Stephen Twist, Governor, County Durham & Darlington NHS Trust

19/11/2025

Online NHS Copilot training this morning with few surprises for those, like me, who are familiar with its functionality - but always useful to refresh on some of the more recent developments. Should we question our anthropomorphism in speaking/referring to a bot? Are we 'over-humanising' this technology by allowing/encouraging it to assume and deploy our individual characteristics in responding to us? LLMs are a fabulous help but background regulation will be critically important at each stage of development.

17/11/2025

In March 2025, 718,577 UK patients aged 65 and over (equal to 9.1% of the population) were identified to be on 10+ medicines. Forecasting forward to 2035, the figure rises to 1,148,279 patients. Nationwide, an estimated £1·1 million could have been saved over the last three years using intelligent prescribing and management.

17/11/2025

'Prostate cancer deaths are a fifth more common in the North East of England than in London, analysis suggests, amid fears of a growing north-south divide on health. In the North East there were 47.8 deaths per 100,000 men in 2021-23, compared with 40.3 deaths per 100,000 in London.'...'According to Prostate Cancer UK research in 2023, one in eight men (12.5 per cent) in London with prostate cancer were diagnosed with stage 4. Figures were similar across the entire south of England but the rate jumped to one in five (20 per cent) in the North East and Yorkshire.' https://www.thetimes.com/uk/healthcare/article/prostate-cancer-death-rates-northeast-england-london-rnw5p2jf6

11/11/2025

Today I joined the Clinical AI Interest Group, Alan Turing Institute, for an excellent presentation by Dr Jeffry Hogg, Assistant Professor at the University of Birmingham and a Clinical Research Fellow at University Hospitals Birmingham who specialises on the implementation of artificial intelligence (AI) in healthcare. We examined https://aireadiness.uk/, a tool in development intended to assess project digital maturity - to help healthcare organisations assess their preparedness for implementing new Artificial Intelligence (AI) technologies. Before implementation, organisations need to be aware of unanticipated secondary effects of AI, local under-performance and underperformance for population subgroups, as well as the prospect of a reduction in performance over time. Its aim is to identify the controls an organisation has in place to manage the associated risks for implementing a new AI technology, and to remedy any gaps.

11/11/2025

Thoughts on the preservation and continuation of an important NHS Foundation Trust

https://stephentwist.wordpress.com/2025/11/10/thoughts-on-the-preservation-and-continuation-of-an-important-nhs-foundation-trust/

08/11/2025

Sir Jim Mackey, Chief executive of NHS England demanded back in March 2025 that regional NHS leaders outline services they would cut to prevent a £7 billion national spending deficit for the 2025/6. He wanted a “fundamental reset of the financial regime” and ordered hospital bosses to “get a grip” on overspending.

Leaders of hospital trusts were told that the initial spending plans they had submitted for 2025-26 were massively over budget and not good enough.

A CDDFT member correspondent, concerned about future cuts to frontline services, has asked me to provide information about NHS salaries: key to future NHS spending - in particular, the cost of executive salaries v frontline clinicians. The information below is generic from published figures, rather than specific to a particular NHS Trust, but will give an indication of salary levels.

CEO in NHS Foundation Trust
Estimated Salary £210,000–£215,000
Pension Contribution £52,500–£55,000
NI Contribution £29,670
Training & Other £3,000
Total Annual Cost £270,000

Medical Director
Estimated Salary £170,000–£175,000
Pension Contribution £40,000
NI Contribution £24,150
Training & Other £3,000
Total Annual Cost £215,000

Other Executive Directors
Estimated Salary £130,000
Pension Contribution £32,000
NI Contribution £17,940
Training & Other £3,000
Total Annual Cost £170,000

Medical Consultant
Estimated Salary £100,870–£111,441
Pension Contribution £15,818
NI Contribution £15,180
Training & Other £2,000
Total Annual Cost £143,000

Minimum waiting times of 12-18 weeks cut costs but, experts say, leave the people who need treatment most hanging on in anxiety and pain

07/11/2025

As readers of this page will know, one particular insight and skill that I bring to County Durham and Darlington NHS Foundation Trust is that of regulation and governance. Hence my recent proposal: 'Enhancing Real-Time Communication and Transparency Between the Trust and the Council of Governors'. Do take a look and message me with your thoughts on the topic.

Background

The Council of Governors (COG) plays a statutory role in holding Non-Executive Directors (NEDs) to account for the performance of the Board. However, current communication practices—such as late document uploads...and overly curated executive summaries—limit governors’ ability to engage meaningfully and fulfil their oversight duties.

Objectives

- To establish a transparent, timely, and interactive communication system.
- To empower public and staff governors with the information needed to hold NEDs to account.
- To foster a culture of openness and shared responsibility across the Trust.

Proposed Actions

1. Real-Time Information Dashboard

Develop a secure, live dashboard accessible to (CDDFT) governors. Include key performance indicators (KPIs), risk registers, incident reports, and Board-level decisions. Integrate with existing systems (e.g., TeamEngine) but allow for real-time updates (currently absent).

2. Pre-Meeting Briefings

Schedule short virtual briefings 7–10 days before each quarterly meeting. Led by Corporate Affairs or relevant NEDs to walk governors through key documents. Allow Q&A to clarify issues before formal meetings.

3. Unfiltered Report Access

Provide access to full, unredacted reports alongside executive summaries. Include annotations or commentary from NEDs and relevant executives to contextualize data.

4. Governor-NED Liaison Scheme

Assign each governor a NED liaison for informal monthly check-ins. (This could be determined on the basis of subcommittee membership). Encourage two-way feedback and early flagging of concerns.

