11.15 am
As part of a series of items of business aimed at bringing members of the Committee up to date on the position of local NHS Trusts, Sir Jonathan Michael, Chief Executive of the Oxford Radcliffe Hospitals NHS Trust will give an update on both the current situation and how he sees the future for the Trust.
Minutes:
As part of a series of items of business aimed at bringing members of the Committee up to date on the position of local NHS Trusts, Sir Jonathan Michael, Chief Executive of the Oxford Radcliffe Hospitals NHS Trust, had been invited along to the meeting to give an update on both the current situation and on the future for the Trust.
Sir Jonathan was welcomed to the meeting. He referred to a number of issues currently affecting the Trust:
- The Trust was working to a £47m reduction in the cost base;
- At the same time they were working hard to improve performance against standards of care, leading to improving targets;
- A new integrated management structure for clinical services had been introduced. Clinicians had responsibility for running the services and accordingly were accountable for them;
- There were six clinical divisions, each with significant health care business, each with a turnover of £100m and each with approximately 1,000 staff;
- The Trust’s financial performance was doing reasonably well, though there were delays in discharging patients from acute care. This situation was not unique to the ORH. An agreement had been reached with the PCT/CHO and SCS to allow the Hospital to discharge some of the patients waiting for healthcare packages and community placements. He expressed his support for the agreement as this would have an impact and would cause an abatement of pressures on the services. The current pressures on discharge had slowed down financial progress due to the inability to reduce the capacity within the hospital system in line with expectations of the PCT;
- With regard to Agenda Item 8 – Creating a Healthy Oxfordshire - the Trust was working with the PCT, CHO and the local GPs on a pilot in Abingdon to support patients who might otherwise have been admitted to a hospital bed and to support patients coming out of hospital. It was still ‘early days’ to measure outcomes;
- The Horton Hospital – the Trust had now developed a vision for the way services should be run at the Horton Hospital site. The Board was keen to expand services, particularly for services for outpatients in order to reduce the frequency of journeys to Oxford;
- The integration of the NOC and the Trust. Discussions were ongoing, and progressing well, the business case was to be considered by both Boards on 2 December 2010. Following this, if approved, there would be a public consultation, following which, if given final approval, the proposals would then be submitted to the SHA and to the DoH in turn. If all were in agreement the integration would take place in mid 2011 and, following that, in 2012/13 the newly integrated Trust would apply for Foundation Trust status ;
- Paediatric heart surgery – following a number of unfortunate deaths at the beginning of 2010, an independent inquiry had identified weaknesses in the way in which the Trust organised its risks in the governance of services. There were, however, no specific risks found in the management of patients;
- Cardiac Surgery – Oxfordshire, the smallest of the eleven centres across the County, did not feature within any of the service options. The Trust was having to consider the implications of this for paediatric cardiac services and the potential knock-on implications on other paediatric services. The Trust was currently in discussion with other health trusts with a view to providing joint services and hence a viable service centre for the South Central region which was acceptable to the DoH’s Safer & Sustainable Review Panel.
Members of the Committee asked a number of questions, some of which are set out below, together with the responses received:
Q Will the current work being undertaken on intermediate care affect this year’s winter pressures?
R We are equally as concerned and hope that by the time they arrive we will have resolved the current problems. There is a need to ensure that the delayed discharge levels are reduced down to the norm and that additional capital is provided to deal with fluctuations in demand. Despite the pressure we will be able to cope.
Q Does the JR have the full complement of anaesthetists?
R This was an issue a year ago, but recently there has been a much clearer separation so that surgical anaesthetists are working to a planned list and not taken out to do elective care.
Q Are there risk management outcomes worked out across all medical areas?
R The work on risk management has been generally welcomed with the view that it will be useful when working on the Government’s move for health organisations to measure outcomes rather than processes. So, for example, consents and policies would be scrutinised during an assessment. In some areas measuring outcomes against risk might prove quite complicated, in others, such as Cardiac surgery it will be easier.
Q Visits to the JR undertaken by members of a scrutiny task group looking into the Single Front Door interface between the NHS and Social Care identified instances when Social Care were only informed of a patient’s discharge at the last minute and thus the care package was not in place. Also social care staff were not allowed to see NHS IT system for reasons of confidentiality.
R This area has been improved significantly.
Q The plans to provide more rounded services to the Horton Hospital are to be welcomed. What are your thoughts on the adverse comments in the media recently about a lack of quality of care for older people in some hospitals?
R One of the core responsibilities of the Healthcare system is to provide care for the most vulnerable people in our society. However, it needs to be recognised that being ill or injured can be risky and treatment is not without risk. He added that he had a strong personal commitment towards older peoples services, provided all partners are involved.
Q The Abingdon pilot scheme is welcomed. Is your nursing ratio healthy and are you seeing a substantial reduction in the use of agency staff?
R This is a joint pilot and is being run by the PCT, and others are contributing. It is early days, at the moment there has been no indication if it has been beneficial or not. There are approximately 8k staff working across the Trust, 65% of which are cost based. It will be necessary to rationalise the work force and the use of agency staff so as to improve efficiency. It is hoped that this could be done by managing vacancies and by redeployment. The NOC has got a workforce of £1k and the merger will be a good opportunity to look at how services will be provided. Efficiencies will more likely to be realised in corporate/backroom functions, not in front line services.
Q What is your view to GPs taking a reduction in their workload in order to take on a commissioning role?
R Community GPs have an important role in deciding the health needs in Oxfordshire. We will work very closely with whomever the consortia identifies. A number of GPs are keen to take on a wider managerial role whilst maintaining a clinical activity, others want to concentrate solely on their personal clinical practice.
Q Why don’t you make car parks in hospitals free?
R There is always a tension between access to hospitals and income generation. Many hospitals have discouraged staff and patients not to use their cars but to use public transport. We have to provide car parking, but cannot provide it free of charge without finding a further source of revenue to replace it.
Q The amalgamation with the NOC will create a larger institution which will be massive in area. Will you be consulting with local people on the impact of this on the north eastern area of Oxford in relation to car parking, transport etc?
R We must be mindful of our role as a healthcare provider to be a responsible member of the local community and to recognise the issues which have an impact.
Members of the Committee thanked Sir Jonathan Michael for his attendance, for participating in the questions and answer session and for his very helpful update.