4 days ago
Inside the best NHS trust in England — how does it do it?
'When we talk about looking after our own, we absolutely mean it,' explains Dr Birju Bartoli, chief executive of Northumbria Healthcare NHS Foundation Trust. 'We all live on the patch. You have generations of the same family who work here — grandparents, mothers, sons.'
The odds are stacked against Bartoli and her team. The trust runs four major hospitals and is responsible for the health of 500,000 people, spanning a vast area from the Borders to the outskirts of Newcastle. The population is ageing, spread across a mix of remote rural communities and deprived coastal towns — areas where recruiting doctors is notoriously difficult.
Yet patients here are seen faster than anywhere else in England, with Northumbria consistently topping national NHS rankings for performance and patient satisfaction. About 91 per cent of patients are in and out of A&E within four hours, compared with a national average of 75 per cent.
Meanwhile, 81 per cent of those on hospital waiting lists are seen within 18 weeks, against a national average of 61 per cent.
The transformation of Northumbria into the best-performing NHS Trust began under Sir Jim Mackey — now the head of NHS England — who was chief executive from 2003 to 2023. 'If anyone can make the changes that need to happen, he can,' said Bartoli, his successor. 'He's competitive, and I'm competitive, in terms of wanting us to do the best we can do, be the best that we can be. Because we have a responsibility to our local population. We are public servants.'
Mackey urged other NHS trusts to follow Northumbria's lead, adding that 'we must learn from the best if we're serious about putting the NHS back on track'. He said: 'Many of the things we aspire to nationally exist now [in Northumbria], so show it is possible. Waiting lists are low, patient and staff satisfaction is high, and services are being delivered within budget.
'Northumbria offers clear evidence that cutting waiting times isn't just an ambitious goal — it's achievable. And with that, we can begin to restore public confidence in the NHS.'
Staff at Northumbria follow a mantra that 'patients' time is precious', and it's evident from the moment someone turns up at A&E. Some 150 patients per day walk through the front door at the emergency care hospital in Cramlington. But a unique 'streaming' system — a form of triaging — means only about one in three end up seated in the A&E waiting room.
Patients are assessed straight away by an emergency specialist in the hospital foyer, who — wherever possible — books them in for treatment elsewhere. This might mean going straight to an operating theatre to have their appendix removed, or being booked for an x-ray for a sprained ankle at an urgent treatment centre. Others are directed back home, or to their GP or pharmacy, after being reassured nothing is seriously wrong.
'We have had people at the front door with a cut finger where we say — 'you need to go to a pharmacy and buy a plaster',' said Dr Sameer Sasidharan, an A&E consultant, stressing that it is understandable why worried people come as 'A&E is the only place that is open 24/7'.
This is the first A&E department in the country to link up directly with community services, aiming to ensure people 'don't bounce around in the system' between GPs and hospitals.
Dr Julian Coffey, head of urgent care at Northumbria, explained: 'It is about getting patients to the right place as quickly as possible,' so they do not face delays or have unnecessary [and expensive] tests. One classic example is chest pain. 'It is very common and the first worry of everyone is that it could be a heart attack, so they come to A&E,' Coffey said. 'However, we send home the vast majority. Often it is anxiety or stress, or they've pulled a muscle. If the patient can be told really rapidly that they're OK, that is so valuable for them.'
The model clearly pays off: a national league table of NHS trusts published last month ranked Northumbria as the best general hospital for four-hour and 12-hour A&E waits.
One of the boldest decisions Mackey made during his two decades at Northumbria was to separate completely 'hot' emergency care from 'cold' elective care. In 2015, the region's three A&Es were merged into a single new facility. All emergency patients now go to the £75 million purpose-built emergency hospital in Cramlington, while routine surgery is carried out at Northumbria's three general hospitals in Ashington, Hexham and North Tyneside.
As a result, routine care — such as hip replacements, hernia repairs or diagnostic scans — is protected from the pressures of Covid, flu or winter crises. Northumbria now has the lowest hospital waiting times of any non-specialist NHS trust in the country.
'If you think about all of those performance metrics, they're all about time, whether it's time in an emergency department or time waiting for an operation. Within the organisation we view time as being very precious for staff and for patients,' said Bartoli.
Centralising emergency care in one hospital also means emergency specialists can be on site 24/7, rather than being 'diluted' across separate hospitals in the region. The Cramlington hospital has dedicated wards for different emergencies, such as trauma, respiratory and stroke, so that patients can start cutting-edge treatment straight away, improving their chances of survival.
It has pioneered lifesaving models of care, including providing more respiratory patients on non-invasive ventilation early on when they are struggling to breathe. 'The quicker you start the treatment, the better the outcome for the patients,' said Karen Brewin, the lead respiratory physio.
Colin Richardson, 91, was admitted to Cramlington Emergency Hospital in March with complications of heart failure. Typically, patients in his condition would face several weeks in hospital.
But instead, as soon as he had stabilised, Richardson was discharged back to his home in Whitley Bay — under the care of Northumbria's virtual wards, or 'hospital at home' service. 'I could get back home to Doreen. She is nearly 90 and we have been married for 60 years so it's hard being apart from each other,' Richardson said.
To meet growing demand from an ageing population, Northumbria is significantly expanding this 'hospital at home' service — part of a national drive to shift more care out of hospitals and into the community under the government's ten-year NHS plan.
Up to 100 patients at a time are cared for on these virtual wards, including those with lung cancer, heart failure and residents of care homes. Nurses visit them every day, checking on vital signs and delivering medication, with consultants monitoring them from afar.
'If we can keep them at home, they're going to eat their own food and potter around more. Their mobility is going to improve. They tend to be a lot happier. Visitors are not restricted, and there is less chance of catching an infection. They can see their dogs and stand in the garden in the sunshine,' explained Jennifer Whitaker, a nurse who leads the community service.
Shifting care into the community is not only better for patients — it is also a financial necessity.
Modelling shows that unless care is moved out of hospitals, the NHS trust would have to build a whole new hospital by 2040 just to meet the demands of Northumberland's ageing population. 'Doing nothing is not an option, because we don't have the money to build another hospital. And even if we did have that money, we wouldn't be able to staff it,' Bartoli said.
While other NHS trusts consistently overspend against annual budgets, Northumbria reported a £30.5 million surplus in 2023-24. 'We have been very strict on ourselves in terms of that financial discipline. It's a mixture of being rigorous in how we manage money, as well as having a commercial eye.'
While Mackey was in charge, the trust negotiated eye-catching deals to save money. These included creating subsidiary companies to manage estates and facilities, transferring 800 staff out of the NHS to save on VAT and pay costs.
Mackey has pledged to take the same approach as head of the NHS, ordering hospital bosses to 'get a grip' on overspending and stressing the NHS must deliver better value for its £200 million budget — an amount that he has noted is 'equivalent to the GDP of Portugal'.