5. Governance Communication Charter

Co-develop a charter outlining expectations for communication, transparency, and accountability. Include timelines for document sharing, escalation protocols, and feedback loops.

6. Digital Collaboration Platform

Pilot a secure, interactive platform (e.g., MS Teams or a bespoke portal prepared by Farouq Din) for ongoing dialogue. Include discussion threads, document sharing, and tagging for urgent issues.

Benefits

- Strengthens the governors’ statutory role.
- Builds trust between the Board and the COG.
- Improves responsiveness to emerging issues.
- Aligns with NHSE’s expectations for effective governance.

07/11/2025

According to the Office for National Statistics (2021 census) here in Darlington we have a slightly older population than both the North East and England overall.

Population: ~107,800
Median Age: 43 years (↑ from 41 in 2011)
Ageing Indicators:
50–64 years: Increased by 11.7%
65–74 years: Increased from 9.2% to 11.1%
75–84 years: Increased from 5.8% to 6.7%
85+ years: Increased from 2.4% to 2.6%

Our local need for services for older residents is higher than in other localities - and increasing. Here is a copy of my paper to the County Durham and Darlington NHS Foundation Trust Interim Chair. What are your thoughts on the topic?

Following a recent discussion with (Ophthalmology) at Bishop Auckland Hospital, this paper highlights several key issues within the ophthalmology service that merit early consideration by the Executive Board. The proposal seeks a proportionate, constructive response focused on capacity, workforce sustainability, and restoration of specialist capability.

1. Capacity and Accommodation

The Ophthalmology Unit at Bishop Auckland Hospital is operating with insufficient space and resources. A practical option may be to reallocate or section off the colposcopy service from its current location, thus extending the ophthalmology footprint to support both present and future demand.

2. Workforce Sustainability

The service faces immediate and medium-term workforce pressures arising from recent departures and impending retirements. To maintain the Trust’s credibility as an ophthalmic provider – and to develop towards a centre of excellence – a structured workforce plan over the next two to three years will be required.

3. Corneal Transplant Capacity

The recent loss of corneal transplant capability is significant for our population, for NHS Blood and Transplant, and for the Trust’s reputation. The issue is increasingly urgent in view of demographic ageing and developments such as retinal implant technology.

4. Proposal

That the Executive Board convene a future meeting at the Bishop Auckland Hospital Ophthalmology Unit, with the first thirty minutes dedicated to informal discussion with staff and senior clinicians. Direct engagement of this kind would provide valuable insight and first-hand understanding of the challenges and opportunities within the service.

06/11/2025

County Durham and Darlington NHS Foundation Trust Board meeting will be held on Wednesday 26 November 2025.
Meetings will usually commence at 9am.

Members of the public are welcome to attend these meetings and observe the CDDFT Board of Directors. Present at the meeting will be the Trust’s Chairman, Chief Executive and the Board of Directors. To register your interest ahead of the meeting email: cdda-tr.Foundation@nhs.net or call: 01325 743625.

Corporate information – Trust Board meetings and papers.

05/11/2025

NHS AI Ambassador Network: a learning forum set up in January 2025 for health and social care professionals and those interested in AI in healthcare to share their ideas and practical applications of AI. Todays event focused on AI in primary care: developments, risk management and regulation: medium-term planning. Outstanding presentations from Dr Tim Caroe, GP and Medical Director Digital Lead NHSE; Dr Tafsir Ahmed, Clinical Research Fellow; and Mark Okun, AI Lead West Yorks ICB. Examining the landscape from procurement to implementation and how to protect patients and practitioners.

04/11/2025

I have decided to put my name forward for another three years as your Darlington Public Governor. This is my biography should you wish to vote for me: 'Darlington-born and QE educated, a practicing barrister, mediator, arbitrator and governance specialist with over 40 years of legal, regulatory and board-level experience. I combine strong financial literacy, NHS governance training and expertise, and a lifelong commitment to local healthcare. Currently serving as Public Governor for County Durham & Darlington NHS Foundation Trust, where I chair the Audit & Governance subcommittee and the Organ and Tissue Donation Committee. I bring independent scrutiny, ethical leadership and a collaborative approach. My background spans financial oversight, clinical governance (including unexplained deaths), workforce wellbeing, and digital transformation. I have a proven record of constructive challenge, strategic innovation, and championing inclusive patient care. My particular interest is in end-of-life care, ensuring that patient and family experience is the best that is possible. If you vote for me, this will be my second (and final) term of three years. To explore what I have been doing over the last three years, demonstrating transparency in real-time, visit my page here: https://www.facebook.com/profile.php?id=100091550093253 To vote, you will need to take 30 seconds to join the Trust as a member - here is the link for that: https://www.cddft.nhs.uk/about-us/corporate-information/foundation-trust

Elected in 2023 for a term of 3 years as a public Governor of our local NHS Foundation Trust to represent the people of Darlington.

28/10/2025

Those who follow my page will be aware that on 31 January 2026 I will reach the end of my term as publicly elected governor for our Trust. It has been a busy and demanding three years as you will see from my postings. In an earlier post I asked whether I should stand again for election? My core followers messaged encouragement. Being a hospital governor is an entirely voluntary (unpaid) role. (For transparency my entire expenses claim for three years was a total of £82.90). If I am to stand again I will need your vote, and for that, you will need to join the Trust as a member. It is free. It takes seconds with the link below. Joining as a member has other benefits, so check it out!

About foundation trust membership.