Issue - meetings

To consider the comments regarding the Full Business Case for the merger of the Trusts running Hinchingbrooke, Peterborough and Stamford Hospitals from the Overview and Scrutiny Panel and confirm the response to the Trusts’ proposal.

i.  That the Chairman of Overview and Scrutiny Panel (Communities and Environment), Executive Councillor for Leisure and Health, Executive Leader and Managing Director meet as a matter of urgency; and

ii.  that the matter be deferred to the Overview and Scrutiny Panel (Communities and Environment) to enable the Panel to convene a Task and Finish Group to undertake a critical analysis of the Full Business Case, to formulate a proposal to the Cabinet as to whether the Council should support the Merger and its suggested response.

Having been invited to address the Cabinet, the Chairman of the Overview and Scrutiny Panel (Communities and Environment) presented a report (a copy of which is appended in the Minute Book) with a summary of the Full Business Case for the merger of Hinchingbrooke Health Care NHS Trust with Peterborough and Stamford Hospitals Foundation Trust.

The comments of the Overview and Scrutiny Panel (Communities and Environment) were circulated to the Cabinet prior to the meeting, the agenda for the Cabinet meeting having been published prior to the Overview and Scrutiny Panel meeting.

The Chairman of the Overview and Scrutiny Panel (Communities and Environment) expressed appreciation to those Members and Officers involved in the matter and explained that the Panel had wished to offer constructive comments.  However, it appeared that the Trusts had formulated their conclusion prior to having commenced the engagement process.

The Panel were concerned that there had been no consideration for a ‘Plan B’, nor of any other options, or of the possible failure of the merger.  When the Panel had challenged the Trust the response had been that the merger would not fail and that if the merger did not proceed the Trust would experience a loss of Consultants.  However, the Panel were aware that a significant proportion of mergers elsewhere had been unsuccessful.

Another significant concern of the Panel had been the ‘democratic deficit’ on the Board of Governors of the merged Trust meaning Hinchingbrooke was currently underrepresented and therefore decisions could favour Peterborough and Stamford hospitals.

The Cabinet were informed by the Executive Councillor for Leisure and Health that what was not apparent from the Full Business Case was the intention of the merger being to put the patient first.  It was noted that the Care Quality Commission inspection area rating had improved and Hinchingbrooke hospital had now been rated ‘Good’.  The size of the accident and emergency department was small which meant that retaining staff was difficult and the proposal looked to address clinical resilience.

In discussing the matter the Cabinet stated that the merger would affect all residents of the District and in order for the merger to succeed, and to have focus, it was not advantageous to have a ‘Plan B’.  The issues that the merger looked to address would not disappear and there was inevitability amongst the Cabinet that the merger would happen.  However, to proceed with a democratic deficit within the governance structure was unacceptable, as the Board of Governors had to be democratically balanced, to enable the public to hold the Trust to account.

There was some concern expressed within the Cabinet that as the merger followed the early withdrawal of Circle, the private company operating Hinchingbrooke Health Care NHS Trust, in the future the Cabinet would be responding to the potential closure of the hospital.  It was further suggested that the merger was unlikely to give Huntingdonshire or its residents any consideration.

It was not apparent from the Overview and Scrutiny Panel recommendation as to the virtue  ...  view the full minutes text for item 49

The Panel is to consider the Full Business Case for the merger of Hinchingbrooke Health Care NHS Trust and Peterborough and Stamford Hospitals NHS Foundation Trust. Lance McCarthy, Chief Executive of the Hinchingbrooke Health Care NHS Trust will be in attendance to address Members followed by a public participation session.

The Panel received a presentation from Lance McCarthy, Chief Executive Officer at Hinchingbrooke Healthcare NHS Trust (HHCT) on the Full Business Case for the merger of HHCT with Peterborough and Stamford Hospitals NHS Foundation Trust (PSHFT). This included details of HHCT’s plan for Clinical Service Provision, presented by Dr Melanie Clements, Medical Director at HHCT.

Members were informed of the background to the Full Business Case and the proposal of merger including: HHCT is neither clinically nor financially sustainable in its current form; PSHFT is clinically and operationally sustainable but not financially sustainable and Cambridgeshire and Peterborough is one of the most financially challenged health systems in the country.

The Panel were reminded that the Outline Business Case that was approved at the Trusts’ Board meetings in May 2016 outlined clear clinical and financial benefits for the Trusts working as one organisation. In regards to HHCT a merged organisation would ensure that clinical services are sustained at the Hinchingbrooke site.

Following a series of public engagement events over the summer the Trusts developed the Full Business Case and approved it at their Board meetings in September 2016. There will now be more public engagement events before the Full Business Case is ratified by the Trusts’ Boards at their meetings in November 2016. After this, the Full Business Case will be forwarded onto the NHS regulator who will make its recommendation to the Secretary of State for final approval in March 2017. The merger would then take place on 1st April 2017.

Dr Melanie Clements, Medical Director at HHCT, presented the Trust’s plan for Clinical Service Provision at Hinchingbrooke hospital. The Panel were informed that the hospital is not clinically sustainable in its current form. As an example of this, Members were told that 20 of the 90 consultant staff at Hinchingbrooke are locums.

A merged Trust would cover a larger population, requiring a larger team of consultant staff. This would make consultant positions more attractive for applicants as a larger team would mean a reduction in the amount of unsociable hours a consultant would have to work. Dr Clements explained that this would reduce the need for locums, cutting costs as employing locums is not the best use of money.

It was explained that not all clinical services are currently provided at Hinchingbrooke. For example, trauma (level 2 and 3) patients are taken to Addenbrookes Hospital. However Dr Clements explained that there is a desire for both Trusts to continue to provide emergency services on the Hinchingbrooke site after the merger.

The Panel were informed that one of the reasons why a merged Trust is preferable to an arrangement of sharing consultants is that with a shared working arrangement the other hospital could pull back doctors to cover their own staff shortages.

Members were informed that the following services have been identified for integration first as they face the greatest sustainability risk: stroke, emergency department, diagnostic imaging, cardiology, respiratory medicine and clinical haematology.

Dr Clements explained the wider benefits of  ...  view the full minutes text for item 41