AFTER a wounding five years — typified by runaway debts, savage assessments and a rejected plan to knock down the hospital and start again— North Devon's hospital trust is, as the jargon has it, "achieving turnaround."
The jargon hides a recent history of forgotten waiting lists, £1 million monthly overspends, and the worst self-assessment of any NHS trust in England.
Indeed, managers at Northern Devon Healthcare Trust (NDHT) were facing nothing less than chaos: in 2005/2006, for example, the trust employed 283 people without even costing how it would pay their wages.
Only the skill and commitment of frontline NHS staff— be they nurses, doctors or porters — was never in doubt, and no assessment attacked them.
While patients were treated and clinical life thrummed along as busily as usual — and the Government poured record sums into the NHS — the organisation which ran Barnstaple hospital faced financial catastrophe.
Things have changed. This month, the Audit Commission confirmed that NDHT was using its resources well. The Healthcare Commission says emergency NHS care in North Devon is among the best in England.
And today, some icing for the cake: the NHS annual 'health check' shows that NDHT has been rated "fair" for its use of resources and "good" for services. It is a dramatic improvement on the "weak-weak" rating of 2007. Chaos, it seems, has finally been supplanted by optimism and order.
NDHT chief executive Jac Kelly told the
: "While the journey back to being a high-performing trust has been tough, and particularly tough on all staff groups, we now have a clear direction for the future delivery of local services for North Devon.
"We are meeting all national performance targets, we are maintaining financial balance and our levels of hospital acquired infection are well below the threshold set by the Department of Health.
"Our waiting lists are some of the shortest in the South West and our maternity, inpatient and pathology services were all rated excellent by the Healthcare Commission."
It was a journey shared by other NHS trusts, where simply balancing the books became a losing battle.
In 2007, Audit Commission beancounters judged NDHT to be "inadequate". This year it is "adequate", indicating a huge turnaround, the trust said. The fact the trust was once seen as a financial disaster zone illustrated how much had changed, and in relatively few months. But how did things get so dire? And who was to blame?
NDHT said several "cumulative issues" contributed to the financial and governance problems which reached a nadir in spring 2006 when the trust revealed it was overspending by £1 million a month. A spokesman said: "Costing and counting errors were discovered which meant the trust was not accurately reporting the treatments and activity it was doing. In turn, this meant it did not receive payment for the patients it had seen/treated.
"In addition, the trust had not fully predicted the effect of payment-by-results and other national targets which meant it was not geared up to control the effect of these events.
"Since 2006, the trust has strengthened its governance and financial systems to ensure that the trust board has absolute control over the trust's strategic and corporate business."
The trust refused to blame individuals, although it did point out there have been "significant" management changes since 2006 (see timeline). And the trust is also certain the financial problems did not affect patients: "Clinical services continued to function as normal throughout this period. At no time has this trust cut services or disinvested in facilities."
Organisational changes have been fundamental. A trust spokesman said: "For the trust to have moved from inadequate to adequate masks a complete turnaround in the way the trust operates.
"From the way decisions are made, services are planned, contracts negotiated and budgets set, the organisation now follows strict processes to ensure the right decisions are made and the trust invests in the services which will most benefit patients."
A trust "service strategy" was published in 2008. The trust now has clear priorities which identify areas urgently needing development, including a planned new outpatients department.
Gloom has been replaced with hope. But is the trust convinced the financial problems of the past few years will not be repeated?
A spokesman said: "Once financial and governance systems and processes are embedded into daily working life, it is harder to slip back as they become a normal part of every day life.
"This trust can demonstrate it has the correct processes embedded into its daily working life, and the evidence for this statement comes from the ratings of the external bodies such as the Healthcare Commission, Audit Commission, National Patient Safety Agency and the Department of Health."