Agenda item

Mr Stephen Graves, Chief Executive Officer of the North West Anglia NHS Foundation Trust will be in attendance to discuss the latest developments of the Trust.  

With the aid of a report (a copy of which is appended in the Minute Book), Stephen Graves, Chief Executive of North West Anglia NHS Foundation Trust (NWANFT), and Caroline Walker, Finance Director & Deputy Chief Executive of NWANFT, provided an update on the merger of Hinchingbrooke Health Care NHS Trust and Peterborough and Stamford Hospitals NHS Foundation Trust.

Following formal approval, the merger took place and NWANFT was formed on 1st April 2017 with Hinchingbrooke staff transferred to the new organisation on that date. Corporate service structures had been consulted on prior to the merger so those staffing structures were in place on 1st April 2017. Consultation on clinical service structures have followed, with new clinical divisions coming into operation on 3rd July 2017 and appointments made to Divisional Director, Divisional General Manager and Divisional Head of Nursing posts for each division. Consultations on the structures to support these key appointments are underway, with more posts available than staff members as a result of vacant positions being held open. Clinical integration includes a single cross-site clinical leadership structure. Recruitment of doctors has been successful with nearly 80 doctors, including 26 consultants, joining with agency costs reducing and sustainability increasing as a result.

Other developments through the merger include delivery of new ICT systems, although this will take time with a two year timescale for completing the change programme. A review of Hinchingbrooke hospital’s finances by NHS Improvement has highlighted the core underlying challenges there, clarifying the situation. As part of this, the proposed sale of land at Hinchingbrooke was reviewed and this found that parts of the plan would not deliver value for money. Assessments such as the demand for key worker residences and alternative costs of refurbishment or replacing buildings had not been completed. The planned Strategic Estates Partnership at Hinchingbrooke has therefore been paused to allow a whole site estates strategy to be developed.

The Panel welcomed the update as Members had been keen to hear how the merger was progressing and how local residents were being served. The £9m savings planned over three years is dependent on longer term developments such as savings from new ICT systems. £4m savings should be delivered this year and the Trust are still expecting to reach the £9m total in the first 3 years.

Members asked about the impact of the merger on services delivered at each site and were informed that no services had been withdrawn or reduced as a result of the merger and the haematology service had been enhanced. Generally, existing differences in services delivered at each hospital remain. For example, Hinchingbrooke hospital has never been a hyper acute stroke unit and ambulances will continue to take stroke patients to Cambridge and Peterborough where specialist staff are equipped for thrombolysis. However, as part of the Sustainability Transformation Programme, work is underway on options to improve stroke rehabilitation services at Hinchingbrooke so local residents can be transferred there for intensive rehabilitation.

There are plans to introduce a single diagnostic imaging system across all sites and the single clinical haematology service will see one team working across all sites and staff working more closely together. There will still be specialist services provided at individual sites where numbers of patients are low. Members were assured again that patients would not be expected to travel to different sites for existing services although clinical staff may rotate.

In response to a question about the impact of the merger on nursing staff recruitment, it was confirmed that this remains a problem locally and across the NHS with more jobs to fill than registered nurses available although there are agency registered nurses who are used to fill gaps. There is a general need to train more nurses, with the removal of bursaries this year requiring nurses to pay full tuition fees having an impact on numbers. As the budget for bursaries previously constrained numbers who could be trained, it is hoped that this will be a temporary dip and numbers will then increase. Healthcare assistants and other nursing staff are being encouraged to become registered nurses and the Trust is also recruiting from overseas, with some difficulties caused by the high standard of English required. The Trust has recruited to all healthcare assistant roles so no longer requires agency staff for these posts and is approaching the same position with midwives. The Trust has its own internal ‘agency’ bank for nurses who can be approached to cover shifts.

Members were advised that all redundancies have been from non-clinical corporate areas such as HR, finance and estates teams. Recruitment was frozen ahead of consultations to reduce the need for staff redundancies and the same approach is being taken for middle-management posts in clinical divisions. Following appointments the Trust will recruit to remaining vacancies.

The Trust has recently taken on some services not related to the merger, with the pathology laboratory partnership transferred back after the partnership came to an end. This is now paid for and run in-house rather than being charged to hospitals by the partnership. Discussions are also taking place about taking back outpatient and GP blood sample services which are currently undertaken in Cambridge.

Members asked for details of the new patient administration system. The budget for this is £4.8m, with the Trust having tendered for and procured a system. The Trust is now six months into the implementation phase. The system is among several ‘exemplar’ systems in use by many hospitals including Lincoln. Other systems will be attached to this main system and the Trust has invested in infrastructure with a 10GB data line between Peterborough City and Hinchingbrooke hospitals with double-running and mirror sites for backup. The patient administration system will allow some access between hospital and CCG/GP systems with the intention to provide GPs with the same access to test results as currently available. Hospital staff already have access to systems at all sites but currently still need individual log-ins for each of them.

When asked about plans to address parking issues, the Panel was told that the three sites had three different systems with free parking at Stamford and different rates charged at Peterborough and Hinchingbrooke hospitals. There is no green travel plan at Hinchingbrooke and Peterborough’s needs to be enhanced. A review will take place and consultation with staff and public will follow, which is likely to be more than six months away. There is a need to encourage more staff at Hinchingbrooke to park off site and to ensure there is sufficient public car parking available. Plans will need to consider impacts of service changes such as relocating the minor injury unit in Peterborough city centre where over 100 patients travel every day. The Chairman reminded the Trust that the impact of Papworth moving to Cambridge on residents in north Huntingdonshire should not be forgotten.

The Panel had raised concerns about governance when previously considering the merger and were informed that all governor elections were contested with the exception of the Staff Governor position at Stamford hospital. Public and staff governorships are separate with neither of the two doctors appointed as Public Governors representing Huntingdonshire being current NWANFT employees. NWANFT’s Chief Executive agreed to respond to the Panel with information about residents’ access to the governors.

The Panel noted the progress with the formation of the Trust, noted those services identified during the merger as fragile and needing support and agreed to continue to monitor, as appropriate, development at NWANFT and particularly at Hinchingbrooke hospital, directly and through representatives on other bodies.