As a recently formed NHS Foundation Trust, North West Anglia required an independent development review of its leadership and governance using the Care Quality Commission (CQC) well-led framework. Arden & GEM’s Effective Leadership Solutions team was appointed to lead a well-led review focusing on leadership, engagement, governance and quality improvement.
Using a tried and tested four-step process, the review team delivered a final report with detailed analysis and key recommendations, which built upon the Trust’s existing development work, to enable a culture of learning to be embedded, robust governance systems to be implemented and high quality, safe care to be delivered.
The challenge
The formation of North West Anglia NHS Foundation Trust, in April 2017, brought together Peterborough and Stamford Hospitals NHS Foundation Trust and Hinchingbrooke HealthCare NHS Trust to serve a population of 700,000 across Cambridgeshire and South Lincolnshire.
Following a rating of ‘Requires Improvement’ for well-led in the Trust’s first and subsequent CQC inspections, support was needed to help the Board embed a culture of learning, implement robust governance systems and enable the delivery of high quality, safe care. Additionally, senior leadership needed to be able to tackle the emerging challenges posed by the COVID-19 pandemic and the establishment of integrated care systems.
The Trust required an independent, development review of its leadership and governance using the CQC well-led framework and associated key lines of enquiry.
Our approach
Comprising an experienced team of senior leaders, with strong consultancy and NHS backgrounds, Arden & GEM’s Effective Leadership Solutions (ELS) was appointed to deliver a well-led review. For this project, team members were selected to cover all the domains of a well-led review as well as the requirements specific to an acute trust.
"I am grateful to you and your team for the effective way the review process was coordinated. Your senior consultant collaborated with my team effectively and was always on hand to provide timely support when required. Coordinating a well-led review is a challenging process in normal times. To do that effectively during a pandemic is testament to your team."
Taff Gidi, Company Secretary at North West Anglia NHS Foundation Trust
Focusing on the key themes of leadership, engagement, culture, governance and assurance, and quality improvement, ELS adopted a four-step approach to delivery. By making full use of video and interactive functionality within virtual platforms, the team was able to use technology as an enabler during the review process – which took place entirely during the COVID-19 pandemic – to observe cultures and behaviours.
1) Preparation
The team undertook a desktop review of evidence provided by the Trust including inspection reports, previous reviews, as well as a range of strategies, policies and papers. This review and analysis formed the basis of an internal report highlighting key areas to be explored further.
2) Observation
Board, committee and divisional meetings were observed by the review team to understand how they operate, content, decision-making processes, behaviours and dynamics. A subsequent coaching and development feedback session was delivered by the review team to support continuous improvement and knowledge transfer.
3) Engagement
Semi-structured interviews were conducted with members of the Board, key senior leaders and external stakeholders using a coaching approach to enable open and honest conversations and support developmental thinking. Focus groups were also facilitated with key internal and external stakeholders, including patients and carers, to understand how the Trust is viewed, particularly in terms of leadership, and how engaged stakeholders feel in making changes to culture, services and clinical quality.
4) Analysis and reporting
Following the preparation, observation and engagement phases, the review team collated all evidence gathered to identify key findings and recommendations against each of the five key themes of the review. A final report was produced with recommendations based on development and improvement opportunities drawn from the review team’s experience and based on evidenced best practice.
The team’s analysis and final report underwent a rigorous quality assurance process by a member of senior panel – with considerable expertise in Board leadership and well-led reviews – who had not been directly involved in the detailed delivery of the project.
The project was underpinned by robust project management which included a detailed project plan and delivery timeline, and fortnightly highlight reports. During the first three steps of the review, regular progress meetings were held with the Chair, Chief Executive and Company Secretary in order to test, confirm and challenge early findings.
The findings of the final report were presented to the Trust Board and have gone on to inform future Trust development and improvement plans.
By utilising a review team with significant experience at a senior level within health and care systems, as well as holding executive coaching qualifications, the review was able to supplement a process of observation and engagement with practical sessions to improve communication and development.
"We chose Arden and GEM because of their experience with other providers and the practical expertise and insights provided by their team. They ran a well-planned and detailed review which took into account our specific requirements and focus areas. Throughout the process they kept the CEO, the Company Secretary and myself updated regularly on progress vs plan and this also allowed clarification and identification of issues to be addressed.
The review was well received by the Board and we welcomed the challenge they gave, supported by recommendations on how to develop and improve. Equally we found the team receptive to feedback from Board members. Despite the majority of the process requiring remote and virtual review, this did not impact on the quality of the findings and recommendations we received in a professional report."
Rob Hughes, Chair at North West Anglia NHS Foundation Trust