Barts Health operates five hospitals and is one of the largest NHS providers. It needed a strategy for 21 surgical services; annually delivering over 90,000 surgical procedures. The objective was to ensure the best quality care for each patient with staff empowered and enabled to deliver it.
The challenges facing our client
In 2012, Barts Health NHS Trust became the largest Trust in the country, following the merger of three existing acute Trusts. The Trust now serves a population of over 2.5 million people in East London, including some of the country’s most deprived areas.
Following the merger, Barts Health moved to a cross-site service-based structure, intending to deliver:
- more consistent services
- economies of scale
- a unified culture
Despite the new structure, financial and operational performance deteriorated; services remained fragmented, which meant it was difficult to achieve economies of scale, and quality remained inconsistent between the different sites. The Trust was placed into financial and quality special measures following a CQC rating of ‘inadequate’. In 2018 the CQC reviewed surgical services at two of the four hospitals as “Requires Improvement”, due mainly to high vacancy rates and poor theatre utilisation, which negatively impacted patient safety, quality and experience.
Aim and objectives of the work
Barts Health wanted to develop its 10-year strategy for Surgical Services, to produce a sustainable model of care focused on reducing variation between the hospital sites, increasing theatre utilisation and improving quality.
Our work focused on the opportunity to move towards standardising surgical services across all sites to better meet the needs of the population and the Trust. This work led by clinicians and managers from 21 specialities across the Trust coming together to agree and deliver a set of common goals.
The work began by establishing a vision for future services that all staff could align behind. Clinical leaders agreed on a baseline of current service provision and a case for change. Building on this, the team worked with the Surgery Clinical Board to develop and identify a preferred option for the configuration of services, create a surgical strategy for the next ten years and agree on an initial implementation plan.
Developing a case for change
The Trust was accustomed to functioning as separate organisations, which meant services were being delivered by discrete teams on each individual site. The key challenge was to align and orientate clinicians from 21 different specialities, across multiple sites, and with differing priorities, to bring them together to work on fewer sites to create specialist centres of expertise.
Supported by us, the Surgery Clinical Board developed a vision for the future of surgery at the Trust: “to be a world-leading provider of surgical services for local and tertiary patients”.
We provided clinicians with extensive analysis, which outlined the current provision of services at each site, as well as the overall quality, operational and safety challenges. From the analysis, six opportunities for improvement were identified:
- 1. standardising quality
- tackling workforce challenges
- enabling better clinical cross-site working
- becoming a provider of choice
- embedding academia and research
- improving their reputation.
Delivering surgical services differently
We developed a framework for clinical co-dependencies and an approach to developing world-leading services. Alongside activity modelling, these formed the basis of the surgical strategy, that was developed through a further series of working group meetings and workshops.
Before the project commenced, staff were apprehensive, believing that it was not possible to bring about the scale of change required, based on differing performance levels as well as a constrained capital environment. By working with clinical leaders and senior managers, we built a sense of optimism about the possibility of delivering these changes. Together with staff, we outlined the six core benefits the strategy, could deliver. The key mechanism for delivering these benefits was through the creation of 13 multi-disciplinary Centres of Sub-Specialist Expertise.
Equitable access to high-quality care:
- The Centres of Sub-Specialist Expertise will consolidate inpatient activity on a given site and ambulatory on another, increasing efficiency and decreasing waiting times.
- Improve wider patient access to clinical trials by expanding the services who have the bulk of their activity co-located with their research.
Developed improved staff rotation, education and training:
- Staff rotation will support local provision and concentration of services in fewer centres is maintained
- ~10% reduction in agency spend
- ~10% decrease in waiting list initiative spend
Re-organisation of services to deliver clinical cross-site working:
- 14 surgical specialities will be on 2 or fewer sites, compared to 9 today
Be the provider of choice through better utilisation of existing resource:
- ~3% expected growth in surgical activity
Empower staff to embed research and academia in their remit:
- 20% increase in publications
Improve the reputation of Barts Health hospitals:
- Publish, share and distribute success stories from the hospital
We produced more than just a strategy document for Barts Health; alongside a clear plan for the future of surgical services, the process also enabled closer relationships within the Trusts to be forged. All surgical leads were bought into designs and solutions which will make services sustainable.
The workshops, and collaborative approach to designing the new surgical structures, meant that not only are clinical leads coming together to take ownership of the strategy, but they are taking it forward independently of us.
A template has been set for clinical transformation whether surgical or otherwise, guaranteeing a successful approach can be implemented for the benefit of the services, the local population and the future of Barts Health
“CF has been an exemplary highly cost-effective consultant partner in providing meticulous attention to detail, outstanding analytical ability and innovative problem solving to allow us to deliver on time and with unprecedented clinical consensus a new radical surgical strategy across multiple sites and many diverse specialities in the largest trust in the UK.”
- Mr Stephen Edmondson, Consultant Cardiothoracic Surgeon and Chairman of the Clinical Board in Surgery at Barts Health NHS Trust