THE BLOG
24/09/2015 07:59 BST | Updated 23/09/2016 06:12 BST

What Can We Learn From the Failure at Addenbrooke's Hospital?

That one of the jewels in the NHS's crown has ended up on a list of high-profile failures has come as a shock to many. The branding of Addenbrooke's Hospital as 'inadequate' by health regulator, the Care Quality Commission (CQC), raises serious issues about the way hospitals are run. How can a hospital that was considered one of the safest two years ago, now be in special measures?

That one of the jewels in the NHS's crown has ended up on a list of high-profile failures has come as a shock to many. The branding of Addenbrooke's Hospital as 'inadequate' by health regulator, the Care Quality Commission (CQC), raises serious issues about the way hospitals are run. How can a hospital that was considered one of the safest two years ago, now be in special measures?

The story told by the CQC's report, however, is not a straightforward one. The most striking thing about it is the contrasts it contains. A host of red flags around inadequate safety and management of services are accompanied by an 'outstanding' rating for the care it provides. Of particular note is that the report praises staff for going 'above and beyond their duties' to ensure that patients received a high quality of care. Speaking to the BBC, Professor Sir Mike Richards, the Care Quality Commission's (CQC) chief inspector, elaborated on this by saying that hospital staff were "extremely caring and extremely skilled", but that senior management had "lost their grip".

Unsurprisingly the finger-pointing has started already. The Chief Executive of the trust has resigned and the chairman has issued a statement apologising to its patients. A statement from Unison points out that the CQC's judgment reflects unfairly on staff who can 'hold their heads up and say that they've done a good job'.

Whilst it's too early to understand everything that went wrong, all this paints a picture of a serious gap between senior management and staff at the hospital. The CQC's report reads like there were two trusts, not one. So how could this gap between staff and management have been prevented? And what could be done to stop this happening in more of our local hospitals?

Instead of finger-pointing we should be looking at alternative approaches that are already working. An increasingly common trend in the public sector is a move towards 'public service mutuals', organisations that emphasise and encourage front-line staff to be involved in the running of services A similar approach is taken by the John Lewis Partnership where staff get a genuine say in what happens to the business. Does it not make sense that organisations owned or run by staff will have less of a top-down approach?

And this isn't just something for the NHS to think about. This approach is already happening across local services: in adult social care, children's services, and public health, and has been championed across the political spectrum.

This way of running things may not be right for every public service, or every hospital, but the big advantage is that it can place more influence and responsibility in the hands of staff, and narrow the gap between management and the shop-floor. Employees are part of decision making, often through staff councils or being a member of the governing board. They can also have a greater say over budgets or freedom to test their ideas. Had this been in place at Addenbrooke's it may have helped to spot that staff weren't happy back in 2014, when an NHS survey found that staff satisfaction with the quality of patient care was falling, while work related stress was rising significantly.

Applying this way of running things to a hospital trust would not be straightforward but could help trusts to prevent a gap between senior management and staff, and provide high quality care. It's very often a criticism of huge bureaucracies such as the NHS that the worker becomes just a small cog in the machine.

Addenbrooke's is a salutary tale of what goes wrong when the gap between staff and management grows too big. There are lessons in this for every other hospital in the country.