From special measures to good approach


A large NHS Trust hospital was in special measures due to sustained systemic failures and organisational cultural difficulties, plans were afoot for it to be subsumed within a different NHS Trust. It comprised 3400 staff and 700 beds.

The estates department was fragmented, disharmony reigned across teams, systems and processes were either missing or out of date. The situation was dysfunctional.

Capital planning was chaotic, with schemes being carried out in an ad hoc manner

The CQC referred to ‘learned helplessness’ within the team. Firstly, this had to be understood, why had it happened and were the existing team able to turn around a failing Trust.

ESG Managing Director Mark Johnston-Wood was approached to work on an interim basis to assist with the transformation.


ESG undertook a forensic analysis of underlying issues, both with the portfolio and its fitness for purpose. We also conducted a root and branch assessment of what was required in terms of delivering change and a gap analysis of the teams’ competencies.

An improvement plan was created defining and setting out each problem, how it was proposed to be resolved, the resources required, the responsible person and the timescales by which this action would be completed. Specifically, space utilisation, compliance, backlog maintenance and car parking were major issues. A plan for these four key areas was devised. This also had an added benefit once resolved of reducing the carbon footprint and improving energy management. We also implemented a compliance check list.

  • An assessment of utilised space and backlog maintenance was carried out, these resulted in a loan from Department of Health to bring buildings into a good environment. It also highlighted a number of buildings that could be disposed of without effecting the service level of the Trust.
  • Car parking was highlighted as a serious problem, Mark gave interviews to the BBC and was asked about what is happening by the then Home Secretary Theresa May. A successfully completed project resulted in at least 300 extra spaces for both visitors and staff with extra spaces being made available as needs arose.
  • A new capital programme was developed with a five year plan implemented, which included a strategy for the estate.


The outcome was a merged Trust, a positive staff group, an agreed investment plan for both back log maintenance and considerable new building. Plus the affirmation from the Care Quality Commission with a Good rating.

Patients were protected from the risks associated with the unsafe use of equipment because staff maintained a reliable and documented programme of checks, including portable appliance testing (PAT).

Patients found the parking better and this reduced concerns over delays.

“I was incredibly proud to work as part of the turnaround team. It started with a Special Measures rating. The CQC returned once the works were completed, and gave the new Trust a Good rating overall. The staff generally felt it was a much better place to work. For the executives, the monthly dash board report and regular briefing meetings we implemented meant there was greater clarity on all issues relating to the estate.”

– ESG Director, Mark Johnston-Wood