North-East Langley Hospital Trust (NELHT) Fictional Case Study – Management Assignment Help

Assignment Task

Task 

Fictional Case Study
1. Introduction
The Secretary of State for Health has invited me to make further recommendations based on the findings of a committee which has investigated recent failings in the North-East Langley Hospital Trust (NELHT).
In 2018 – 2019 a spate of allegations about the management of the trust emerged in the media prompting the Secretary of State for Health to take action. The committee was instructed by the Secretary of State to investigate frequent complaints from patients and the families of patients concerning the service being delivered by NELHT in the period 2005 to 2017. The committee took evidence from patients, relatives of patients and members of staff. A separate investigation was conducted by the police into allegations of financial irregularities by a ‘whistleblower’.

2. Findings of the Committee
 

2.1. Evidence from Management Consultant The committee commissioned a general survey from a management consultant. The findings were:

• The trust operated on two sites: one consisted of a 1960s building in a shabby condition; the other consisted of a small 1980s building in fair condition with several Victorian buildings which were once part of a mental hospital on the same site.
• The Victorian buildings were difficult to use because the sizes of the rooms do not lend themselves to contemporary use and because of the inefficiency of the heating system.
• The other buildings have suffered from skimping on routine maintenance.
• The IT systems on both sites were inadequate with poorly designed networks that operated at slow speeds. The software was not regularly updated or reviewed. The
• IT department were not involved in planning and often IT was not used or was under used.
• Processes were not standardised and were often haphazard.
• Managers seemed to be unaware of such generally known management concepts as right first time, total quality management and zero harm.
• There was no clear set of priorities in the minds of staff, such as patient care. Each department, sometimes each individual, had his or her own priorities.

The following could be surmised from the verbal evidence given to the committee by a sample of the witnesses.

2.2. Mary Kotecha – former Financial Director the NELHT
Mary has had a very tough time since being suspended without pay by the trust. She has been unable to find work in her field since prospective employers always contact NELHT for references. She is working as a cash till operative for a supermarket chain. Mary contacted the Secretary of State’s office directly when she noticed that sums of money were unaccounted for. She repeatedly asked the director the trust for an explanation but was fobbed off with delays and excuses. She contacted the police who
took no action. Finally, she contacted her local MP.

2.3. Sissi Begum – Palliative Care Nurse
Sissi said that she had been criticised from time to time for “wasting time talking to patients”. She said that immediately after one of these reprimands she overheard two
senior nurses chatting for half an hour about how too much was expected of them, and they couldn’t do everything. Sissi said that patients were left lying in their own excrement because the nurse on duty wanted to push the work onto the nurse on the following shift. Sissi felt that whenever she commented on poor professional behaviour or suggested improvements she was reprimanded and told to mind her own business. She said, “This is not what I came into nursing for, but I need the job, so I decided to close my eyes and keep my mouth shut. In the end, you have to look after your own interests, don’t you?”

2.4. Fred Ohmeagh – A & E Nurse
Fred said that there was a very bad working atmosphere in his department. The clinicians were abrupt, often to the point of rudeness and mostly only seemed to be interested in doing as little work as possible. He said that he and his nursing colleagues would try to keep those in authority in the dark about what they were doing as much as possible. That way, they could “look out for each other” and support each other in doing a good job and so “prevent the bosses from messing things up”. The A&E department was generally found to be working at an average to above average standard. Fred said that there was a lot of unnecessary paperwork which seemed to be taken very seriously but which was irrelevant to the care of patients. He said that he had found that it was best just to tick all the boxes that suggested that everything was going well otherwise there would be “a whole lot of trouble without any results”.

2.5. Bruno Bosco-Marr – Administration Manager
Bruno said that he was surprised that the hospital trust had come in for so much criticism, from his viewpoint everything ran quite smoothly with only a few occasional problems. He said that they had put many quality systems in place and every effort had been made to ensure that they were adhered to. When asked why a lot of processes were not being done using IT, he said that a costbenefit analysis had been conducted by senior managers which showed that introducing new IT based systems would involve a lot of expensive training and disruption while the new systems were being taken up so it wasn’t worth spending the money.

2.6. Pamela Kiddson – Administration Manger
Pamela said that she thought that the organisation of the hospital trust was a complete mess. There were many areas of activity where the processes had not been worked out and everyone was focussed on a show of looking good rather than doing things properly. “But”, said Pamela, “there was nothing I could do about it, so I just got on with what I was told to do. There wasn’t much point in doing anything else; nothing was going to change. No one cared.”

2.7. James Butterworth – Consultant
“I am extremely good at my job. I stay focussed and I don’t worry too much about things outside my responsibility. The nursing and administrative staff at NELHT weren’t very good – most of them seemed a bit dozy to me – but that wasn’t my concern. I managed to get out to a better job before NELHT became a bad news story, so all this scandal didn’t really affect my career.”

2.8. Dr Eric Wolfenden – Director of the Opthalmology Unit
“As soon as I arrived at NELHT to head up the unit I could see that the trust was a useless organisation, so I decided to go my own way. I formed a consortium with the
ophthalmology departments at another two hospital trusts in the area. We got hold of some direct funding and benchmarked each other for best practice. We have always had an excellent success rate and been singled out for praise by many authorities in the field. The managers at NELHT didn’t notice what I was doing at first and by the time they did notice it was too late for them to interfere. They could not understand how I had managed to gain so much autonomy from the trust and they didn’t like it, but they left me alone. One of the senior managers was overheard saying that I had got too big for my boots and that he was watching me for when I slipped up so that he could cut me down to size. It’s all very petty among the managers here but I have assembled an excellent team and we do work that we are proud of.”

2.9. Alex Goodfield – Director
Alex has been suspended indefinitely on full pay while investigations proceed into the trust’s finances. Preliminary examination of the figures suggests that there is several million pounds unaccounted for, though the external auditors did not pick this up. Alex is presently holidaying on his yacht which he berths in Cannes.

2.10. The Role of the Secretary of State
The present Secretary of State responded to queries about NELHT by setting up the present enquiry. The period over which concerns had been raised spanned the periods of the three previous Secretaries of State who were members of the previous government. Evidence was produced that all three of the previous Secretaries of State had responded to complaints raised by several MPs by first showing concern and then lapsing into silence and inaction.

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