need for improvements in culture, with a focus on racism and violence and aggression. Governance had been updated to ensure staff felt more heard and a new Freedom to Speak Service had also been launched to assist staff in helping to raise their concerns. The Chief of Staff from the ICB added that the interim CE was taking action to address the cultural issues at pace.
• Group model examples of best practice – in response to a question about whether there were examples of group models working well elsewhere and why this was becoming a more popular model, the interim CE explained that Warwick ran a successful group model with 4 trusts included. In terms of why this model had become more common, he cited a number of reasons, including shortage of suitable candidates willing to be CEs in the NHS, the ability it brought to onboard someone with relevant experience already and therefore were better equipped to steer organisations through the challenges the NHS was currently facing at pace, and efficiency savings.
• Key challenges for Medway – when asked what the key challenges for Medway were, the interim CE reiterated the need to improve the organisation’s culture and added that the financial pressure the organisation was under was incredibly difficult, with saving targets of around £45m. He explained focus was being placed on ways to improve efficiencies, including improved procurement but that the head count of staff would inevitably need to be reduced.
• Comparative data – a request was made that future reports include benchmarking data to enable Members to understand how the performance related to the wider area and nationally. In addition, the interim CE signposted Members to the MFT Board papers which were published online and included detailed performance data.
• Key aspirations – in response to a question about the interim CE’s aspirations for the trust, he explained his areas of focus were around culture and addressing unacceptable behaviour, as well as a focus on Emergency Department waiting times as he sought to eliminate patients waiting longer than 12 hours in the Emergency Department and reduce waits overall. He added that Medway was one of the top performers in relation to ambulance handling times and he would not want that to deteriorate.
• System wide improvements – the Chief of Staff at the ICB added that results from friends and family feedback at MFT was improving, but recognised that some of the complexities to the issues at the Trust needed to be addressed at a system wide level, such as managing patient flows, developing community based provision and maximising potential from technology.

Decision:

The Committee noted the report and thanked staff of Medway NHS Foundation Trust for their continued commitment and hard work.