North by North West: Blackpool rocking

Swift exit

Wendy Swift’s announcement that she will retire from Blackpool Teaching Hospitals was unfortunately timed – coming in the same week as a major update in the police investigation into allegations of mistreatment and neglect on the trust’s stroke unit.

As I understand it, there is no direct link between the two bits of news, although the developing investigations (which include a murder probe) will obviously have created an immense amount of stress, pressure and distraction for the board.

The more relevant context is that the FT has been struggling on several fronts now for quite some time.

It’s performance against the four-hour target has been particularly alarming, and the urgent and emergency services was rated “inadequate” by the Care Quality Commission last year.

Its finances have also been deteriorating (compared to national improvement), with a £6m deficit expected for 2018-19, and it’s in the third tier of trusts within NHS Improvement’s single oversight framework, which is one level below special measures and signifies that it requires “mandated support”.

No date for Ms Swift’s departure has yet been announced, although she is expected to depart relatively quickly.

We’ll have to see, but further board level changes could also be on the cards as concerns mount over the trust.

Joint leadership?

The imminent vacancy could be an opportunity to take a serious step towards acute transformation in Lancashire by combining the leadership of two trusts.

There’s a lot of difficult reconfiguration to be done in a county which has struggled to make progress in redesigning services such as emergency care, stroke, cancer, maternity, and paediatrics.

A joint leadership model with one of the other three acute trusts might just provide a catalyst for bigger and quicker steps to be taken, by changing the dynamic and reducing the potential for disagreement.

Whether one of the other chief executives – who of course have plenty of their own pressures – would have the will or capacity is another question.

Chain model

If Lancashire were to go down this route, then the Northern Care Alliance in Greater Manchester would offer a template of sorts.

The NCA chain combines and divides Salford Royal FT and Pennine Acute Hospitals Trust into four distinct “care organisations”, with a corporate group board sitting above them.

It is very much still a work in progress, with two formal acquisitions still to take place and persistent problems with finance and A&E performance. But feedback about the new management structure has generally been positive, with some clear quality improvements recognised on the Pennine sites.

Replicating this completely in Lancashire – by creating a corporate board overseeing the four trusts – seems unlikely any time soon, but elements of the model could perhaps be introduced gradually.

Leadership pipeline

One emerging benefit of the chain model is the new, broader, leadership experience which it offers beyond typical executive structures.

For example, James Sumner has just been appointed chief executive of Mid Cheshire Hospitals FT, largely off the back of his experience running the Salford care organisation within the NCA chain.

He told me this allowed someone with board experience in a single discipline (such as finance director or chief operating officer) to hold a more autonomous, broader role, with a greater level of accountability in leading a senior management team and being seen as a system leader in the locality.

“It’s a great way to build that experience but has the benefit of being within the supportive structure of a group,” he said.