Minutes:
Mr. Daniel Elkeles, Chief Executive, Epsom and St. Helier University Hospitals Trust, provided an update to the Panel on the Trust’s latest performance, financial position and its estates review.
The Panel was reminded that the Trust had five corporate objectives. Mr. Elkeles was pleased to report that the Trust had a lower infection rate than last year and that staff sickness was also low (3.52% as at end of July against a target of < 3.65%).
In terms of creating a positive patient experience, recommendation rates from the patient Friends and Family Test (FTT) continued to score between 93% and 97% and staff FFT (% of staff who would recommend the Trust’s hospitals as a place of work and as a place to receive treatment) indicated that staff would want to be treated there.
In respect of providing responsive care, the Trust was the second highest performing Trust in London with 96.5% of patients spending less than 4 hours in A&E. The 62 day cancer standard had been challenging and was still not being met. However, the Trust was doing everything it could to treat patients as quickly as possible. The Trust was investing in additional CT and endoscopy capacity, changing pathways to enable investigative procedures to be carried out more quickly and was working with GP partners to ensure plans were in place for increases in demand.
The Trust’s financial position was very challenging with a £7.6m deficit as at the end of July. A financial recovery plan had been developed which focussed on three areas: in particular, continuing to reduce the Trust’s reliance on agency staff in both nursing and medical posts. Mr. Elkeles was pleased to report that, having started the year with 550 clinical vacancies, by the end of July this had been reduced to 90 posts and there were almost 100 new starters due to take up their posts by the end of September. The Trust had filled all its midwifery posts and all current clinical posts were full. This would significantly reduce the pay bill.
The Trust also continued to work in partnership. In particular, Mr. Elkeles highlighted the exemplary work around care of the elderly which ought to make a real difference.
Mr. Elkeles also wished to highlight the annual Volunteers Tea Party which took place last week at Epsom Racecourse and which he had the privilege of presenting long standing service awards. Volunteers provided much valued support to the hospitals, patients and visitors and provided over 78,000 hours of their time per year.
Finally, the Panel was informed that work was also well underway to prepare for the Care Quality Commission Inspection of the hospitals commencing on 10 November 2015.
In regard to the estates review, Mr. Elkeles reiterated the commitment to retaining consultant led, 24/7 A&E, maternity and inpatient paediatric services at both Epsom and St. Helier hospitals over the next five years but that the focus for Epsom would be on the provision of planned care. However, in addition to challenges around staffing, financial viability and clinical variability, the Trust also faced major challenges relating to its estate (as illustrated by a number of photographs displayed at the meeting). The aim of the Trust was to provide an estate which was affordable and well utilised, environmentally friendly, safe and easy to maintain. This would facilitate a healing environment and infection prevention in which high quality care could be delivered and patient privacy and dignity maintained.
The Trust had commenced a consultation process with key stakeholders and the public, including two open days at the hospitals on 17 and 23 September 2015. An engagement booklet had also been produced to seek people’s views which included specific questions around different patient journeys to help inform decisions. Multiple options were likely to emerge and it would be a complex process to choose them. However, what was clear was that the cost of implementation would be over at least £500m based on future capacity needs. Therefore, the Trust needed to answer four questions:
· How much hospital-based healthcare would the Trust need to provide in 2025? (This was already known)
· How would the Trust ensure this care was high quality, delivered to sufficiently high standards, around the clock? (the current conversation with stakeholders and the public would answer this)
· How much space would the Trust need, paying particular regard to bed numbers? (this would be informed by bullet points 1 and 2 above)
· How much would it all cost and how would the Trust pay for it? (The Trust would need to borrow and would have to demonstrate a business case to make investment, particularly to the Government, more attractive. PFI funding was an unlikely option based on the current experiences of other NHS Trusts, but Mr. Elkeles did not rule out different private sector funding models if they were out there).
In response to questions from the floor, the following points were noted:
· Regarding stroke care, outcomes were better if acute care was concentrated in a number of specialist centres. Epsom was the smallest area so it was unlikely that acute beds would be located in here. However, Mr. Elkeles considered that there was a strong case to retain rehabilitation services in the area but stressed this was a decision for the CCG. The Trust would want to play a role in encouraging home recovery and was willing work with community providers in this regard.
· The Trust was exploring all options in securing investment in its estates, including private charitable donations, and was putting together a robust business case. However, if enough funding was not secured, compromises would have to be made.
· In regard to revenue streams, it was not permissible to invest NHS funds into private health care but there was a private market out there and the Trust was open to working with a private sector partner within permitted boundaries;
· All consultants worked weekends. Mr. Elkeles stated that the issue was far more complex than presented in the media: in particular, the fact that there were not enough trained consultants nationwide to deliver a 24/7 service.