Themes:
- Addressing the elective backlog
- A focus on staff wellbeing
- Collaboration across systems to tackle health inequalities
Background
Maidstone and Tunbridge Wells NHS Trust (MTW) is a large acute hospital trust in South East England. It is part of the Kent and Medway integrated care system (ICS), which serves 1.9 million people. MTW serves around 760,000 people living in West Kent and the north of East Sussex, and employs around 7,000 staff.
Elective recovery since Covid-19
In February 2022, MTW eliminated its backlogs of 52-week waiters, making it the first major acute trust to meet this target. MTW is aiming to achieve a maximum wait of 40 weeks by March 2023.
MTW is now collaborating across the Kent and Medway system to support recovery, for instance by treating long waiters from neighbouring trusts. The team is also reviewing trustlevel data to better understand elective waits in the context of health inequalities.
A clinically led model before the pandemic
MTW's effectiveness in addressing elective backlogs has been part of a longer journey for the trust.
In the years before the pandemic, MTW made significant progress in meeting key national performance targets around A&E, cancer, and electives, meaning the trust went into the pandemic in a strong position.
Miles Scott, who was appointed chief executive of MTW in 2017, oversaw the implementation of a clinically led model of service delivery before the pandemic. This was key in driving forward improvement.
There are now five clinical divisions at the trust, including the surgical division, leading on elective recovery. Sean Briggs, chief operating officer, says: "The impact of the clinically led structure can't be underestimated," because, although it was a significant shift for MTW, it has given clinical staff more autonomy. Sean says: "We've now got brilliant clinical people being supported and enabled by strategic managers."
A focus on staff wellbeing during recovery
The MTW surgical division place a real focus on staff wellbeing. Dr Greg Lawton, surgery division chief, says: "We made a deliberate decision to restart slowly [after the peak of the Covid-19 pandemic]. We allowed staff time to recover and then build back up again." This was important because, as Greg explains: "We were all a bit rusty; we had been working in a different way for 18 months." Sean adds: "It gave staff the confidence that we weren't trying to break them, that we were listening, and taking it step-by-step."
The surgical division has rolled out several different initiatives for staff, ranging from stand-up information sessions to newsletters and tea rounds. This sits alongside trust wide support for staff, which includes free parking and meals. Rantimi Ayodele, consultant trauma and orthopaedic surgeon, says: "Division leadership has been focused on staff wellbeing. This allows staff to concentrate on doing what they want to do – look after patients well and prioritise them."
An impact on recruitment and retention
Delivering clinically led services and prioritising the wellbeing of staff has had a positive impact on recruitment and retention at the trust.
Clinical staff have a say over what recovery looks like and play a key role in strategic decision making. For instance, Greg oversees a budget of £115 million and 1,400 staff in the surgical division. He reflects: "While recruitment has been tough in the last few years, in the surgical division we've done really well." The clinically led model is viewed as central to this. Greg says: "The reputation of the trust has changed. People want to come and work with us."
Significant operational pressures
Despite making progress on elective recovery, MTW is facing some significant operational pressures, particularly in emergency care. Sean says: "Going into Covid-19 we would see around 450 patients a day in A&E, and now this is closer to 600." This has a knock-on effect on capacity in the surgical division as the same teams do elective and emergency work.
Despite taking more patients from the 'front door' of the hospital, MTW is, like many others, finding it difficult to discharge patients in a timely way. The team estimate that, before Covid-19, there were 60 to 70 medically fit patients awaiting discharge residing in hospital beds, but this is now closer to 150. As Sean says: "This is two to three wards of patients that we didn't have before. That puts a lot of pressure on elective and emergency pathways." To support these challenges, MTW have implemented a digital bed management system, which has helped to speed up discharges at the trust.
The importance of national support and action
MTW is grateful for the national support given in the last year. Community diagnostic centres, which were rolled out in October 2021 to act as local hubs for checks, scans and tests, are viewed as "absolutely crucial" to delivering more elective and cancer care at MTW. The local centre has delivered 12,000 additional scans in the last six months.
Sean describes close working relationships with local social care leaders in the patch, and proactive work to enable strategic level partnerships. Likewise, collaboration with the community sector has been essential to recovery. Sean says: "Our A&E and elective successes are because we have incredibly good community partners. Even when it feels challenging, we know they are doing everything they can to support us."
However, there are challenges in social care and in the community, including around capacity and funding.
Infrastructure is also seen as a critical part of the puzzle, and there must be the right facilities and sufficient space to see patients. The team recognise the financial constraints the NHS is operating under, and the scope to work innovatively at a local level, for instance by using independent capacity or unused town centre space to support activity like diagnostics tests. However, additional capital funding would support MTW, and others, to address elective backlogs by delivering extra theatre space and equipment.
Looking forward
The MTW team acknowledge there is further to go and are committed to making further progress on elective backlogs, and other national targets. They also want to continue supporting wider system partners, and developing partnership working with acute, community, and social care providers across their ICS. More specifically, the team are looking at ways to create separate locations for emergency care and elective care, because as Greg says: "Every winter we run into problems."