Barnsley Hospital NHS Foundation Trust

Highlighting best practice as a representative in The Parliamentary Review

The ability to listen and learn from one another has always been vital in parliament, in business and in most aspects of daily life. But at this particular moment in time, as national and global events continue to reiterate, it is uncommonly crucial that we forge new channels of communication and reinforce existing ones. The following article from Barnsley Hospital NHS Foundation Trust is an attempt to do just that. We would welcome your thoughts on this or any other Parliamentary Review article.

www.barnsleyhospital.nhs.uk

BEST PRACTICE SPONSOR 2020
THE PARLIAMENTARY REVIEW
Highlighting best practice
50 | PICKERING MEDICAL PRACTICE
The role and skills of allied health
professionals such as advanced
nurse practitioners are often poorly
understood by patients. Appointment
reattendance data on Edenbridge Apex
was used to show that 97 per cent of
patients seeing an ANP did not return to
see a GP. Sharing this information with
patients improved the uptake of their
appointments and led us to expand the
ANP team. Their role in home visiting
elderly housebound patients and in
supporting junior nurses has increased
with highly positivefeedback.
Our reception team undertook
intensive support and training to
understand what services were
available and the skills of our varied
workforce. We used collaborative
working and bottom-up redesign of
signposting systems to strengthen their
work and increase the proportion of
patients seeing the right clinician at
the right time. Crucially, we started
to see meaningful reductions in our
waiting times. Within eight months,
we had experienced a 47 per cent
reduction in our average wait time to
see a GP, and a further 11 per cent
reduction in urgent care appointments
as more patients were able to access
routinecare.
The impact
The impact was always intended to
be twofold: reduced waiting times
for patients and reduced stress for
our practice team. With measurably
reduced stress levels, greater support
from allied health professionals and
slicker systems, we felt confident we
were on the right track. Changes took
several months and we ensured the
whole practice team were involved in
the change process from beginning to
end. Our practice culture evolved and
we embraced a new way of working
together with positive outcomes,
including better staff retention
andrecruitment.
The leadership bug soon spread, and
many more members of our team
started to access Time For Care training.
Having demonstrated that we could
change effectively, we were offered
projects within our local healthcare
system that enhanced our services
and grew our team, for example the
provision of first contact physiotherapy in
conjunction with our local hospital trust.
As primary care networks continue to
develop, our experience of changing
well, collaborating with multiple teams
and measuring outcomes stands us in
good stead. Furthermore, we are fully
aware that without such accessible
training and the implementation of
Edenbridge Apex, our position would
be significantly different and we would
likely not be as well poised to develop
going forward.
We are positive about the future of
our practice and have a clear vision
for the new developments in primary
care, working in an integrated way
with hospital trusts, community teams
and social care. This collaboration
will only work if we, measuring the
before and after both quantitatively
and qualitatively, align our values and
define our aims.
Having
demonstrated
that we could
change
effectively, we
were offered
projects within
our local
healthcare
system that
enhanced our
services and
grew our
team
Patient Support Team
Manager Nicola
Scott, who has led on
improved signposting to
the right appointments
51BARNSLEY HOSPITAL NHS FOUNDATION TRUST |
HEALTH & SOCIAL WORK
Chief Executive DrRichard Jenkins
Members of the occupational
therapy team at Barnsley Hospital
In 2014 an unplanned financial deficit plunged Barnsley
Hospital into an existential crisis. With a disappointing CQC
rating and low staff morale, it had reached a serious low point.
However, over the course of the six years that followed, the trust
transformed into one of the highest-performing hospitals in the
country. Chief Executive Dr Richard Jenkins tells
The Parliamentary
Review
how focusing on staff experience, improving emergency
care and stabilising finances have made this possible.
Barnsley is a town of close to a quarter of a million people in South Yorkshire. Its
once proud tradition of coal mining has passed into history. Although the area
