Building a legacy for the future

Covid put our Trust under major stress – not least, as the Covid-19 pandemic arrived just as the trust merged from our three separate hospital trusts. Through the experience we found that operating across a larger system enabled a more effective, rapid response, says Chief  Strategy and Improvement Officer Charlotte Williams.

When I joined the trust in 2017, if anyone told me we would navigate a major public consultation, a three-hospital trust merger and a global pandemic and secure £118m capital investment for our area in the space of four years – all during a period of significant political and economic upheaval – I wouldn’t have thought it possible. But that’s what happened. We wouldn’t have planned things that way, but our team rose to the challenge, and the changes we’ve seen have moved us further ahead as a unified trust.

Joining forces

I’m responsible for designing and setting the trust’s strategy and making sure we have everything we can aligned to deliver it. I joined MSE about two years after NHS England had formally asked our three hospital trusts – Southend University Hospital NHS Foundation Trust, Basildon & Thurrock University Hospital NHS Foundation Trust and Mid Essex Hospital Services NHS Trust  – to come together for our future, and to spread resources more equitably across the region.

By the time we announced our plans to merge, in 2018, many teams were already working together. But the three sites still felt very separate. Each had a centre of excellence in its own right: Basildon’s cardiothoracic centre, Broomfield’s burns and plastic surgery unit, and the cancer centre at Southend. Each had its own story, identity and culture, and they served varying local populations. Models of patient care and pathways differed between sites, too, as did levels of staff experience and engagement. We wanted to make sure all patients and staff across Mid and South Essex could expect the same high quality and good experience, whichever site they were at.

Pandemic peak

The formal merger was set for 1 April 2020 – as it turned out, just as the first wave of the pandemic was peaking. We’d done a public consultation on standardising and redesigning some services, so this was already in progress, but when it came to planning the Covid ‘surge’ response, each hospital site developed its own approach. During the pandemic, people didn’t have much headspace to engage with a new collective identity, and it was always going to take time for the benefits and understanding about having one trust to filter through to people’s daily working lives.

That said, we did have some real benefits straight away from working together. Across the NHS, accessing equipment and supplies during Covid earlier on in the pandemic was a major challenge.

So, having a single, skilled and resilient procurement department to negotiate best deals on PPE and equipment, and to work with organisations across our region to share and exchange, was a major advantage. Similarly, having unified equipment, logistics and facilities teams meant we could move stock more easily to where it was needed most.

By the end of Wave 1, with the merger complete, we took forward a new management structure spanning the three sites, creating clinically led divisions. We took the opportunity to reset, briefly, knowing further demand would come, and to plan how to mobilise resources for Wave 2, putting in place capacity for more critical care and respiratory care beds. We probably did two years’ worth of planning over that one summer! Because we now had one critical care division, rather than three separate ones, we could select the operational models that would ensure the best clinical care and implement them universally. Staff moved between sites, sharing learning, and we set up protocols to transfer patients between sites or complete their care at home. That made a big difference in how we were able to respond.

Lasting change

Now we’re getting back to delivering planned care at, or above, our pre-pandemic levels and more and more services are being offered across the trust rather than site by site (see the box). Much of this change is happening ahead of our original schedule, as we’re increasingly seeing colleagues become more willing to work across multiple sites. As a trust, we’re also going to be developing new, Essex-based services that the smaller, individual trusts could never have offered, so that our patients don’t have to travel for treatment.

As an organisation, we mobilised under duress extremely well, with 54% of our beds occupied by Covid patients – among the highest rates in the country – and we never turned a patient away from our front door. But it wasn’t just firefighting: the changes we made to our critical care and respiratory services have resulted in sustainable, expanded care facilities, better transfers and improved skills in our workforce for the long term. We have become better able to manage our capacity and pool our resources.

That’s something to be very proud of – and it’s not just us noticing it. We have been able to run successful recruitment campaigns and seen high numbers of nursing staff joining our teams. In critical care, respiratory care and radiology, we have been over-subscribed by candidates interested in taking up medical positions. That’s important, because keeping staffing levels strong is a major priority, along with promoting health and wellbeing in our staff and local populations alike. Having a wide, single-organisation view on these issues will be a big help, and this amplifies our ability to improve.

Looking to the future

Across the organisation, some colleagues may identify more than others with our new single trust identity, and I think that's inevitable. Having local pride and supporting our individual hospitals, as a team, is vital. At the same time, it is encouraging that we have seen so many positive developments, with teams self-organising to redistribute their strengths and skills across the organisation. Now that some of those big institutional changes are behind us, we can take the time to build up our shared culture and values and learn together. I feel really optimistic about the future.

Examples of change

• In areas such as surgical specialties and orthopaedics, we are able to better support clinics and planned surgery across our many sites and expanding when, and how, they are delivered, enabling more vulnerable clients to see someone locally.
• Our gastrointestinal service has pooled endoscopy resource and developed new diagnostic pathways to increase capacity and reduce waiting times, as well as introducing a novel pathway enabling patients with inflammatory bowel disease to take more control of their own care.
• Now that children from all three areas are being treated by the one trust, we’ve been able to offer improved services in haematology and oncology. This means they, and their families, don’t have to travel to London and they can receive treatment alongside other local children, which can support care and recovery through relationships.
• Our research capacity and capability has increased considerably since we became one of the top-recruiting Covid study sites in the country.