As most people’s experience of the NHS is interaction with their local hospital, in this its 70th year reporter Stuart Arnold posed a series of questions to hospital chiefs in a bid to assess the relative health of the organisations they are responsible for. First up is Siobhan McArdle, chief executive of the South Tees NHS Foundation Trust.

Q: What year-on-year savings are you being required to make by the Government and in general terms where are these savings going to come from?

A: There are financial challenges across the NHS which have been recognised nationally, resulting in the recent announcement about a funding increase. At South Tees, similar to all NHS Trusts, we have a challenging financial position and while we have made significant efficiency savings over an extended period of time the last financial year was particularly difficult. However, against a background of some real pressures in emergency care and cancer services, we successfully delivered about £19m savings against a target of £30m. Going forward we have a programme of savings aimed at protecting front line services as much as we can. This focuses on areas such as drugs, clinical supplies, travel re-imbursement, premises costs and agency pay – payments for locums and temporary staff.

Q: How have you managed to meet the four hour waiting target in A&E and how confident are you that this can continue to be met?

A: We are the best performing major trauma centre in the UK. We continue to meet the four hour target in A&E and in fact during 2017/18 we came sixth nationally having achieved 95.7 per cent compliance overall. We have had to work in new and different ways, such as the Emergency Physician in Charge arrangement which ensures all patients are seen first by a consultant. We have also invested in our ‘front of house’ model with an expansion of the acute medical team and assessment bed capacity.

Q: Similarly, with cancer targets how content are you with the trust’s performance in this category?

A: Improving performance over cancer targets is a priority. We had good performance in 2017/18 against cancer targets which was achieved by a team effort. Senior clinicians and managers meet on a weekly basis to identify where there are any delays which need to be addressed. This includes tracking every patient with cancer through the diagnosis and treatment pathways.

Q: The Trust had 28 clostridium difficile cases in 2017/18. How are you tackling these infections and endeavouring to bring this number down?

A: For two consecutive years the trust has been below the threshold for attributed cases of clostridium difficile infection. This is being achieved through the implementation of a healthcare acquired infections action plan and by robustly tracking all actions to ensure that they are implemented. We have a skilled infection control nurse working alongside staff in A&E and in the acute admissions unit, which ensures that any patients who come through these areas with diarrhoea are identified as early as possible so that appropriate actions can be taken to reduce the risk of transmission. There is also an enhanced cleaning programme in operation to prevent transmission when patients have had diarrhoea.

Q: What investments have taken place over the last 12 months to improve patient care?

A: The trust has a rolling programme to maintain and develop its buildings and equipment. During 2017/18 this expenditure totalled £24.5m, which included development of a new cancer centre at the Friarage hospital site, building maintenance, new medical equipment, radiotherapy development and IT improvements. In 2018/19 the Trust is continuing to invest in new assets including the continued development of the Friarage cancer centre, a new energy centre on the James Cook hospital site, replacement of medical equipment and IT upgrades.

Q: What is the vacancy rate at the hospital in terms of posts that are unfilled and is there any particular area causing concern? What are you doing about it?

A: In nursing our vacancy rate is about four per cent against a national average of ten per cent. We are achieving this by working very closely with local universities to ensure that the numbers of nurses in training will meet demand now and in the future. We have also recruited small numbers of nurses from abroad, most recently welcoming some nurses from the Philippines. We are also working hard to ensure that once we have recruited nurses that they stay with us. In terms of medical and dental vacancies the rate is around ten per cent, with particular pressures in specialties such as anaesthesia. This compares to a position nationally of about 12 per cent.

Q: What are you spending annually on agency staff and has this figure been going up or down in the last few years? How do you ensure spending in this area is kept under control?

A: During the last financial year the agency spend was £4.5m. This has reduced year-on-year over the past three years. Measures to further reduce this level of spending include robust sickness absence management, more flexible working across areas, having nurse consultants supporting the medical rota and strict governance measures in the management of agency spend, including caps on hourly rates. In addition we are working together with other trusts across the region to pilot a regional locum bank.

Q: Do you think the NHS will last another 70 years and what needs to change in order for it to remain strong and sustainable?

A: The NHS is a national institution and is much loved by the public. NHS organisations have been changing ways of working to meet changing population needs and increasing demand, particularly in emergency services. This transformation, which is already seeing results, will continue. We need to ensure that the most seriously ill patients receive the specialist care to give them the best chance of a good recovery. We also need to make sure that the increasing numbers of frail older people who are living longer often with more than one long term condition such as diabetes, chronic chest and heart disease receive more support to stay in their own homes, only coming into hospital when their condition cannot be managed in a community setting.

Q: What message do you have for your patients and staff?

A: Providing timely, high quality and safe patient care is at the heart of everything that we do. Like many other NHS organisations we have had challenging times and we have no doubt that the challenges will continue in the year ahead, but we are confident that we will continue to succeed with the commitment, hard work and support from our workforce. This will help to drive continuous improvements, building on our strong foundations to deliver excellent services for every one of the patients we serve.


HOSPITALS: The James Cook University Hospital, Middlesbrough and The Friarage, Northallerton

STAFF: 9,000

REACH: 1.5m people


A&E FOUR HOUR WAIT TIME TARGET: 93.49 per cent compliance (national standard 95 per cent)




* Tomorrow – Sue Jacques, chief executive of the County Durham and Darlington NHS Foundation Trust