Carnall Farrar with Barts Healthcare

In 2012, Barts Health NHS Trust became the largest Trust in the country, serving a population of 2.5m following the merger of three acute trusts. Since then, the Trust has been placed into financial and quality special measures following a CQC rating of ‘inadequate’. The CQC reviewed surgical services at two of the four hospitals as “Requires Improvement”, due mainly to high vacancy rates and poor theatre utilisation.    

As part of their ‘journey to outstanding’ Barts Health put out a tender to develop its 10-year strategy for surgical services. The strategy aimed to produce a sustainable model for surgerywhich would see a move to services managed across the trust, rather than on a site-by-site basis. This would reduce variation between the acute sites, increasing theatre utilisation and improving quality.  

CF was chosen because of our clinical expertise and unique ability to align stakeholders across shared change goals in the health and care sector. Our proposal focused on standardising surgical services across all sites to better meet the needs of the population and aligning 21 specialities to a set of common goals. 

CF worked with the Surgery Clinical Board to develop a preferred option for the configuration of services and created a surgical strategy for the next ten years and an initial implementation plan.  

We developed a framework for clinical co-dependencies and an approach to developing world-leading services. Alongside activity modelling, these formed the basis of the surgical strategy, developed further through a series of working group meetings and workshops.  

CF worked closely with the Barts Health surgery programme team, led by Surgery Board Chair Mr Stephen Edmondson. We addressed scepticism and built confidence that the aspirations of the strategy and its benefits were realistic. 

CF outlined the six core benefits of the strategy, mainly through the creation of 13 multi-disciplinary Centres of Sub-Specialist Expertise.   

The benefits are: 

1.      Equitable access to high-quality care  – residents from across the Barts Health catchment will have access to the best quality care in the area, regardless of which hospital is closest to them 

2.      Address workforce challenges, and the imbalance of opportunities across sites:  an estimated 10% reduction in agency and waiting list initiative spend 

3.      Re-organisation to enable better clinical cross-site working: 14 surgical specialities will be on two or fewer sites, compared to nine today.  

4.      To be the provider of choice in east London and beyond: Through more referrals, Barts Health can grow surgical activity by ~3% annually.   

5.      Embed academia and research: The Trust has targeted an increase in staff publications by up to 20%.  

6.      Improve the reputation of Barts Health hospitals 

We approached the work with the understanding that developing co-designed solutions would be vital to the success of the project. Making sure that the surgeons were signed up to the solution developed would ensure implementation and lasting improvements. We worked flexibly with the surgeons, regularly engaging 1:1 and providing bespoke support. Delivering this additional support ensured we hit the endpoint on time.  

View the Carnall Farrar profile in the MCA Members Directory.