Shrewsbury and Telford Hospitals Trust is facing a major inquiry into what is already Britain’s biggest-ever scandal over maternity services, investigating the deaths of as many as 800 babies. Huge questions are being asked over its management culture, staffing levels and the safety of patient care in its A&E, most recently a CQC warning letter over inappropriate treatment of mental health patients.
The Trust has also recently received Matt Hancock’s rubber stamp of approval to press ahead with a controversial £312m plan to downgrade emergency services in Telford’s Princess Royal Hospital and ‘centralise’ acute services on the Royal Shrewsbury Hospital 16 miles away.
So we might expect Shrewsbury and Telford Hospitals Trust to be dusting down its long-standing, controversial “Future Fit” plan, drawing up Strategic Outline and Outline Business Cases, beefing up its clinical strategy (since arguments for the concentration of services at Shrewsbury are heavily based on staffing) – and almost obsessively focused on patient safety and practical issues.
But the Trust’s November Trust Board papers show us things are very different.
Future Fit appears to have been discarded within two months of being approved, and replaced by the mumbo-jumbo of a ‘Hospital Transformation Programme’.
Senior managers are spouting half-understood Japanese jargon arising from its links with the Virginia Mason Medical Centre in Seattle, whose website proudly proclaims that its management mixes “basic tenets of the Toyota Production System with elements from the philosophies of kaizen and lean.”
So now baffled staff in Shrewsbury and Telford have to deal with a ‘Kaizen Promotion Office,’ and a battery of obscurely written documents that insofar as they tell us anything make clear that there are a lot of “Gaps” – not least in understanding the kaizen approach which they think they have adopted.
According to the Transformation Programme, for example, despite six years of discussion on reorganising hospital services, which was endlessly claimed to be based on clinical criteria, “The Trust currently doesn’t have a clinical strategy”.
A Trust Board document from ‘Director of Transformation and Strategy’ Bev Tabernacle-Pennington also warns of a problem with the Trust’s wider “strategy and vision” – admitting that even leaders attending a workshop “were not clear on these, and could not articulate the main drivers for our strategy work.”
There is also concern over “the overlap and lack of understanding about the many work streams and how these currently work to address the Quality deficits identified to date.”
If even the leaders don’t understand what the Trust is trying to do, imagine how bemused other staff must be at what’s going on.
They may not be impressed or enlightened by news that “The improvement methodology has been utilised to test the sustainability of the plans put in place by the ISG’s for example the use of Genba walks.”
But worse, the document admits that work on “Human Factor” – the most important part of kaizen and lean, the focus on empowering staff at all levels to intervene to eliminate or address human error and maximise quality and safety – is not included in the Trust’s strategy. If this is true then all the efforts are being wasted.
Worse still there are no plans for engagement with staff on Human Factor to explain it and make it real, or roll out any proposals, and – in a Trust embroiled in a safety scandal – no focus on patient safety.
There is also a lack of “workforce modelling”, and doubts whether the ‘Out Of Hospital Programme’ would be adequate to carry through the downgrading of services at Telford and relocation in Shrewsbury.
To put the tin lid on it, the Director of Transformation and Strategy admits that even the financial modelling on the plan they have been arguing for since 2013 is “yet to be completed:”
Campaigners already knew there was management talk of a “gap” of upwards of £100m between the allocated funding of £312m and the likely actual cost of the hospital upgrade.
The ‘Hospital Transformation Programme’ team understandably try to look on the bright side, and assure us that even though they don’t really know what they are doing, they do have “a number of enthusiastic individuals” … and propose to set up still more confusing meetings, including a “Transforming Care Partnership Board.”
And there are also plans to pay city accountants Deloitte for six weeks consultancy to help “form plans” and “advise” all the managers and staff who can’t make head or tail out of the Japanese jargon and the directionless Trust Board.
People expecting a new hospital to be built, or services to be improved are advised not to hold their breath waiting.
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