has good road and rail links, there is significant deprivation across parts of the
catchment and large rural areas heading into the Pennines.
Barnsley Hospital is a single-site district general hospital in the heart of the town,
employing 3,800 people, mostly local. There are about 400 beds with activity levels
rising progressively year-on-year. We deliver a standard range of DGH services to
Barnsley and also deliver assistive technology services to the whole of Yorkshire.
The trust began to struggle both financially and in delivering the four-hour
standard in 2014, with a sudden severe deterioration in finances. A whistleblower
raised concerns of financial irregularities, which in turn triggered an investigation.
Once the position was fully understood, the trust had a larger deficit and was put
into triple breach of its licence by the regulator, Monitor.
In 2015, the CQC inspected the trust, awarding a “requires improvement” rating
– the third best of four rating levels. It was a disappointing outcome. As such, we
FACTS ABOUT
BARNSLEY HOSPITAL NHS
FOUNDATION TRUST
»Chief Executive:
DrRichard Jenkins
»Established in 1977
»Based in Barnsley
»Services: Hospital
»No. of employees: 3,800
Barnsley Hospital NHS
Foundation Trust
THE PARLIAMENTARY REVIEW
Highlighting best practice
THE PARLIAMENTARY REVIEW
Highlighting best practice
52 | BARNSLEY HOSPITAL NHS FOUNDATION TRUST
addressed a range of issues that the
CQC had asked us to review, putting
in place comprehensive work to
improve the quality of our services. In
late 2017, the CQC reinspected the
trust, awarding a “good” rating in
early 2018. This is the second highest
rating, making us one of a minority of
district general hospitals rated “good”
at the time. The positive impact of this
on our staff has been overwhelming.
Creating a safe and happy
workplace
Undoubtedly, the financial crisis and
the necessary immediate measures had
a profoundly negative impact on staff
morale, not helped by the 2015 CQC
rating. Over the last two to three years,
however, a lot of work has gone into
improving staff experience. We have
a new people strategy, introducing a
range of new approaches recognising
individual and team performance,
have improved the top-down
communication through directors –
giving team briefs to local teams – and
have anonymous questions to the
chiefexecutive.
Furthermore, we have begun addressing
departments with particularly poor
staff survey responses, introducing a
behavioural framework and, being
an early adopter of the NHS Rainbow
Badge scheme, as well as operating
engagement meetings for BAME staff
and other groups. Finally, we have
also introduced Schwartz Rounds, an
evidence-based forum for hospital staff
from all backgrounds to come together
to talk about the emotional and social
challenges of caring for patients. The
aim is to offer staff a safe environment
in which to share their stories and offer
support to one another.
Over the last three years, since
implementing these changes, our
results in the national staff survey have
improved each year.
Improving emergency care
and stabilising finances
After a difficult winter in 2017/18,
we vowed “never again” and
implemented a comprehensive
programme to transform our
emergency care pathways. This
included dedicated clinical leadership
and a carefully designed eight-themed
improvement plan supported by high-
quality programme management,
a continuous learning mindset with
engagement and contribution from
staff at the heart of the improvement.
Within six months improvements were
clear and sustained thereafter. In
September 2018 the trust was number
one in England for the four-hour
standard despite a 15 per cent rise in
Barnsley Hospital’s
emergency team
Barnsley Hospital NHS
Foundation Trust
After a difficult
winter in
2017/18, we
vowed ‘never
again’ and
implemented a
comprehensive
programme to
transform our
emergency care
pathways
BEST PRACTICE SPONSOR 2020
THE PARLIAMENTARY REVIEW
Highlighting best practice
52 | BARNSLEY HOSPITAL NHS FOUNDATION TRUST
addressed a range of issues that the
CQC had asked us to review, putting
in place comprehensive work to
improve the quality of our services. In
late 2017, the CQC reinspected the
trust, awarding a “good” rating in
early 2018. This is the second highest
rating, making us one of a minority of
district general hospitals rated “good”
at the time. The positive impact of this
on our staff has been overwhelming.
Creating a safe and happy
workplace
Undoubtedly, the financial crisis and
the necessary immediate measures had
a profoundly negative impact on staff
morale, not helped by the 2015 CQC
rating. Over the last two to three years,
