Having spent a year in the job, the chief executive of Queen Alexandra Hospital is now looking ahead to the future.
Mark Cubbon has spent the past 365 days meeting staff at the Cosham site, bringing in new board members and implementing new schemes and ways of working.
In his first year the former NHS Improvement employee has overcome challenges from the hospital being at full capacity over Christmas, a damning Care Quality Commission (CQC) report finding thousands of chest X-rays had not been looked at by radiology experts and snow causing staff to work throughout the night.
But since starting on July 31 last year, Mr Cubbon has also seen the emergency department’s four-hour target hit its highest percentage for more than a year, the trust’s finances stabilise and staff morale improve.
Now, he and the other Portsmouth Hospitals NHS Trust (PHT) board members are looking ahead to the future with the launch of their five-year strategy.
The document outlines the hospital’s plans until 2023 and how it will deal with demand while improving its services and care to patients.
It looks at how QA Hospital will work with its system partners to promote care in the community as well as how it will improve its performances from finances to workforce.
Mr Cubbon says: ‘One of the things we have wanted for sometime is a very clear strategy about how we take the organisation forward.
'It addresses how we sort the challenges we have now as much as what we look like in five years time.
'It is how we resolve some systematic challenges from the past and how we intend to respond to the local and national challenges in health and social care.
‘The strategy describe how we address things like issues found in the CQC reports and how we deliver further investments in urgent care.
‘Looking at the workforce to meet the national workforce challenges is also a big part of it.’
In the strategy, it says QA Hospital has ‘challenging workforce pressures resulting in high agency and locum spend, and skills shortages’.
To help solve this, the trust wants to look at new models of working and what roles people are doing.
Mr Cubbon adds: ‘We need to be an attractive hospital for newly-qualified nurses and make sure we are the hospital people want to come to.
'We need to change the workforce model and how we run services.’
With the strategy published and rolled out across the hospital, it will enforce any future decisions made by the trust board.
‘It doesn't just describe what we look like in five years time but allows us to be upfront about the changes we are looking to make,’ Mr Cubbon says.
'It will help when we are looking to make changes as we can refer to the strategy before going ahead. We will use it when making key decision about future investment whether that's in IT, our estate or changes in key roles.
'All of that is a key part of the strategy. The plan is just as important for where we aim to be in the next six months as where we aim to be in the next five years.’
A big part of the strategy is how QA Hospital builds on its partnerships with other healthcare providers.
It works with community providers Southern Health NHS Foundation Trust and Solent NHS Trust, local authorities Hampshire County Council and Portsmouth City Council as well as other organisations like South Central Ambulance Service, the area’s three clinical commissioning groups and GPs.
A number of schemes have been implemented by the A&E Delivery Board, which has representatives from all the agencies, to help ease pressure at QA and get patients treated in the community.
As part of its five-year plan, PHT wants to do more for community care and working with its partners to achieve less people needing to visit hospital for treatment.
Mr Cubbon says: ‘Another key change is how we work with our partners in the community and working more closely with GPs, community health providers, charities and community groups.
'While we have existing relationships, we would like to see how working with our partners can support patients getting home from hospital quicker.
'It sets out how we will support patients with long-term conditions because we want to make sure we are supporting care that's provided in the community.
'It is about getting that care without having to come into QA Hospital.
'It's a more holistic view on how we manage long-term conditions and that is a strong part of the whole document.’
While producing the document, the trust held 80 engagement sessions for staff as well as going out into the community to speak to the public and patient groups.
Mr Cubbon said it was important to get the views of everyone who used the hospital along with key stakeholders.
‘The approach we have taken has a strong resonance with what patients want, what our staff see as the best way to deliver services and what our stakeholders and partnership organisations experience with us and the role we expect to play,’ he adds.
When asked where he hopes QA Hospital to be in five years time when the strategy ends, Mr Cubbon said he wants to see year-on-year financial stability, consistent care across all of the site’s areas and improved community treatment.
He says: ‘I would like to be in a more financially-stable position, at the moment we are recovering.
'I also want to be in a place where our services meet the future needs of patients. The care of patients is already fantastic but some areas aren't where we need to be, in particular urgent care.
'I would like us to be able to give a real example of delivering care in communities and in order to address the long-standing challenges it is important for us to have close working relationships with our partners of the system.
'Some people feel care is disengaged. The more we can make sense of that so it's more patient-friendly, the better someone's journey through the health system will be.
'I hope patients will see this strategy and see how we get to a point where their experiences are consistently good rather than the inconsistencies we have seen in the past.'
QA chief executive’s first year in charge
When he took over as the boss of Portsmouth Hospitals NHS Trust, Mark Cubbon was not disillusioned to the problems facing Queen Alexandra Hospital.
Nor was he phased by the challenge ahead of him to make the hospital somewhere patients receive safe care while also improving its heavily-criticised emergency department and boosting staff morale.
A year on, Mr Cubbon is pleased with the progress made but said he plans to do much more to build on his first year.
‘I have enjoyed my first year getting to know more about the community we serve, the organisation and meeting all the fantastic staff,’ he said.
‘I am starting to get a much better sense of the pride the city has for the hospital and its staff and the wealth of support there is.
‘Our staff are also really proud of the community they serve.’
When Mr Cubbon took over as chief executive last July, he had four key objectives he wanted to work on including the hospital’s finances, governance, urgent care and leadership.
He said improvements have been made in all of those areas.
‘In terms of leadership, we almost have an entirely new board and I am pleased with the team I have created,’ he adds.
‘Getting the leadership right was really important.
‘Making improvements in governance was key for me too and hopefully the latest Care Quality Commission reports will reflect that.
‘This year we have started to see improvements in urgent care and July was the fourth month where we have seen an increased figure in the A&E four-hour target.
‘Finally, our finances are starting to stabilise and we have a very clear plan to keep improving.’
Mr Cubbon said he set high expectations for himself and he will not get carried away will the success he has seen so far.