Report of the Chief Executive of the University Hospital North Midlands.
The Chief Executive of the University Hospital North Midlands (UHNM) Tracy Bullock; Helen Ashley, Deputy Chief Executive and Director of Strategy and Performance; and Jonathan Tringham, Acting Chief Finance Officer attended the meeting.
It was reported that staffing levels and retention of nursing staff was currently 90% which was particularly good for a Hospital Trust. There were work areas where consultants were difficult to recruit, such as care for the elderly, respiratory and A&E, but this was similar throughout the Country. Effort had been made to develop new roles such as advanced nurse practitioners and increasing the number of apprentices, but this did take time to train people to the required levels. The use of agency staff was low as the hospital had a bank of hospital staff who it called on as a first option. A Member asked why Administration and Clerical staff had a relatively high turnover. In response, it was felt that this could be due to promotion or people leaving the area. The Trust had also recently gone through a “Management of Change” exercise which may have created anxiety for some staff.
The Committee asked if hybrid appointments (more than one partner involved) were being considered both at medical and nursing levels. The understanding of both cultures was important. In response, the Trust informed Members that they had explored this and had varying success. Conversations were taking place with the Midlands Partnership Foundation Trust about the rotation of Health Care Assistants and joint Consultant appointments were already in place between UHNM and Mid Cheshire and UHNM and Shrewsbury and Telford.
UHNM was asked if The County Hospital A&E was due to close. In response the Committee was informed that there were workforce challenges but there were no plans to close it. However, the service needed to be safe and sustainable which may mean that the service models needed to change. There were currently concerns over the usage of the Birthing Unit and the Trust was due to launch a campaign to increase the usage. Currently there were only 1 to 3 babies born there per month on average, when there should be 350 per year to remain viable. A Member asked if the number of people who could have used The County but hadn’t was available. It was agreed that his information would be forwarded.
With regard to Paediatric provision, the only area discussed recently had been the minor injuries unit. There were continued instances when young children were taken to the Hospital for minor illnesses (not injuries) and had to be referred to a Primary care provider. This model hadn’t changed for some time and there were no proposals to change services in the near future.
In relation to the treatment of cancer, the data in the report was considered and discussed. It was reported that the Hospital were looking at pathways so that only those who needed to see a consultant did so, and those people who needed less specialist advise would see less senior members of staff. This may be one area where improvements could be made. Another area was that of Community Services. In one GP practice, there was a pilot running on lung cancer. If this proved to be successful it may be rolled out. As this was such a small cohort there had been little effect on demand at the Hospital.
A Member asked if the delays in Endoscopy was due to staffing or a facilities demand problem. The Committee was informed that there were two pieces of work taking place in that area:
1. A national programme which would see less serious cases attended to by advanced nurse practitioner; and,
2. A discussion with consultants on whether there is any spare capacity or if things could be done differently to increase time.
The Chief Executive reiterated that in terms of detection rates, in her opinion capacity was not the issue, the problem was more to do with late presentation of symptoms.
A Member stated that it would have been really useful to have the range of times taken so that Members knew that if the 62-day target was missed that patients weren’t waiting 150 dates for example. A further Member asked for national statistics and for a full 12 months period so that trends could be formed.
In terms of specialisms, a question was asked on whether such cases should be referred to other hospitals which may specialise; and, the impact of any delay can have on the patient.
The Committee was informed that some cancers are very difficult to diagnose, and so can take longer than the target period which explains why the target is not 100%. It was noted that delays can also be down to patient choice. Members were reminded that on every occasion where the 62-day target was breached, a Harm Review was carried out.
A Member asked if some patients were still sent to other areas such as Brampton in London. The Officers present were not able to answer the question but would ensure that the information was sent to the Chairman for consideration. A memorandum of understanding had been entered into with Christies Hospital in Manchester. This was to support workforce issues, to improve research and to enable experience to be shared.
In relation to mortality rates, the Committee was informed that the SHMI was within the expected band and was partly due to an increase in Palliative care coding. This was due to more patients being diagnosed with non cancer related illness. A member asked for the number of delayed discharges on death figures.
