New leadership team at Pennine Acute Hospitals takes action to drive improvements and safety following critical CQC report

Sir David Dalton, Chief Executive of The Pennine Acute Hospitals NHS Trust

Sir David Dalton, Chief Executive of The Pennine Acute Hospitals NHS Trust (PAT), says the Trust will be better, stronger and more determined than ever to drive up improvements following the Care Quality Commission’s (CQC) Report so that it becomes one of the best and safest NHS Trusts in the country.

In briefings given to Trust staff this week, Sir David, who took over as Chief Executive in April, said he is determined to apply his track record of patient safety, high quality of care and high staff satisfaction, taking the learning from Salford Royal, to drive the necessary improvements and changes at PAT to ensure services are “safer, more reliable and sustainable for the future”.

CQC Rating

England’s Chief Inspector of Hospitals has given the Trust an overall rating as ‘Inadequate’ for services provided by PAT following an inspection by the CQC in February and March 2016.

The CQC – the health and social care regulator - can give one of four ratings to Trusts and services: ‘Outstanding’, ‘Good’, ‘Requires Improvement’, or ‘Inadequate’. A team of CQC inspectors found the Trust provided services that were Good for ‘Caring’, but were deemed overall ‘Inadequate’ for being ‘Safe’ and ‘Well-Led’, and ‘Requires Improvement’ to be ‘Effective’ and ‘Responsive’.

The CQC inspected all four hospitals and all community services run by the Trust:

• Rochdale Infirmary was rated as ‘Good’
• Fairfield General Hospital in Bury was rated as ‘Requires Improvement’
• North Manchester General Hospital was rated as ‘Inadequate’
• The Royal Oldham Hospital was rated ‘Inadequate’
• All community services run by the Trust were rated as ‘Good’ across all CQC domains
• ‘Outstanding’ rating given for the Caring domain in the community End of Life Service
•  Outpatients, x-ray and other diagnostic services rated ‘Good’ across all hospital sites 

Although CQC inspectors mostly saw Trust staff “treating patients in a compassionate and sensitive way” during their visits, they reported concerns about the systems and procedures that are in place to keep people safe and free from harm.

The CQC has stopped short of recommending the Trust to be placed into special measures. Under the leadership of Sir David Dalton, PAHT’s new management team working closely with Salford Royal has put in place a comprehensive action plan to deliver improvements.

As part of its plans, the Trust has secured a finance package of £9.2 million with local commissioners and regional and national health and social care partners - additional money to spend on staffing and service improvements.

New leadership

Since April 2016, the Trust has been led by a new executive management team. In March, the Chairman and Chief Executive, Jim Potter and Sir David Dalton, of Salford Royal Hospital NHS Foundation Trust agreed to provide leadership and support to PAT from 1 April 2016.

Salford Royal is one of the top performing Foundation Trusts in the country where Sir David Dalton has been chief executive since 2001, leading it to an ‘outstanding’ rating by the CQC. Salford Royal, which prides itself as the safest organisation in the NHS, is only one of five Trusts in the country to achieve this rating and the first in the North of England.

In addition to Sir David Dalton’s arrival, in March 2016 a newly appointed Medical Director, Professor Matthew Makin, started in post days after the CQC inspection. Professor Makin, born and brought up in Manchester, was previously Medical Director at Betsi Cadwaladr University Health Board. 

On 1 August, Elaine Inglesby-Burke CBE was appointed to Chief Nurse at PAT whilst also continuing her role as Nurse Director and Deputy Chief Executive at Salford Royal.

Sir David said: “The CQC report doesn’t make comfortable reading and whilst staff will be very disappointed with the Trust’s overall rating, we welcome this report which I believe is a fair assessment of the issues facing the Trust. Encouragingly, CQC inspectors found that the Trust was a caring organisation and found staff treating patients in a compassionate, caring and sensitive way.

“The CQC report is holding up a mirror to the organisation and reflects very much what staff have been saying for some time on issues related to staffing pressures, inadequate systems, culture, leadership and resources.

“We know improvements must be made not only in the short term to stabilise pressured services, but in the longer term to ensure services are sustainable. We want all services to meet the high standards that our patients expect and deserve.

“We have not waited for the publication of this report to put an improvement plan in place to support staff and patients. Our priority is to keep our services running safely and to ensure patients receive good safe treatment in a timely manner. We will not allow this organisation to run unsafe services.

"It is recognised that for this Trust to make services safer and more reliable, it requires the support from our health and social care partners to provide over the next six months and to consider longer-term solutions for services across Greater Manchester.

“The Trust needs stability in its services and its leadership. This week will be the start of a new journey and a new focus for staff here. The Trust and the 9,000 staff who work across the four hospitals and our community services will be stronger, better and more determined than ever to drive improvements as a consequence of the publication of this report so that Pennine Acute Hospitals Trust, like Salford Royal, becomes one of the best and safest NHS Trusts in the country.”

Professor Matthew Makin, Medical Director at the Trust, said: “As one of the largest NHS Trusts in the country last year our staff saw over 320,500 A&E cases, 670,000 outpatients,106,000 inpatients and 73,200 day cases across our four hospitals. In addition, our community staff made over 146,000 visits to patients in their own homes and our maternity teams helped women deliver 9,700 babies. The majority of these patients received excellent care and a good patient experience from committed staff. But we know we have to do more to ensure patients and their families receive safe and effective care much more reliably.

“The CQC inspection carried out five months ago reflects a particular moment in time and we have taken immediate actions to strengthen the leadership and staffing arrangements across a number of our services, particularly those that are pressured and fragile.”

Improvement Board

Health and social care organisations within Manchester and across Greater Manchester have come together through a new Improvement Board to help stabilise and offer support to some key service areas that are facing pressures due to staffing shortages – namely A&E, maternity and children’s services, and critical care services. Under the leadership of Sir David Dalton, and with the support of partner organisations across Greater Manchester, a range of immediate actions are being put in place.

Work is already underway to ensure maternity services are safe and sustainable through the Trust’s Maternity Improvement programme and collaborative working with colleagues from Central Manchester University Hospitals NHS Foundation Trust.

CMFT has been working to develop a programme of Clinical Leadership and support in order to stabilise services on the North Manchester General Hospital site.

The recruitment and retention of maternity staff has been a major focus for PAT over the last few months with a new management team in place and the Trust recently recruiting a further 33 midwives and 25 healthcare support workers to enhance its midwifery staffing establishment, which includes over 350 midwives.

Lord Peter Smith, Chairman of Greater Manchester Health and Social Care Strategic Partnership Board - the body overseeing the region's devolved health and social care system - said: "Devolution has given us the opportunity to work together - and support each other - in instances like this, so that we can collectively raise standards or tackle key issues across the whole area. Problems must not be viewed as individual area issues - they need to be addressed by Greater Manchester and other parts of the wider region.

"We now have senior clinicians from across the region meeting regularly to advise - and act on - how the whole Greater Manchester structure and its expert workforce can be best used to help each other. This is not only in times of crisis, but as the start of that transformational process of making the entire system more robust and sustainable."