When Kevin McGee arrived at East Lancashire Hospitals Trust three-and-a-half years ago the organisation had just been released from special measures.
It had come through one of its darkest chapters but was still facing a prolonged period of uncertainty and intense scrutiny.
Fast forward to 2018 and the Trust now holds a “good” rating with the Care Quality Commission, investment is extensive and Mr McGee believes the future is bright.
“There’s still an awful lot to do,” said Mr McGee. “But if you look at the organisation in terms of quality and safety, although there are still things to improve on, I think we’re in a really good place.
“If you look at our access standards around cancer, around referral to treatment; very good. I think the area that we still need to do more work on is A and E and the emergency pathway.
“We are in a good place though. Staff satisfaction is in a good place. The reputation of the organisation is in a good place. But we need to get it to ‘outstanding’ and that is where we need to go next, in terms of the CQC ratings. There’s no time frame because they are unannounced visits so we don’t know when we will next be inspected. But I believe within the next two years we could get to ‘outstanding’.”
The Trust’s 95% target for people to be treated or admitted to A and E in four hours was well down in December with it only hitting 84.1%. It is a target that has not been hit since June 2015.
When asked whether this target was realistic, Mr McGee said: “I think we should still be striving for it. But there are a few things that are making it difficult. First is the issue around staffing but secondly, people are, and this is a success of the NHS, living longer. But they’re not necessarily living longer healthier.
“You’re getting people living longer with lots of comorbidities who then need real intensive treatment. And so the length of stay increases, they’re in hospital for longer and it’s causing pressure.
“On one level it’s a success story; the NHS is keeping people alive longer, but it is putting more pressure on the services. So what we are trying to do is completely remodel our pathway – how people come into our emergency services.
“We’re investing £11m. in the next couple of years in the front end – the A and E department. That will give us more physical capacity.
“Instead of everyone coming into A and E it’s going to change. There’s going to be a frail elderly unit, there’s going to be a respiratory assessment unit so if somebody comes in with really poor breathing, rather than directly going to A and E they’ll go in to the RAU. We’re trying to build other services around A and E to take some of the pressure off.”
Talking about A and E inevitably brings up the decision to close Burnley’s emergency department 10 years ago.
Mr McGee is adamant the right decision was made then and would not reverse it.
“A and E closing is not the reason the target isn’t being hit. The Urgent Care Centre here is first rate. The majority of the people who would have gone to A and E on this site can still come. We still deal with over 50,000 presentations a year.
“It’s only the very poorly that go to Blackburn. And the reason for that is in terms of trying to improve clinical care – trying to consolidate clinical expertise – the very poorly people need to go where you have got everything around it. And that’s more and more being concentrated up and down the country. It shows that this saves lives rather than if you had it dispersed
“It’s also a staffing issue. The biggest pressure that we have in terms of staffing is in A and E, both for doctors and nursing staff. So if we were diluting that over a number of different sites it would become really difficult to maintain those services.
“Doing what we do now, we have a really first rate service here in Burnley for the majority of people to use.
“We still see people turning up who don’t need to be at Blackburn though. They could go to their GPs, their pharmacist, there really is a brilliant site here at Burnley, but people still, for whatever reason, migrate towards Blackburn when they don’t need to.”
Staffing is an issue that comes up regularly during our 30-minute interview. The BBC published a story recently stating that the NHS was “haemorrhaging” nurses with 33,000 now leaving the profession a year – more than the number joining. Mr McGee is fully aware of the predicament and nurse recruitment is high on his list of priorities.
“It is a problem everywhere. Nurse recruitment is certainly something we look at and try to push. At any one time we probably have around 200 nursing vacancies in the organisation but we do better than most.
“National turnover rate is around 11%; for us it’s around 6%. So what that shows you is that when nurses come here, more of them want to stay than elsewhere. We’re also doing an awful lot of work with UCLan around nurse recruitment.
“We’re trying to make it a very attractive place to work, working with local universities in terms of developing the education base. And what we find is that 99% of nurses who have gone through the training actually choose to stay here and work once they have finished.
“But there is a national shortage and I wouldn’t underplay it. There are some areas where we struggle.”
Pick up a newspaper or watch the news and you would be forgiven for thinking only doom and gloom surrounds the NHS. That is certainly not the case according to Mr McGee, who points to continued investment as a major positive for this area.
“What we have done on this [Burnley] site over the last couple of years and what we’re doing is significant capital investment. We upgraded the Rakehead Unit, for neuro rehab; we put £1.5m into the elective care centre; we just upgraded and opened three new facilities on the Burnley site – paediatric outpatients, new chemo unit and the breast unit.
"In addition to that, go around the front and you will see all the demolition work; that’s £16m – £18m. worth of capital investment which is providing new outpatient facilities and new operating facilities for ophthalmology.
“Then the next plans that we have and they’re not quite there yet concern the old accommodation. We’re going to knock all of that down and we’re currently in negotiations with UCLan for building new student accommodation and education facilities in that area.
“What that will do is really secure that site. This is about £40m. worth of capital investment. There is more capital investment going on here than in most places in the country. We really want to secure this site and make it fit for purpose for the next 20, 30, 40 years. This is a real statement of intent.
“This really is a massively important site. I think it’s got a fabulous future. We’ve got the women’s and children centre on this site; our maternity service I feel is as good as you will find anywhere in the country. The UCC we have here, it’s fabulous.
“If we can pull off the educational housing facilities it becomes areal centre of excellence for education, for training, for clinical work. Our objective is not just to be a centre for Burnley but for the whole of Lancashire; a real beacon of excellence.”
He calls himself an “eternal optimist”. He knows times are hard but he also believes the Trust, courtesy of its “brilliant staff” is on the right path.
“I genuinely think the services that we provide in East Lancashire are first rate. We don’t get everything right and there are things, absolutely, that we need to improve on.
“But generally, if you look at our services they are really good. The staff that we have got I think are the best anywhere; we have some absolutely brilliant staff. I think the facilities we have, the buildings, are first rate, and we are continuing to invest and develop things. But it is tough, it is really tough at present. And we mustn’t forget that.”