Judy Terry is a marketing professional and a former local councillor in Suffolk.
Whilst we are all grateful for, and rightly praise, NHS frontline and other essential workers for their selfless commitment to saving lives and helping vulnerable people cope with the Covid crisis, other key NHS-related issues are escaping public scrutiny. Not least because local authority Cabinets and Health & Wellbeing Boards aren’t convening in the usual way to share information.
For example, a report by Lord Carter, a non-executive director of NHS Improvement, examining Operational Productivity and Performance in Ambulance Trusts, highlighted ‘unwarranted variation in delivery of ambulance services and potential £500m efficiency savings which could be made in 2020/21’.
He noted that ‘too many patients are being taken to hospital Emergency Departments unnecessarily, when many could be treated at the scene, but aging fleets means this is not always possible, despite paramedics working incredibly hard as demand soars.’ As Chair of the Department of Health’s Procurement and Efficiency Board, no doubt he will develop a central procurement programme to replace outdated ambulances, which would be better value for money than leaving local Trusts to purchase individually.
Meanwhile, building on the recommendations in Lord Carter’s report, last October, the East of England Ambulance Service NHS Trust launched a consultation on its Corporate Strategy for 2020-25, led by the Chief Executive Officer (CEO), Dorothy Hosein, initially appointed as an interim in 2018 and confirmed in her role last autumn. Covering 6 counties, the Trust receives about one million emergency calls annually, and employs more than 4,000 staff, but suffered leadership challenges in recent years which it was hoped the new Strategy would address.
Concluding in November, feedback from the short consultation amongst staff, patients, and various organisations, identified some key issues, including three which were eerily prescient:
- Provide long term leadership stability to ensure the Trust is well led;
- Ensure staff feel valued and supported, with emphasis on wellbeing and mental health;
- Improve training and development to help staff reach their full potential.
Shortly after its release, the Trust experienced three unexpected deaths of ambulance staff within days of each other; at the time, they were alleged to be suicide.
The CEO’s report to a public meeting of the Trust in January “addressing all issues since the previous public meeting on 13th November makes no mention of the deaths or any investigation.
But, in December, independent management consultant, Christine Carter, was commissioned to examine ‘the circumstances surrounding the deaths, to ensure that all appropriate actions were taken, and will continue to be taken, to ensure staff welfare is the highest priority and learning identified and translated into improvements by the organisation to mitigate the reoccurrence of any similar events.’
The investigation involved interviewing more than 40 witnesses, including the families of the three staff members. Given the significant amount of personal details revealed, the full report will not be published, to protect families’ privacy, but it has been shared with the Care Quality Commission (CQC) and NHS England/Improvement. Case specific reports have also been shared with relevant families and coroners.
Following discussion with the Trust Board, which accepted the report, on 13th May it did publish the full recommendations and Action Plan, “in the interests of transparency.”
Key to Ms. Carter’s twelve recommendations, is the “need to make improvements around guidance, policies and additional training and support for managers and staff.” In addition to the need to update policies and ‘cross-reference management’, the Trust is urged to:
- Develop training for managers in supporting staff with mental health problems – in partnership with specialist mental health professionals;
- Consider how it can contribute to and learn from the range of suicide prevention strategies and initiatives across its catchment area and incorporate suicide prevention into its strategic goals;
- Establish a programme of change and development to address sexual harassment and change the behaviours of staff and managers that enable it to thrive;
- Amend the Disciplinary Policy in relation to suspension of staff to include a clause reflecting the need to undertake a risk assessment at the time the decision to suspend is made;
- Review its arrangements for first line management support in order to move to a model that provides front line staff with consistent and regular management support;
- Senior operational managers (Deputy Chief Operating Officer and Heads of Operations) should be reminded of their responsibilities under the Duty of Candour Policy; and
- Carefully consider the findings of all current investigations, together with this one, to assess any common themes or consistent messages that would suggest the need for remedial actions and further organisational development initiatives.
Welcoming the recommendations, CEO Ms. Hosein commented:
“Every day our staff do fantastic work at the frontline of healthcare and often in demanding circumstances.. the investigation brings home clearly that we must do more to support the mental health of staff if they suffer problems or anxiety in their private, family or work life.
“I am committed to instilling a culture which sees, respects and cares for all staff as individuals…taking rapid and robust action to address issues arising in the workplace and outside of work… with all managers listening to and supporting colleagues and spotting any early signs where help might be needed.
“We are already making progress on our action plan to address these recommendations and half our actions will be completed by the end of May, with all recommendations addressed by the end of September, providing regular updates to the Board and online.”
This is an opportunity for Health & Wellbeing boards across the six counties served by the East of England Ambulance Service NHS Trust to get together and set up a sub-group to monitor progress and hold the leadership to account, in order to restore confidence amongst all paramedics and staff that respect and wellbeing will genuinely be a priority in future.
The Norfolk & Suffolk Mental Health NHS Foundation Trust is another victim of poor leadership; following yet another CQC report describing a litany of errors, it still requires improvement and remains in Special Measures, first ‘awarded’ in July 2017 when deemed ‘inadequate’.
If there is to be any partnership with the Ambulance Service to support staff mental health, improvement needs to accelerate.
On several occasions I suggested that Norfolk and Suffolk county councils should co-operate in monitoring and holding the ever-changing leadership to account. It is heartbreaking to read of nine further deaths, and there needs to be stronger local oversight. After all, it is local residents who are suffering and not being listened to, despite various action groups desperate to be heard.
The same is true in the Ambulance Service; experienced paramedics are refusing deserved promotions because “we don’t want to be part of existing management”.
With a degree of ‘normality’ returning after the lockdown, local authorities need to recognise these shortcomings in our proud NHS, and work positively to ensure quality service is delivered to both patients – and staff.