however, a lot of work has gone into
improving staff experience. We have
a new people strategy, introducing a
range of new approaches recognising
individual and team performance,
have improved the top-down
communication through directors –
giving team briefs to local teams – and
have anonymous questions to the
chiefexecutive.
Furthermore, we have begun addressing
departments with particularly poor
staff survey responses, introducing a
behavioural framework and, being
an early adopter of the NHS Rainbow
Badge scheme, as well as operating
engagement meetings for BAME staff
and other groups. Finally, we have
also introduced Schwartz Rounds, an
evidence-based forum for hospital staff
from all backgrounds to come together
to talk about the emotional and social
challenges of caring for patients. The
aim is to offer staff a safe environment
in which to share their stories and offer
support to one another.
Over the last three years, since
implementing these changes, our
results in the national staff survey have
improved each year.
Improving emergency care
and stabilising finances
After a difficult winter in 2017/18,
we vowed “never again” and
implemented a comprehensive
programme to transform our
emergency care pathways. This
included dedicated clinical leadership
and a carefully designed eight-themed
improvement plan supported by high-
quality programme management,
a continuous learning mindset with
engagement and contribution from
staff at the heart of the improvement.
Within six months improvements were
clear and sustained thereafter. In
September 2018 the trust was number
one in England for the four-hour
standard despite a 15 per cent rise in
Barnsley Hospital’s
emergency team
Barnsley Hospital NHS
Foundation Trust
After a difficult
winter in
2017/18, we
vowed ‘never
again’ and
implemented a
comprehensive
programme to
transform our
emergency care
pathways
53BARNSLEY HOSPITAL NHS FOUNDATION TRUST |
HEALTH & SOCIAL WORK
emergency department attendances.
Other high-profile operational targets
were all routinely delivered through
2018/19 and much of 2019/20.
Initially, there was a need to take
some immediate and difficult decisions
to reduce costs. Through external
financial expertise, we obtained a
detailed analysis of the underlying
financial issues. Progress was closely
monitored by the regulator and their
confidence was gradually secured.
Cost improvement plans and financial
targets have now been achieved every
year since.
A few interventions are worth specific
mention, including improving market
share for local elective services from
58 per cent to 85 per cent, reducing
medical agency usage by 60 per
cent and setting up a wholly owned
subsidiary company. Trust income has
risen from approximately £185 million
to £230 million per annum.
Lessons from Barnsley
So, looking back, what were the critical
success factors? We feel the burning
platform in 2014/15 meant a thorough
reappraisal of governance and systems
was easier to justify. In the early stages,
changes were made to the senior team
and, since then, there has been a strong
thread of continuity of leadership.
The regulator took a challenging but
supportive approach and must be
credited with bravely allowing the trust
the chance to address the challenges.
Setting an ambitious strategy but, even
more importantly, having an effective
system for ensuring execution of the
plans has been critical. We have largely
co-terminus health and local authority
partners who have been supportive,
taking bold decisions and identifying
best practice from elsewhere. Also,
recognising that there are no shortcuts
and reliable, sustained improvement
will not come from over-simplistic
solutions has been critical. It takes
proper understanding of the problems,
well-designed plans, time, relentless
effort and strong staff engagement.
Overall, we feel that the Barnsley
story demonstrates that where there
is alignment of staff, leadership,
local partners and an ambitious
mindset, improvement can occur in
a financially challenged environment.
The future path of the trust will
require different strategies focused
on more service integration with local
partners and closer working with other
hospitaltrusts.
The Barnsley
story
demonstrates
that where there
is alignment of
staff, leadership,
local partners
and an ambitious
mindset,
improvement
can occur in a
financially
challenged
environment
Barnsley Hospital’s
Macmillan team
Barnsley Hospitals
volunteer support

www.barnsleyhospital.nhs.uk

This article was sponsored by Barnsley Hospital NHS Foundation Trust. The Parliamentary Review is wholly funded by the representatives who write for it.