Preston and Chorley hospitals' boss leaves this week after ten years in charge
“In a 41-year career in the NHS, not much has actually stayed the same,” laughs Karen Partington when asked to reflect on how things have changed during her four decades in healthcare.
The chief executive of the Royal Preston and Chorley and South Ribble Hospital brings down the curtain on Tuesday on the role that has occupied a quarter of her working life.
The departing boss - who will officially retire from the NHS at the end of the year when she also steps down from some regional-level positions - says she never imagined when she started out as a registered nurse that she would rise through the ranks to run a hospital trust that serves almost 400,000 patients.
She credits that achievement to some “very kind” people she encountered in the early stages of her career who “saw potential in me” - and as she looks back on ten years at the top, she remains grateful for the route that took her there.
“I think I've always been able to have honest conversations with clinicians - and I think that’s as a result of my training back in the day.
“When I became chief executive, I also started to do ‘back to the floor’ sessions. A minimum of once a month, I’d put on a uniform and go and work in the theatres or with the porters or do a night shift in A&E.
“That has always helped me connect board to ward, [because] we must never lose sight of why we're here as executives - and it’s to do the right thing for patients and do right by our staff.”
Another thing that Ms. Partington could not have predicted when her career began was that it would end in the midst of a global pandemic. She says that the enduring capacity of the NHS to evolve in response to almost perpetual change has served it well over the past 18 months - but admits that the scale of this particular challenge has been immense, especially for those on the frontline.
“Dealing with the complete unknown was quite frightening for a lot of staff, who have been right at the sharp end of it, [treating] patients coming in with Covid. But our hospitals have pulled together like nowhere else I know and it has been a privilege to watch people grow and come up with brilliant ideas - and, equally, shape how we’re going to do things in the future.
“In terms of how we work, the pandemic has really accelerated change - the whole [service] has done something really different and we have done things that perhaps would have taken several years [otherwise]. We’re doing more [video consultations] - so while some patients will still have to come into hospital, others can easily [be seen from home].”
“You're not paying to park and sitting in a waiting area - you're comfortable at home. These are things we have talked about for a long time and not actually done, but the pandemic has made us really think about how we do things more quickly, efficiently and effectively.
“I think this is just the start of how things might change in the future - and for the better for staff and patients.”
Amongst her proudest achievements during her ten years in charge at Lancashire Teaching Hospitals NHS Foundation Trust (LTH) was the Royal Preston becoming one of England’s major trauma centres back in 2013 - the place to which the most seriously injured patients across Lancashire and South Cumbria are taken. The Sharoe Green Lane site is also the destination for people from across that wider region who are in need of the most specialist services, such as neurology.
“When you look at where we sit in the scale of major trauma centres, we’re steadily moving to the top end [in terms of] of outcomes for our patients, which is fantastic - and we have got the best vascular centre in the country for outcomes as well,” says Ms. Partington, who also ranks the trust’s launching of the first non-commissioned nursing school in 2015 as another milestone moment of her time running LTH.
She says that the idea for that facility - which offers an adult nursing degree in partnership with the University of Bolton - came out of a recognition that the NHS needs to invest in finding its next generation of staff.
“We’re only going to grow our workforce by growing from within our region, so let’s get our nurses and doctors of the future to want to come and work in the health service - and where better than your own local hospitals?”
“Something else really close to my heart is a programme we have to bring young people with learning and physical disabilities to our education centre for six weeks. They come and work [in different departments] and at the end of their time, they do a big show-and-tell to their parents and teachers about what they’ve learned.”
Ms. Partington says that parents often tell her that a spin-off project offering permanent jobs to young people with disabilities has “given them hope for their children and an opportunity to see them flourish”.
“It’s such a privilege to do those things and we have got to do much more of them.”
However, anybody spending a decade leading an NHS trust is likely to have their service punctuated by periods of controversy - and for the LTH boss, the most significant of those came in 2016 with the nine-month closure of Chorley A&E and its subsequent reopening as a part-time facility.
The move was made after the trust revealed that it did not have sufficient middle-grade doctors to staff the unit safely - but it attracted criticism from local politicians and sparked weekly protests from campaigners at the gates of the Euxton Lane hospital, which continue to this day.
Ms. Partington says that she would “not wish” the decision she had to take on anybody - but defends it as the only option.
