In the second of a two part series to mark the 70th year of the NHS, reporter Stuart Arnold poses questions to Sue Jacques, chief executive of the County Durham and Darlington NHS Foundation Trust to try and establish what state the trust is in.

Q: The trust achieved a £7.1m surplus in 2017/18. How was that achieved and how healthy is the trust’s financial position generally?

A: We were able to achieve our financial position at the end of the last financial year thanks to the fantastic efforts of our workforce in delivering effective and efficient care for our patients.

Because our teams performed so well and achieved financial targets in each of the quarters, as well as the A&E performance targets across two quarters, it meant that we were able to access a national funding reward. It was the addition of this which improved our overall surplus position at the end of the financial year. This is really important because it means we can draw on this money to re-invest in our services and a capital programme during 2018/19.

As well as benefitting from having an engaged workforce supporting this agenda, it is also about working closely with our local clinical commissioning groups and looking at how best we manage our resources and performance as a system, not just in isolation.  

Q: How is the trust intending to improve its overall ‘requires improvement’ rating from the Care Quality Commission?

A: I think the most important thing to say first is that our patients should feel absolutely assured that their safe, quality care and experience remains our highest priority.

Our last full inspection was back in 2015, and then in September last year, the CQC returned and inspected four services areas – urgent and emergency services, medical care, surgery and maternity across Darlington Memorial Hospital and University Hospital of North Durham.

As an organisation we are fully committed to continually improving services and much work has been undertaken since the inspection last autumn. The inspection recognised improvements over all the limited services inspected and we  also received a ‘good’ rating in the well-led category, which reflects our commitment to quality and in developing clinical leaders, learning and innovation across the organisation.

As the CQC did not re-inspect all services last year some of our ratings remain those from the 2015 inspection.  Therefore, we look forward to a re-inspection, which can consider all the improvements we have made, which we would hope to be reflected in an overall good rating.

Q: The trust is well below meeting the four hour waiting time standard for A&E. Why is this and what measures are you taking to meet the target?

A: There are many things which affect our ability to achieve the four hour standard, it’s not just about what is happening with the A&E departments themselves. It’s about how the whole health system works together and that’s what we are doing. It’s been well publicised nationally that there is increasing demand on services and we are seeing a year on year increase in the number of patients presenting at our departments, and some of this also comes down to physical space. Our A&E departments were built to manage around 30,000 attendances annually and we are now seeing double that in a year. That  said we  recognise that having a lengthy wait in A&E does not lead to a positive patient experience, so there are a number of things we are working on.

We have invested in both our departments in terms of how we best use the space available so at Darlington Memorial Hospital we recently opened the new Emergency and Urgent Care Treatment Centre and while it’s still early days we are seeing good things happening in terms of supporting our patients to access the right care from the right professional at the right time. We’re also carrying out work in the department at Durham.

We continue to work with colleagues in primary care and the local Clinical Commissioning Groupd to look at how urgent care is best provided for our local communities and we are working at improving the flow of patients into, out of and within our hospitals.

And while we may not be where we would like to be in terms of meeting this [four hour] standard for our patients, if we look at our performance in a national context, you can see that actually on average we are consistently within the top third of the 138 trusts in the country and we would intend to improve on that in 2018/19.

Q: What is the position with staffing at the trust?

A: Your readers will know that there are pressures nationally on nursing and medical staffing numbers and that up and down the country there are difficulties in filling some, particularly medical vacancies, because of shortages - there just aren’t enough specialists available out there in some areas. 

We are continually looking at our recruitment and retention initiatives and some of the things we have done include introducing our own staff bank for nursing colleagues and more recently medical staff.  We have also seen a reduction in our vacancy rate for nursing and midwifery posts which in April 2016 was 8.63 per cent, but at the end of March last year had reduced to 5.86 per cent. In 2017/18 we also recruited an additional 30 new consultants.  

Q: What are you spending annually on agency staff and has this figure been going up or down in the last few years?

A: We have a dedicated team of more than 7,000 staff managing about two million patient contacts every year and we regard our workforce as our greatest asset. As a major employer, recruiting and retaining a high performing workforce to provide safe, effective and compassionate care is one of our top priorities. Over the past few years, we’ve achieved some significant reductions in agency spending. Particularly with regards to nursing agency spend where we have seen a reduction of more than nine per centover the past three years.

