11 June 3013
With permission Mr Speaker, I wish to make a Statement to the Assembly on the report of the Turnaround and Support Team on the Northern Health and Social Care Trust.
As Members will recall I made a Written Statement to this House on 10 December 2012 on the appointment of a small Turnaround and Support Team to the Northern Health and Social Care Trust to complete a strategic overview to establish what changes and support might be required to accelerate progress at the Trust. The Team was asked to provide an assessment of the changes required to improve performance, and to support the management of the Trust in the delivery of services.
Under its Terms Of Reference, the Team was asked to take forward the work in two phases with Phase 1 focusing on the analysis of the challenges facing the Trust and its ability to deliver on services commissioned; and Phase 2 focusing on turnaround and support in light of the findings of Phase 1.
I have now received the report from the Turnaround Team detailing the findings of Phase 1 of the Review. The report addresses the Terms Of Reference comprehensively and I am very grateful to Sue Page and her team for the significant work in taking this forward. I am making the report publicly available on the Department’s website today.
In line with the Terms of Reference for Phase 1, the Review included an analysis and assessment of the challenges faced by the Trust and its ability to deliver on the services commissioned taking account of previous reviews, and their implementation, and drawing on information about similar providers elsewhere. Given the need to reduce waiting times in relation to unscheduled care, the Review examined performance, including the quality and safety of services, outcomes and patient experience, at the Trust’s Emergency Departments and has identified specific areas and aspects of the work of the Trust, and its relationships with other providers of health and social care, where improvement is required. The report provides the Team’s assessment of leadership capacity at the Trust and the changes necessary to improve performance.
The report makes five distinct recommendations. They are to:
- Enhance the leadership capacity at the Trust and empower clinicians to lead change;
- Ensure support to deliver an Improvement Plan in three phases;
- Gain assurance that Governance and Quality systems are robust;
- Gain assurance that mortality data is robust; and
- Put in place a performance framework that will ensure delivery of the Improvement Plan and contains clear consequences for non-delivery, alongside incentives for delivery.
Throughout the Review, the Team not only focused on those issues which were impediments to improving performance but also considered the existing capacity for improvement and opportunities to develop new capacity for improvement within the Trust.
However, in overall terms the analysis has identified that the Northern Health and Social Care Trust is in a poor position and requires intensive support to improve.
Mr Speaker, it is reassuring to note that the Team concluded that the Trust can be turned around. That is essential to improve the patient care and experience at the Trust. However support needs to be provided to enable it to do so.
Members will be aware that I announced the appointment of two Senior Directors to the Northern Trust on 2 May. These appointments were made, in light of emerging findings of the Turnaround Team at that time, to lead on the next stages of the turnaround process in order to improve critical areas of service delivery. Mary Hinds and Paul Cummings joined the Trust on temporary secondment from the Public Health Agency and the Health and Social Care Board respectively on 13 May. As Senior Director of Turnaround, Mary Hinds will lead the improvement programme in Antrim and Causeway Hospitals, and the related community services. In his role as Senior Director of Corporate Management, Paul Cummings will oversee the remaining service Directorates and the corporate management functions. A new Acting Medical Director is now in place and two middle management staff have also been seconded from Health and Social Care Board and the Public Health Agency to the Trust. These appointments are the first steps in the change as part of the intensive support programme that will be provided to the Trust to ensure the necessary turnaround is achieved. The over-riding objective is that interests of and outcomes for patient care are at the centre of Trust activity.
Specifically, the report recommends a three phased Improvement Plan. Phase 1 has three separate components covering operational delivery of services at Antrim Hospital; operational delivery of services at Causeway Hospital; and maximising Primary and Community Care and Older People’s Services.
Phase 2 of the Improvement Plan will involve developing clinical networks and integrating clinical teams with devolved accountability. The outcome for Phase 2 should be that clinical services be fully integrated and aligned to populations with an accountability framework in place to manage resources and agree priorities for Service Review.
Phase 3 of the Improvement Plan will involve a systematic programme of Service Reviews to implement Transforming Your Care. The outcome for Phase 3 should be systematic delivery of the changes needed in line with the strategic objectives of TYC.
Initially, the key element of the work will be delivery of Phase 1 of the Improvement Plan. It is anticipated that this phase of improvement will be completed within six months. The Department will put in place governance arrangements to monitor progress against the Plan. In this regard there will be close working with the HSCB. It will be important that these arrangements are effective but that they will not introduce an overly bureaucratic system which would impede the progress.
In relation to the Causeway Hospital the report signals the need to remove any sense of uncertainty in regards to its future management arrangements. I am very keen to remove that uncertainty. I told this House on 19 March that the TYC consultation had indicated significant support for action, as set out in the Vision to Action document, and I confirmed that I was asking officials to begin work to take forward an options appraisal which would consider the future management arrangements for Causeway Hospital, whether it should remain with the Northern Trust or transfer in the near future to the Western Trust. Preparatory work on the options appraisal has begun.
I believe that the implementation of the Turnaround Team’s recommendations will provide a solid basis to deliver the much needed improvement at the Northern Trust. The learning will be shared across Northern Ireland. I do not underestimate the scale of the task involved. Members, Trust staff and the public will want to consider carefully the Team’s report released today. The over-riding consideration is the need to put the quality of patient care at the top of our priorities for Health and Social Care. I am determined therefore that improvements are made at the Trust. That is not just in the interests of patients but also in the interests of the staff who work there. I recognise that turnaround will not happen overnight though there are already some signs of improvement at both Antrim and Causeway hospitals and that is to be welcomed.
I have stated previously my appreciation for the professionalism and continuing dedication of the doctors, nurses and other front-line staff at the Trust who want to provide safe, high quality services to their patients and clients. Clinicians must be at the centre of the improvement process. I also recognise the commitment and determination shown by the previous and the new management teams and I want the Department, HSCB and PHA to work with the leadership in the Trust to ensure that the actions we are now taking are fully effective in securing change. I am encouraged that the Trust will be following a path that is clinically led and managerially supported. It is essential that the processes now underway are a success in delivering the much needed improvements for the local community.
I commend this Statement to the House.