An NHS England spokesman said the organisation "took action early this year to provide additional improvement support to the trust's senior leaders" and added enrolment in the recovery programme would "provide a system-focused approach" to enable it "to address and resolve the complex issues it faces". An improvement board has been put in place by NHS England, alongside the appointment of an improvement director, to oversee the trust's work.
The trust was placed in special measures in after being rated as inadequate following an inspection by the Care Quality Commission CQC. The watchdog said it required "intensive support" after finding medical care in one part of the Royal Lancaster was "of particular concern" while the overall recruitment of nurses and doctors was identified as a "fundamental" worry with "too much reliance" on temporary staff.
It was allowed to come out of special measures in December the following year when inspectors noted it had made progress addressing some of the issues it faced. Trust leaders talk of the importance of spending time listening to staff, understanding their concerns, acknowledging the challenges the trust and staff are facing, and being role models for the behaviours, values and vision for the trust.
Charting and navigating the future strategic direction for the trust, and supporting staff throughout the process, are considerable leadership challenges.
In addition to the increased oversight from regulators, trusts in special measures find themselves subject to significantly increased scrutiny from their commissioners, other national bodies, such as Health Education England, and professional regulators. Trust leaders describe being overwhelmed with separate, often duplicative, reporting requests, the consequence of which is that they are left with little time to focus on improvement.
While the national bodies' commitment to supporting improvement is clear, they can inadvertently put hurdles in the way. Developing a more coordinated approach to regulatory and oversight requests within the special measures regime, or giving NHS Improvement the task of providing assurance to other bodies, could be ways of removing these obstacles and allow trusts to focus on their improvement journey.
The special measures regime is founded on the notion that problems lie within individual organisations. However, we know from the evidence about special measures in the education sector that context matters and there is now general agreement that local integration and system working are essential to meeting the challenges facing the health and care system.
Trusts and their local partners are increasingly working together to plan and deliver care, and are taking on greater responsibility for the performance of all organisations within the system.
It makes sense then to assume that local system partners will play a greater role in supporting trusts in special measures in their system, and we are already beginning to see examples of this. But this throws up more questions. Children and young people. Autistic people and people with a learning disability. Safehouses and outreach services. We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find, including performance ratings to help people choose care.
About provider portal. Keywords or service name. Location e. Special measures: one year on. Special measures: one year on PDF. What are special measures? What progress have the trusts made?
Trust by trust: progress since After the 11 trusts were reinspected in , the Chief Inspector of Hospitals made the following recommendations. Tell us about your care Your information helps us decide when, where and what to inspect. About us Who we are We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage them to improve. We know little about the unintended consequences of those interventions and their costs.
The special measures for quality regime has been a national improvement initiative to improve low-performing health care organisations, and it's important to find out the impact of that programme. NF: We carried out a rapid systematic literature review to develop a theoretical understanding of organisational failure and turnaround — this included literature in the health care sector but also in education and local authorities. We then quantitatively looked at performance trajectories of 62 NHS trusts over a period of six years, to evaluate the impact of improvement interventions for trusts under special measures for quality.
We conducted interviews at national level to understand the programme, and conducted eight case studies of trusts either in special measures or the challenged providers regime to understand how they responded. One is an improvement director to work in and alongside the organisation. The second is the opportunity to buddy with another organisation. And the third is the opportunity to bid for central funding for quality improvement.
These interventions were delivered within the context of significant leadership changes, including at board level. NF: In terms of the improvement director, when they used a more coaching style and offered tactical advice, that was viewed as helpful. There was also some debate about the length of time that improvement directors should be in organisations — some CEOs wanted them for longer. In terms of buddying, there was a mixed picture about how often it actually happened and it seemed to work better when the buddy was in a similar context.
On the additional funds, we conducted an analysis of what they spent those on. These were mainly used to cover additional posts and external consultants and experts, which brought a risk of spending their way out of special measures. More broadly, changes to the senior leadership were seen to be a key driver for change. In all the examples we looked at, the board was completely changed and the chief executive either resigned or was forced out.
Bringing new ideas and approaches was seen as very helpful, especially if they had previous experience of special measures of quality. But stability of leadership remained a big issue. New leaders are not given enough time to embed changes. If improvements aren't being made after nine to 12 months, they're often moved out and a new team brought in, which isn't always helpful.
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