In 2017, we spent just under £800,000 on agency costs for nurse staffing, compared to more than £8m in 2014. There are a number of ways we look to manage our spending, including the introduction of our staff bank, as I mentioned, and we have also successfully recruited nursing colleagues from Italy over the course of the last two years.  And, it is important to consider this is all within the context of us operating as an organisation with a £0.5bn turnover.

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

A: If I think back over the past 12 months, there really are so many things which come to mind. There are some of the large investment schemes into our estates and facilities - for example nearly £30m to build new state of the art operating theatres at Darlington, as well as a new dedicated bereavement suite and mortuary facilities.

We are completing work at both of our emergency departments to improve the way patients access the right services at the right time. Then we have also invested in upgrading the operating theatres at Bishop Auckland Hospital to enhance our centre of excellence for patients needing joint replacement surgery.  We’ve also created a state of the art simulation centre at Bishop Auckland which provides high quality training facilities not just for our staff but also for NHS colleagues across the region.

In addition to these, we also invested more than £1m to introduce a new team which works across Darlington Memorial Hospital and University Hospital of North Durham. It’s called the acute intervention team and it supports the care of our sickest patients. The team is able to help identify deteriorating patients and work with ward staff to best look after these patients and deliver the best end of life care.

Technological investment has been a theme for us as well over the past 12 months, we provide care and services in our local communities as well as from within our hospitals.

So ensuring our staff have mobile technology to support this patient care is really important. We're also seeing a lot of innovation in the way that patients can be supported to manage their own care through the use of technology.

We recently launched a forum to encourage more colleagues to come up with ideas which could enhance patient care and we wait with great anticipation to see what  new developments will emerge through this.

One of the really fantastic things about the trust is the innovation and the passion which runs through our organisation. We run a 'Dragon’s Den' style event where colleagues can pitch for funding to support their ideas which are linked to improving patient care or the patient experience and we’ve seen some excellent ideas come through this forum which we have invested in.

For example, ‘orientation boards’ for patients living with dementia. This came from one of our nurses and means that on our elderly care wards the environment is set up differently to best meet the needs of dementia patients and that rooms have the date, month and time displayed as well as old photographs from our local areas – all of which research shows can have a positive impact on caring for patients with dementia.  

What is extra special about some of these schemes is that they really do make a big difference to the overall care and experience we are delivering.  

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 jewel in our country’s crown. It transcends people from all walks of life and binds the population together. It is something we are all proud of and which is here for us all at our time of greatest need.

It is my personal belief that while there will no doubt be many changes politically or otherwise over the next 70 years, the NHS as an institution  will remain strong. If we think of the foresight shown by Nye Bevan in 1948 to establish something which would transform the lives of so many, it would have been impossible to predict the developments and evolution of care we have witnessed over the past 70 years.

And, with this continuous pace of change in terms of innovation and technological advancement it is impossible to imagine completely what care will look like in another seventy, but even now we stand at the precipice of some amazing changes such as personalised medicine linked to our own genes.

Looking ahead we will all have a stronger obligation to play in terms of taking responsibility for our own health, and the health of our families. Now that we are able to understand the pre-determinants to so many conditions and diseases, it will be about how do we as individuals make choices to lead healthy lifestyles which support our own health and well-being.

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

A: Firstly I'd like to extend a huge thank you to our talented workforce for the dedication and commitment we see each and every day across the organisation. And then more than that, it is about all those who support us in a variety of forms – not least our patients, health and social care partners and stakeholders, Governors and local businesses and communities.

Last year we received nearly 18,000 compliments from patients or their loved ones and it is these insights and comments which are truly humbling. We see ourselves very much as part of the local communities we serve, many of our staff live in our patch and the care we are providing is very personal to us. We have a fantastic network of volunteers supporting our services and hope to see this continue to flourish in the future.

In essence, delivering the best health care takes real time and effort and in County Durham and Darlington we have an amazing team, a team we are fortunate extends beyond our hospital walls and geographical boundaries, out across our local communities. And as chief executive of the hospital trust, it is a team which I consider myself extremely privileged to be part of and I know that together we can achieve great things in the future and deliver care that we can all be proud of.


HOSPITALS: Bishop Auckland, Darlington Memorial, University of North Durham

STAFF: 7,000

REACH: 650,000 people

DEFICIT/SURPLUS: £7.1m surplus

A&E FOUR HOUR WAIT TIME TARGET: 85.7 per cent compliance (95 per cent is the national standard)