Learn from Addenbrooke's: We need new solutions for intermediate care

The labelling of Addenbrooke’s as “inadequate” by Care Quality Commission was a real surprise to many as it was considered one of the safest hospitals in the country only two years ago. How could such a hospital end up in special measures in such a short period of time?

‘How could such a hospital end up in special measures in such a short period of time?’

The CQC rated the hospital as “outstanding” for caring, with staff going “above and beyond their duties” and being “extremely caring and extremely skilled”. However, its poor scores for safety and leadership were enough to merit an overall “inadequate” rating. CQC chief inspector of hospitals Sir Mike Richards said senior management have “lost their grip”.

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Specific issues

Sir Mike raised a number of specific issues but there are two in particular that concern me. The first is the lack of connection between staff and management, and the second is the issue of “bed blocking”, which Sir Mike correctly states is a problem across the country.

From this inquiry, it is clear the level of interaction between management and staff at Addenbrooke’s is woefully inadequate. Staff feel they are not listened to, they are overworked and demoralised, yet somehow manage to deliver “outstanding” care. The fact that staff managed to deliver great care, despite management problems, shows the dedication of the team at Addenbrooke’s. Think how good the hospital could be if there was a high functioning management team in place?

Sir Mike also revealed that beds were being taken up, as patients were unable to access the support they needed to leave hospital and return home or go to an intermediate care setting.

It is a problem that can only get worse as we face the annual winter pressures. Indeed, as new figures reveal NHS trusts in England racked up a massive £930m deficit from April to May this year, the warnings are already beginning. Newcastle upon Tyne Hospitals Foundation Trust chief executive Sir Len Fenwick, the longest serving hospitals boss in the health service, said the pressures on hospitals could be greater than ever before.

‘That staff managed to deliver great care, despite management problems, shows the dedication of the Addenbrooke’s team’

So, what can be done to tackle these fundamental problems?

I strongly believe lessons can be learned from looking at new ways organisations are approaching healthcare.

Spiral Health in Blackpool is an award winning health and social care social enterprise. It launched in 2012 as a community interest company, becoming the first independent nurse owned social enterprise in the UK to spin out of the NHS. The service was previously part of the Blackpool Teaching Hospital FT.

Chief executive Tracey Bush and her colleagues deliver intermediate care and rehabilitation, most often to older patients who have been discharged from hospital (step down) or who need a bit more support than they can receive at home for a short period of time (step up).

Spiral’s staff group are intimately involved in the running and improvement of the service. In fact, they are the legal owners of the organisation. As well as being empowered to use their professional judgement on a day to day basis, the staff elect two members of the company board – they have a say in the big decisions affecting the organisation and the service. It is an approach that is working and the organisation is growing.

Staff engagement

The benefits of staff ownership (or even just better staff engagement) was recognised by King’s Fund chief executive Chris Ham in his report, Improving NHS Care by Engaging Staff and Devolving Decision Making. He highlighted that organisations in which staff are engaged and valued deliver better quality care.

The NHS will continue to be plagued with low morale and onerous bureaucracy unless frontline staff are better engaged in the management and governance of services. It is a shame exploratory work by the Department of Health and Cabinet Office on mutualising entire hospital trusts found that it would be impossible without legislative changes to allow FTs to alter their ownership structure.

However, many of the characteristics of a mutual, such as more open and honest communication between management and staff, and a more trusting and empowering culture, can be replicated and would benefit patients, frontline staff and, ultimately, management.

As hospital waiting lists get worse, the issue of bed blocking is also one we cannot ignore. Again, this is an area where a new approach can really help; indeed Spiral developed its intermediate care service to solve exactly this problem.

‘A more trusting and empowering culture can be replicated and would benefit patients’

By providing a more affordable yet still nurse led service for those who need a bit of extra support, it means people don’t need to be stuck in hospital. This not only alleviates the pressure on more expensive acute hospital beds but also is a much more pleasant and relaxed environment for patients.

Again, staff engagement is key here, with their ideas actively encouraged. After all, working on the frontline they know where the problems lie. For example, Spiral is now looking at increasing its home based service so their patients can return home and be supported to stay there.

One can’t help but think that the “outstanding” Addenbrooke’s staff would really thrive in an environment like Spiral’s. As we prepare for the inevitable horror stories of an NHS unable to cope during the winter, we need to ensure management and staff communicate a lot better and new approaches to intermediate care are considered. In short, we need more Spirals.

Andrew Laird is co-founder of Mutual Ventures