Health chief's job in balance

On September 24, Brighton Health Care NHS Trust's chief executive was given a stark ultimatum - improve the performance of your hospitals in three months or you will be out of a job.

That deadline is reached today, on Christmas Eve.

When the Department of Health launched its hospital star-rating system in September, the chief executives of those found to be "failing" were told they had to improve quickly.

If they didn't, then a chief executive from a better-performing trust would be brought in to take over.

A decision on Mr Welling is expected to be made next month.

Hospitals had to perform well in nine key targets to be given a good star rating - Brighton Health Care failed in three of those targets.

The first target was that all patients with suspected breast cancer, who were referred by their GPs, should be seen by a consultant within two weeks.

The second was that patients in the accident and emergency department should not have to wait more than 12 hours for a bed after being admitted to hospital.

The third was that the trust should cut the number of patients waiting more than 13 weeks for an outpatient appointment from 5,775 to 2,352.

In all three targets, the trust performed badly, having one of the worst records in the South-East for breast cancer referrals, a significant number of patients waiting too long in A&E for a bed and it only cut its waiting list down to 3,166.

Since then, the trust says it has made significant progress and is confident of meeting and sustaining the standards set.

The most significant improvement has been with urgent breast cancer referrals, where patients are now consistently being seen within the two weeks.

Mr Welling said: "This was partly achieved by looking more closely at the appointments process.

"Clinic times have also been moved to fit in with patients better.

"We are addressing all the issues of breast cancer care so we can sustain this performance."

Mr Welling wants to move the Nigel Porter Breast Cancer unit from the Royal Sussex County Hospital in Brighton to Princess Royal Hospital in Haywards Heath.

He says it is the only place where the service can continue to improve.

But thousands of people have signed petitions organised by The Argus and the Friends of Nigel Porter Unit, saying the unit should stay in the city.

The trust is in the process of looking again to see if a new location can be found in Brighton and Hove instead of Haywards Heath.

Trolley waits have also started to improve. The trust has opened a 30-bed medical assessment unit, which speeds up the rate patients are seen when they first arrive at A&E.

The trust is in talks with local GPs, social services, community and other health organisations to re-establish the criteria for hospital referrals.

But the main issue is bed-blocking.

The trust has patients stranded in hospital because nursing or care home places cannot be found. This means patients are stuck in A&E until a bed becomes free.

Mr Welling said: "This is not just a Brighton Health Care problem. It affects all local social services and health organisations.

"We are still concerned about finding nursing home places but it is something we are continuing to address. In the meantime, we are improving how patients are dealt with in A&E. Next year, there are plans to calculate the length of time waiting from when the patient first comes into A&E.

"That will be a challenge but we are working towards that."

The number of patients waiting more than 13 weeks for an out-patient appointment is continuing to fall, due to rescheduling clinic times and the appointment of new staff.

Mr Welling said: "Although we missed the difficult target we were set, the number of patients waiting more than 13 weeks last year fell by 2,609, almost half the total. This was the largest fall in the South-East."

As he waits for a verdict on his position, Mr Welling says he believes the trust has a good future.

He said: "We accept we failed the three targets but that does not mean we are a failing association..

"We provide high-quality health care and staff do a tremendous job, which the vast majority of our patients will agree with.

"The way the star system has been presented has undermined public confidence in the hospitals, when it shouldn't.

"I am not trying to shy away from the importance of the ratings but a balance needs to be struck."

But some patients believe it is time for a shake-up at the top.

Lesley Morrill, of Rosebery Avenue, Brighton, wrote to the trust in 1999 because she was unhappy with the care of her mother Rose Wintle, who died 20 hours after she arrived at casualty.

Mrs Morrill received a promise from Mr Welling that lessons would be learnt.

She said: "It is all very well saying improvements have been made. But two years after my mother's death the same problems are still happening. I think it's time for a change."