Doctors and nurses need to “step up to the plate” and help tackle a crisis of leadership in the NHS, the chief inspector of hospitals has said. Professor Sir Mike Richards said the health service’s financial problems were making it difficult for even the best hospitals to deliver good patient care.
He added that a few hospitals were managing better than others, and those that were in need of help required ''better leadership'' more than money.
Out of 70% of the NHS Trusts that the Care Quality Commission's (CQC) hospital inspectorate has visited, only two hospital trusts have been rated outstanding whilst 68 have been told that they must improve and 12 have been rated as inadequate.
The increase in health spending has not met the demand recently, and the NHS in England has been warned that it must make savings of £22bn by 2020. NHS hospitals are expecting a total overspend of £2bn this year, and are under a lot of strain to cut budgets and reduce dependence on expensive agency staff.
Sir Mike, however, doesn't think that the main factor is to blame funding shortages for inadequate care.
“I have been round a lot of the NHS and have asked the question of very senior people: if I could wave one magic wand and it’s either to give you more money or to give you better leadership, they almost all say ‘I’d choose better leadership.’ I don’t want to diminish the financial problem. Even the ones at the top end are finding it very, very difficult. But in those that are struggling, if we could get the better leadership that would be a major contribution to dealing with the financial problem.”
The CQC have set up a new scheme, following the February 2013 report into failings at Mid Staffordshire NHS trust and inspection teams, including doctors, nurses, managers and patients, have appraised most of the country’s hospitals, mental health and community services.
Trusts which have been labelled inefficient are placed into special measures and partnered with an accomplished neighbouring trust. As a result, Trusts such as Basildon and the George Eliot Nuneaton have since been taken out of special measures.
The burden on hospitals has led to a series of resignations in recent times, often in the wake of unfavourable CQC reports. According to research by the Health Service Journal, the average tenure of an NHS trust chief executive is three years.
When asked if the resignations troubled him, Sir Mike said:
“What does concern me is that we should have good leadership in the NHS.
That’s not just the chief executive. It is also the medical director, the director of nursing, the chief operating officer, the finance director but also the leadership at service level as well as at trust level.
“The trusts we’re rating good and outstanding don’t have difficulty getting clinicians to step up to the plate to be clinical leaders. If you go to somewhere like Frimley Park [rated outstanding], they have no difficulty getting clinicians to take on leadership roles.”
Sir Mike said struggling hospitals were becoming caught in a “vicious spiral”, taking on too many patients, forcing them to open overflow wards and cancel operations. Some have said bed capacity problems are due to a shortage of community care beds and support. Council care budgets have been reduced by 40 per cent in five years.
While it was “likely” this was furthering the problem, Sir Mike said well-run hospitals were managing. “The best hospitals are saying ‘Don’t let’s open more beds – let’s work hard to ensure people who don’t need to come into hospital, don’t come in’. If they do come to A&E, that may mean having ambulatory services so it may not be necessary to admit the patient.
[The best hospitals are asking] are physicians and surgeons coming to A&E to see if patients need to be admitted or not? I recognise how difficult it is, but the best hospitals are managing this and it is where hospitals are losing a grip on that, that it is a spiral that is financially damaging and very bad for patients.”
Last month, the CQC rated the distinguished Addenbrooke’s Hospital, Cambridge as inadequate, leading to complaints of heavy-handedness. Sir Mike defended his assessment, saying patient safety had been compromised because managers had failed to control the “flow” of patients through the hospital, leading to over-stretched staff working in areas unfamiliar to them.
With the NHS leadership is crisis, the question then turns to how we tackle the problem. If leadership within the NHS and across healthcare is to be reinforced and successful, then the task must be made more manageable. Health and social care need to work as a system, with officials and local authorities and NHS organisations sitting at the same table. Any NHS leader must be able to look beyond their own board and across the whole system. That means being able to influence where they cannot command, and show vision as well as tactical ability.
By Amrita Patel, Paralegal