With regard to the financial position of the Trust, UHNM plan to breakeven at the end of the 2019/20 financial year. This is an improvement on the 2018/19 deficit of £63m. It was explained that the Trusts Control Total (CT) is to achieve a deficit of £32 million by March 2020 and if achieved the Trust would receive £32 million through the national Provider Sustainability Fund and national Financial Recovery Fund (FRF) which would deliver the breakeven position. The Committee were informed that the central grant funding was available each year whilst the FRF was new this year and only for Trusts in Financial Special Measures or with significant deficits. However, it was noted that each year the CT would be made more challenging to push the Trust to deliver more efficiencies.
Mr Tringham advised that to achieve the £32 million deficit that a cost efficiency programme of £40 million was required. In response to a question on how this would be achieved, Mr Tringham offered the following:
All clinical service areas were being reviewed to ensure that services are sustainable (financial and workforce), high quality, efficient, productive and maximising market share opportunities etc.
The selling of land at County Hospital was raised. The Committee were informed that in response to national directives surplus land at all sites were being looked at with a wide range of options available not just sale and discussions were already well underway with partners and other key stakeholders. Members encouraged the Trust to talk to partners prior to any decision being made and to consider using for medical or social care use. Mrs Bullock advised that such discussions were already underway.
In relation to future service changes, a Member asked if the Trust had considered meal preparation from The County site instead of it being contracted out. In response, this had been considered but was not economical for one site and not practical to deliver for both sites as the facilities were not large enough to produce enough food for the number of patients on both sites. Catering was also part of the PFI contract for Royal Stoke Hospital which would prohibit catering provision by others.
The Chief Executive informed the Committee that there weren’t any plans to change services at the moment, however, all service areas would be reviewed with an aim of providing efficient, responsive, safe, sustainable and high quality services and this may result in changes being needed in the future. Where appropriate, consultation would be undertaken, and key stakeholders will be given the opportunity in due course to comment on any potential changes. UHNM would refresh its clinical strategy, the outcomes of which would enable delivery of the 2020/25 vision.
Dementia training was being given to all staff on both sites.
In previous years, Royal Wolverhampton Hospital provided a range of services which they now were not able to provide due to demand. One example was Glaucoma services which may have to return to The County. There may also be a range of other services that could move back once the staff and facilities were in place.
The Committee asked for a list of services which are currently provided at the County Hospital. The Committee was informed that work was taking place with partners, particularly GP’s so that services at The County were offered to patients as part of the normal choice list (e.g. for x-rays).
The Committee had raised concerns with UHNM that in a recent Care Quality Commission (CQC) report it had been documented that the hospitals priorities were not aligned with those of the Sustainability and Transformation Partnership (STP) and they asked for assurances that this was not the case. The Committee was informed that as the Service reviews took place, all partners would be engaged and currently nothing was running contrary to STP priorities.
Mrs Bullock asked for examples to be sent to her of where this was the case. Mrs Bullock advised that the only change that had taken place had been the development of the strategy for County Hospital. This had previously been led by the STP and Chaired by a Council Leader and she felt that little progress had been made over the last 18 months. Mrs Bullock advised that the most appropriate facilitation of the development of the strategy for County Hospital was with UHNM, whilst noting she had advised all stakeholders that this would be done with their inclusion which would include the STP as they had a role to play in overseeing strategic developments across a wider area.
The Committee felt that there needs to be a unified approach with all partners so that there was one direction of travel for the system and that at the moment the best co-ordinator of that seemed to be the STP.
That the information provided by UHNM be noted and the following be requested in writing:
a) The number of people who could have used The County’s Birthing Unit but chose to use an alternative provision.
b) In relation to cancer targets, the range of time for those patients who miss the 62-day target before they are treated; this to include specialisms and whether these cases were referred to other hospitals which specialised in this area; and, the impact of any delay had had on the patient.
c) National Cancer statistics for a full 12 months period.
d) Details of patients sent to other geographical areas for specialist cancer services such as Brampton in London.
e) Delayed discharges on death figures.
f) A list of services which are currently provided at The County Hospital.