“Throughout that whole period, the people I took my counsel and guidance from were the clinicians [who] were at the forefront of everything we did. It was about providing a safe service for the residents of Chorley.
“When you have to make those difficult decisions, you have to think ‘What is the right thing to do?’ And the right thing to do at the time was to close it, because we couldn't guarantee that we would have enough staff to run it.
“We can sustain 12 hours in Chorley [A&E], seven days a week - and people got used to that very quickly.”
She admits to there being “some disappointment” when the five-year-long Our Health Our Care (OHOC) programme - one of the aims of which was to determine the future of the emergency department at Chorley - was scrapped in February after the intervention of the then health secretary, Matt Hancock. It came just as a long-awaited public consultation appeared to be drawing closer, with the main options set to be presented to the residents involving the closure of the facility and its replacement with one of two versions of an urgent treatment centre.
“OHOC was a clinically-driven process which took place over a number of years. However, we all understand that things change and it is important to remember that there has been a great deal of investment at Chorley and South Ribble Hospital, including within the emergency department, [and also] the new birth centre and ophthalmology unit which will come online soon,” Ms. Partington adds.
The A&E’s long-term future will now be bound up in the new hospitals programme, under which local NHS leaders are bidding for funding for the creation either of two new facilities to replace each of the Royal Preston and Royal Lancaster hospitals - or one so-called “super hospital” serving both localities.
Ms. Partington says she does not have a personal preference as to which option is ultimately chosen, but admits that the Royal Preston is “a difficult place for people to work and to be treated, [because] the buildings are so old”.
“This opportunity is not going to come again - we are not going to be given something in the region of £1.1bn across our patch to build a new hospital, so we need to use it wisely and make sure we secure the health services that patients need and deserve.”
Reflecting on the future of the NHS, the long-time LTH leader says she is “optimistic” that the service will flourish in spite of its many challenges - not least the need to reduce the soaring waiting lists that have built up during the pandemic, something which she describes as “absolutely tragic” and predicts will take “a long time” from which to recover.
However, she is candid in her assessment of the England-wide changes that were ushered in not long after the start of her tenure at the top of the trust by the 2012 Health and Social Care Act - which formalised competition for the provision of NHS services - and the fact that the direction of travel has shifted in less than a decade.
“The Lansley reforms [developed by then health secretary Andrew Lansley] were particularly challenging for all of us.
“Moving from that competition to collaboration is absolutely the right thing to do for our patients and staff.
“I think we could have done a lot of things that the Lansley reforms wanted to do without that wholesale reorganisation of the NHS [which included the creation of clinical commissioning groups].
“Sir Simon Stevens [chief executive of NHS England between 2014 and this July] has worked really hard to bring us back round into something that is where we need to be.
“You learn from all of these things and each element [of change] that we go through - you take the good from it and hopefully move on and make it a better place for the next generation of people coming to work in the NHS and for the next set of patients [so that they] receive good quality care.”
Meanwhile, Ms. Partington hopes to leave a legacy at LTH of the trust being ranked as “good” overall at its next Care Quality Commission (CQC) inspection - a status which has eluded the organisation in the eight years since a new assessment regime was instituted, with it receiving four consecutive "requires improvement" ratings. It did achieve a “good” standard in the “caring” and “well-led” domains during the last CQC visit in 2019, but has not been reinspected since because of the pandemic.
“I do regret that we were not able to get there and I regret that over the past couple of years that we have not been able to showcase some of the fantastic work that the clinical and management teams have been doing to get us to good in the future,” says Ms. Partington, adding that she is pleased that all clinical areas at Chorley and almost all at Preston have already achieved that status.
“We look at a wide range [of metrics] from right across the organisation - we’re scrutinising these all the time. The CQC is one of those measures, but we also have other external scrutiny...that we’ve done really well with.”
Ms. Partington says that uncertainty about the revised mechanisms now underpinning CQC inspections mean she cannot predict whether the organisation will make the step-up in grade next time - adding that the weight given to its financial health will play a part, with most trusts under pressure in that regard.
However, if LTH does ultimately achieve the sought-after “good” accolade the next time an inspector calls, she stresses that it will have been a team effort.
“I’ve been fortunate to have a very talented executive team. The key to all this is a strong board, executive and senior leadership teams - and I'm absolutely handing over that level of strength.”