Too big to manage: Is the largest NHS Trust in England struggling under its own weight?

By Chris Hurlston, medical negligence solicitor at Irwin Mitchell

The biggest NHS trust in England has been told it requires improvement due to concerns over patient safety. I was disappointed to read this. But was I surprised?

April 2018 saw University Hospitals Birmingham NHS Foundation Trust swallow up its neighbour – Heart of England NHS Foundation Trust. Known as HEFT, it was once responsible for three major hospitals in the West Midlands; Heartlands, Good Hope and Solihull. It was said at the time that combining the expertise of two trusts would benefit patients. However, with a combined budget of £1.6billion, the merger was so big, it had to be cleared by the Competition and Markets Authority.

University Hospitals Birmingham NHS Trust 'requires improvement'

Fast forward three years and this NHS giant has now been told by the Care Quality Commission that it ‘requires improvement’. It was previously rated ‘good’. The pandemic has no doubt stretched services, but could its unwieldly size be the source of the problem?

What are the concerns?

• Ineffective monitoring of patients
• Incomplete safety checks on equipment
• Patients having to waiting outside in ambulances due to lack of space
• Some staff said their concerns about patient care were not listened to

Does big equal better?

Over the last decade, the government has been intent on a programme of reducing the number of NHS organisations. This has led to bigger and bulkier trusts. In theory at least, fewer trusts save money as overheads are reduced and efficiencies driven up. 

But how easy is it to manage an organisation of such a size? How quickly can an organisation of that scale adapt to changing patient needs, competing targets and new initiatives? 

History has shown that size does not always equal success. South London NHS Healthcare Trust was broken up, in part because it was too big.

There is now real pressure on England’s biggest NHS trust to rise to the challenge and improve the experience of staff and patients. If this isn’t turned around, we may see another trust having to be dismantled. 

This would be a worry for 2.2 million patients estimated to use the trust each year. This would be a costly and cumbersome exercise, but perhaps one that could see standards improve.

Find out more about Irwin Mitchell's expertise in supporting people and their families following care issues at our dedicated medical negligence section.

This NHS giant has now been told by the Care Quality Commission that it ‘requires improvement’. It was previously rated ‘good’. The pandemic has no doubt stretched services, but could its unwieldly size be the source of the problem?”