In January 2024, the CQC published a report into their focussed inspection of the cardiac surgery department at the Freeman Hospital, alongside a trust-wide report.
Following publication, and subsequent leadership changes , we have continued to work on delivering improvements in the service in an open and transparent way.
As part of this process, Newcastle Hospitals’ board of directors met in public on 23 May 2024 to discuss four reports which specifically looked at issues in the department that date back to 2017. These are now being published on our website.
We know things have not been easy within the service. There have been some real challenges which have, over recent years, impacted on morale, working relationships and the wellbeing of individuals, and ‘culture’ is a recurring theme.
Several internal and external reviews have been carried out to try to understand the concerns raised and, importantly, support the service moving forwards. This began with internal peer reviews followed by a Royal College of Surgeons invited review in 2021 which was widely reported.
The reports, which have some redactions to protect the confidentiality of patients and members of staff, are:
- The Royal College of Surgeons invited review 2021
- NHS England Quality peer review (undertaken on 14 / 15 November 2023 and reported in January 2024)
- The Adams Report (received 2024)
- Thematic analysis and safety recommendations (internal report)
Their recommendations fall broadly under four themes:
- Quality and safety of patient care.
- Culture in the department and the way in which people work with one another.
- Governance structures – making sure we have appropriate systems and processes in the department to monitor activity and highlight when there are concerns.
- Training.
Quality and safety of patient care
Cardiac surgery is complex, and not without risk, but it’s important to emphasise that, overall, the trust’s results and outcomes for adult cardiac surgery are in line with that of other organisations of similar type.
Where colleagues have highlighted specific concerns about quality and safety, these have been investigated, addressed and appropriate action has been taken.
We have embarked on a process of rebuilding the department for the future, restoring sustainable planned case load whilst balancing the needs of emergency work and with a real focus on outcomes for the team as a whole. Key to this will be building confidence from referring hospitals in our catchment population.
Culture and ways of working
A significant piece of work is underway to try to improve the culture and working conditions for staff in the department, supported by an external company. Since January, we have reviewed and strengthened our governance arrangements to ensure that the board of directors has a clear understanding and oversight of these areas.
This is a complex situation that has developed over several years so will take some time to fix. All of our efforts are focussed on rebuilding the service.
Governance
Several reports identified we need to strengthen our clinical governance and put in place better systems and processes so we can provide assurance to our patients and staff that our services are safe and of high quality.
A key part of this is people feeling safe and confident to report clinical and broader concerns where they see them and having the confidence that when they do, their concerns will be addressed, and appropriate action taken.
A major programme of cultural change is underway which includes:
- strengthening new leadership arrangements and behavioural expectations
- improving multi-disciplinary team processes and decision making
- improving the consistency of approach to referring clinicians from other regional hospitals, ensuring patients are transferred promptly and that the number of patients treated is in line with a unit of this size.
All of this, along with the improved approach to governance, will strengthen the quality and safety of the service.
Training
As previously reported, there have been concerns about the quality of training available to cardiac surgeons in training and some of their experiences on an individual level, resulting in the removal of trainees from the department some time ago.
The presence of trainees is a key element of success for all clinical services and it’s extremely important we create an environment where trainees can be well trained and, importantly, feel that can function effectively within that department.
Ensuring that the unit is training the surgeons of the future is very important and we are working very closely with medical education colleagues to create the conditions where surgical trainees will be able to return to the department.
What next?
Our focus now is on accountability and improvement through what we do and how we do it. We need to ensure the actions we are taking are appropriately supported and deliver the change we need to see to allow the department to prosper.
While there are some tough messages in these reports, it’s important we get this right and that people can see change happening. Our key priority is ensuring patients have confidence in our services and the care and treatment they receive.
We’re working very closely with our Integrated Care Board and NHS England to monitor and measure close all of the improvements, including those outlined above.
Patient concerns
If anyone has a specific concern about their care or treatment, please contact the patient relations team on 0191 2231382) or email nuth.patient.relations@nhs.net
