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My evening with Keith McNeill & Roy Lilley

Addenbrookes faces significant challenges. The recent CQC inspection judged them “inadequate.”  The Trust has a significant financial deficit and there has been significant board change in recent years including a number of departures this year.    

I can think of many other Trusts facing a similar set of circumstances.  

What I know is that Addenbrookes is a world-class teaching hospital, with a highly skilled and dedicated workforce. I have spoken with and met met some fantastic individuals working there during my recruitment career and I know many that have used its patient services.  Keith himself highlighted some of the Trust’s achievements: 

  • 18 consecutive months without MRSA
  • Low C. diff levels
  • 92% of patients would recommend the Trust
  • No maternal deaths since 2007

For Keith, the focus should be on achieving good outcomes and in many instances these were visible.  He accepted that the CQC had highlighted areas of improvement. The Trust was aware with plans and processes underway to take action. 

So what went wrong? 

Reading the CQC inspection report, key findings to support a judgement of “inadequate” focus on a shortfall in staffing levels with an inappropriate staff skills mix and significant pressure on surgical services. For Keith, Addenbrookes was a victim of its own success - people wanted to come to the  hospital.  

A Non Executive Director at the Trust had commented that Keith was “a centre forward, being played as a midfielder.” In Keith’s view, to move the Trust forward there would need to be a significant transformation agenda combined with micro management and that wasn’t where his skills were best suited.  

What’s to be done?  

Keith highlighted a number of issues which will be familiar to those within the NHS. Difficulty in recruiting clinicians, an internal market which results in the provider or commissioner “loosing out”, a regulatory framework which operates in isolation as opposed to distilling learning.  

I agree with him. 

I think there needs to be a fundamental conversation around how we want to deliver healthcare in the future, how we inspect it, how we share learning across different organisations. No less than fundamental system reform. In my view the National Health Service is what it is: a national service. We need collaboration, joined up thinking and learning.  

We have made several tentative steps in the right directions. Vanguards have the ability to provide a positive disruptive influence. Accountable care organisations, if successful, have the ability to radically alter the provider/commissioner split which currently leads us in Keith’s words “to ration, irrationally.”  

What do you think is to be done? 

Do we continue to place Trusts into special measures indefinitely? How do we increase staffing levels? Is fundamental system reform what’s needed - is it doable or desired?  I’d be very interested to hear from you.   

David Rason is the Consultant for Healthcare at Interim Partners.

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