David Dalton: Use NHS trusts not management consultants to solve problems

The chief executive of Salford Royal Foundation Trust said he believed the NHS should find a way to reward well performing trusts and encourage them to support trusts in need of help.

His comments come as Salford Royal became the first acute trust to retain its outstanding rating by the Care Quality Commission following a second inspection. The trust was specifically rated outstanding for its successful integration of health and social care and for its use of resources.

Sir David told HSJ the way funding had been used to support the global digital exemplars to spread improvements to others in their areas “is a concept worthy of consideration for further application in the NHS”.

He added: “Whilst we currently spend the amount of money on management consultants and turnaround directors in organisations in difficulty, would it not be better to use a proportion of that money to say to organisations like Salford Royal we would like to use you now to take your known methods and processes and introduce those into other organisations.

“What management consultants don’t have is a responsibility for running large healthcare organisations. They don’t have the experiences of how to build these models and processes. They can commentate, advise and give you a recipe book, but they are not there for the cooking.

“Using organisations with a track record can not only help you to go through the recipe book but they can be there and do the cooking with the other organisations and do so on a voluntary basis.”

He said he had raised this idea with NHS Improvement and “they were thinking about it”.

Salford Royal’s team have also been working to improve neighbouring Pennine Acute Hospitals Trust, which has formed part of a hospital “group” with Salford Royal, with Sir David as the chief executive.

He told HSJ that trusts who were used to provide new forms of support, as he proposed, would need financial support to create what he described as the “spare management bandwidth” to be able to do the work. He also emphasised that troubled organisations would not be taken over but instead offered the choice to be associated with well performing trusts.

He did add that for a minority of trusts where there may be longstanding issues they could be required to link up with trusts for help.

In its latest inspection report, the CQC said Salford Royal was outstanding overall as well as for whether its services were caring, responsive and well led. It was rated as good for whether its services were safe and effective.

Areas of outstanding practice highlighted by the regulator included:

• The trust was a “leader for integrated care services” which reduced the need for hospital admissions.
• Its use of an electronic patient record technology for patient safety.
• A redesign of the trust’s stroke service with external partners.

Sir David told HSJ he was “thrilled” at the report’s conclusions and said staff at the hospital had again “proven they are at the top of their game”.

Asked how the trust had achieved its rating he said: “We have good systems and processes in place at Salford which can stand the test of people coming and going. They are now a strong core of what we do and they do deliver results for us. The other is retaining very strong leadership.

“The third ingredient is the staff themselves. The staff are engaged and participate in our improvement programmes and methodologies. We get them involved and practising how to measure whether a change in the system results in an improvement.”

He said the successful integration of care had come about via a “clarity of purpose” and mature relationships between the trust, commissioners and the local council. Two years ago, adult social care staff transferred to the trust, which also now has responsibility for some primary care and domiciliary care.

Asked whether the model and success can be replicated, Sir David said: “I am not a fan of imposing models on people but I do think it can be replicated if people can see the benefits and value of it.

“It can be forced but I don’t think that is the right thing to do. Form follows function. What areas shouldn’t do is let it drift. They have to answer the question of what is the right set of organisational arrangements that works for them. They must not dodge the question.”

Sir David said Salford Royal had not received any longer term support for taking on Pennine Acute Trust.

“I had hoped we would be able to confirm a greater level of support when we stepped in. We did the decent thing to say we saw a neighbour in difficulty, we have an idea and concept we would like to test but we know this is going to cost money. I had hoped we would have a greater level of support in agreeing a longer term financial package, in the end that didn’t materialise.

“We had some start up funding but other than that we have had to take this forward and get our systems introduced into Pennine largely through our own efforts.”