Scunthorpe General Hospital: Special report

The chief executive of the trust that runs Scunthorpe General Hospital has spoken publicly in detail for the first time in the wake of a damning report on mortality rates at the hospital. In an interview with RICHARD SHARPE, Karen Jackson says she did not consider resigning and explains what the trust will do to improve the situation ...

What was your reaction to the report? Were there any parts that shocked you? Was it as bad as you thought?

Bearing in mind we had been looking at Risk-Adjusted Mortality Index figures since April 2010 and we had been on our mortality rates action plan, it was still disappointing to see the news that I saw. We will work with our health care community to address the issues. This index is a development index. This is for us to understand why we are where we are but this is not an exact science and it is incredibly complicated and keeps changing. It was disappointing. It is not where I and this organisation aspire to be and our first job is to address this.

We were absolutely committed to the work with our commissioners, not just as a committee but as a hospital. We are doing everything we can to move our mortality position. Remember, we were given a different report in June. There were some things that were factually incorrect. (These were addressed in the final report.) There were things that concerned me but we had measures in hand. For example, the issue of not having adequate staffing on our wards. This is not the same for every ward as patients are more dependant on some wards than others – for example, on the elderly medical ward. I wanted to be assured that the work we had done would make sure that our staffing levels were safe.

We introduced e-rostering. Everything used to be done on pen and paper. Now, when people are on annual leave and off sick, we are still able to staff the wards fully because of the virtual world team that we have created. If one area needs to be staffed, then it can be.

I was not shocked. It was really disappointing but there are some things that have been really valuable for us. Every month we meet about staffing levels and have a complete review of our direction on the wards.

How is morale among the staff? Are the staff good enough? Do you think the hospital is understaffed? Will any staff be sacked, or have they been since the report has come to light?

Our staff are incredibly committed to the quality of care to patients. When the Care Quality Commission came round and did an independent review on an unannounced visit, the findings were that our staff are delivering a high quality of service.

I have contacted and had conversations with staff and they are as concerned as I am that we have to improve this position. In terms of how it has impacted on morale, it has made us more determined. I am part of the staff and it has made us more determined to get to the resolution of this and continue to deliver a high standard of quality of patient care.

We have appointed 145 nurses into the organisation. There are issues about how quickly we appoint nurses but we are very clear that if there is a vacancy in a required post, then we will fill it.

Who is responsible for these findings? Whose fault is it?

This is not about apportioning blame. I am not a blame individual and within our organisation we will move forward.

What will you be doing personally to ensure improvements are made?

Personally, I lead the executive team. Medical director Liz Scott will head up the lead for mortality rates within the organisation and we have established a mortality task team. We will hold regular report meetings every month. I will work with these people involved in helping us move the mortality rates position and I will ensure that this progress is being met and I can see that it is.

What is the timescale on the improvements?

I will continue to reinforce the message, talk to the staff and I want them to see an improvement on our position. We want to be realistic in our targets.

Are you confident you can meet the recommendations in the report?

I am confident that we will deliver the action plan. What will be interesting is that in terms of the improvements that are on the report, if we keep moving this action plan forward and that if we deliver this, it should deliver us an improvement.

End-of-life care was heavily criticised in the report. Would you be confident of delivering a high quality of service to patients and the family of patients at Scunthorpe General Hospital?

Yes, I am confident. People who come in to our organisation are put on a Liverpool care pathway (a form of care used at the bedside to ensure sustained quality of life for the dying in the last hours and days of life). I am confident this process is happening and in the quality of care. Sure, there are situations where that could be improved and we welcome people telling us where it is not. I go on the wards dressed as a cleaner to check for myself. We have dashboards on quality of care and independent visits and we have a programme of events where the governors will visit the wards, formally and informally and we ask them for their feedback. I am required to review and sign every complaint response and I have a view on every complaint. The action plan that has been put in place gives me a good view of things. This is not to say that we have always got it right, but it is really valuable for these patients or carers to come and tell us about the care throughout our service.

Dr Karen Dunderdale, the chief nurse, will head up quality, safety and patient experience, getting real-time data about the quality of care they receive. We want to do it real-time and we want to get more in to that.

What was your role before becoming chief executive?

I am an accountant by background and I was, until September 2010, director of finance, information and performance management. My role widened to allow me in to more operational issues and services.

When you became chief executive, what was your remit?

As chief executive, we are the accountable officer for the trust, we are responsible for the delivery of service to the whole organisation, the delivery of targets, patient safety, staff issues, all of it. The regulator appoints the chair, who is Jim Whittingham. Then there is the council of governors who set the direction of travel for the organisation.

What was the reaction of the other board members to the report?

Because we have been looking at mortality rates for a long time, they understood the position. There was some concern about some of the recommendations and they agreed with some of the recommendations that we should implement. There is a feeling we now need to move this position as it is not what we aspire to.

On the day of the report, you were not at the press briefing. Did you not think as chief executive you should have been there to answer any questions that came out of the report?

We knew the date it was coming out, so we made a conscious discussion about who the appropriate people would be to answer the questions and address the public. That said, anybody could have asked to talk to me until I got on that aeroplane on Friday afternoon. We all work as a team. My executive team will have all the information so any question that you ask you will get a consistent, truthful answer so I did not feel in any way nervous, and felt that I provided the right leadership.

The really important issue is to continue the work that we are doing and make sure that we are improving. That said, as we go through the processes we will be constantly reviewing all the ways we are following the required protocol and procedures. This is not a weak way of managing. We have agreed an action plan and said this is how we will deliver it to make sure that we meet these recommendations.

Your salary has come out in the report (£140,000 to £145,000) and many would see this is as a really large figure. How can you justify this?

I don't want to discuss my salary. My salary is set by the Remuneration and Terms of Service, that is headed by Jim Whittingham. The board judges the performance of the chief executive.

Have you considered resigning?

No. Jim is the chairman of the trust board and they will consider the performance of the chief executive.

What are the financial challenges that face the trust in the coming years?

There is no doubt that finance will be a challenge, not just at this hospital or because of the NHS but because of the national finances. The challenge is how do we maintain quality of service while trying to manage this financial position. Quality of service is as important as finance. This is why it is important that we have a strong financial position.