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ITEM CA7
CABINET
– 18 JULY 2006
OXFORD RADCLIFFE
HOSPITALS: PERFORMANCE IMPROVEMENT AND COST REDUCTION PROGRAMME
Report by
the Director for Social & Community Services
Introduction
- The Oxford Radcliffe
Hospitals NHS Trust (ORH) has issued a consultation on service changes
it wishes to introduce at the Horton General Hospital in Banbury and
the Trust’s hospitals in Oxford. Considerable concern has been expressed
by local people and organisations about the proposals, which have significant
implications for a range of services across the County. They also have
significant service and financial implications for the County Council.
This paper summarises the main proposals and their implications for
the County Council and in particular the services provided by the Social
& Community Services directorate (SCS).
- The ORH’s plans
and proposals are issued in a two-part paper "Performance Improvement
and Cost Reduction Programme": a copy is in the Members’ Resource Centre.
Part 1, "Efficiency and Performance", covers the performance improvement
and cost reduction measures that it is introducing. It makes clear that
actions which are considered not to impact on patient care are well
under way. Part 2 is a specific set of options for service changes at
the Horton Hospital, Banbury, and these are subject to full public consultation.
The consultation period started on 6 June and closes on 4 September.
The Part 1 measures are not seen by ORH as requiring consultation although
comments on the measures described are invited.
Background
- The measures and
proposed service changes are put forward in the context of well-publicised
and significant financial pressures, which have been very evident for
some years. The consultation document (Part 2) also discusses changes
in training and other workforce issues, including staffing level requirements,
and these are outlined later.
- Oxfordshire receives
only 85% of the national average funding for NHS services. This reflects
the relative health of the County but at the same time services have
to be provided in an area of relatively high cost of living which would
not appear to be properly reflected in the funding formula. This applies
as much to social care and other services provided through the County
Council as to the NHS. As well as facing the same cost of living pressures
as the NHS the County Council has received only a 2% increase in government
funding for its social services while the NHS has received 9% over the
past 3 years.
ORH Proposals
for Service Developments and Measures to Increase Efficiency and Performance.
- The two key approaches
that the ORH is using focus on :
- Improving efficiency
and productivity; and
- Improving performance.
- The efficiency
improvements focus on:
- Reduced use
of agency staff;
- Savings in administrative,
secretarial and clerical services;
- Strict vacancy
management;
- Procurement
from the ORH’s major suppliers of goods and services.
- Over 60% of expenditure
in the ORH is on staff and the total workforce is nearly 10,000. The
plan is to reduce the number of posts by 600 and the reductions are
summarised in the table below. A number of these posts will be vacant
as a result of the management of vacancies.
|
Posts
|
Estimated
reduction
|
|
Managers,
administrative, clerical and estates staff
|
250
|
|
Nursing staff
|
225
|
|
Allied health
professions and radiographers
|
50
|
|
Medical staff
|
30
|
|
Scientists
|
30
|
|
All other
staff
|
15
|
- Performance improvements
build on work that has been under way for some time and which includes
making more use of day surgery, developing new community services and
reducing the length of stay for patients. The specific programmes for
improving efficiency include:
- Eliminating
unnecessary delays in tests, x-rays and other examinations;
- Using operating
theatres and diagnostic services in better ways;
- Extending the
use of day surgery and improving outpatient services;
- Reviewing the
use of administrative and clerical services.
- The plans include
improvements to geratology services, including the introduction of rapid
assessment and diagnostic services.
- As part of the
cost savings the ORH is planning to close 130 beds during this financial
year; 75 of these have already been closed. In addition 31 beds at the
Radcliffe Infirmary (RI) are planned to be closed by September this
year.
Impact
on Social & Community Services
- The impact of
these reductions on the SCS are considerable and they are clearly reflected
in the activity and financial performance information. This has been
extensively discussed with the Cabinet Member with responsibility for
Adult Social Care and other members of the Cabinet. In summary, the
impact is as follows.
Financial
- The pooled budget
for older people and physical disability, which is the budget to which
the County Council and the PCT contribute for the purchase of care home
beds, will over-spend at the end of May 2006 by £317,000.
- In addition the
SCS budget will over-spend at the end of May 2006 by 266,000. This budget
includes the home support services.
- The PCT(s) have
made available additional funds for the 31 additional placements resulting
from the close of RI beds for this year but there is no final agreement
for funding for these placements next year. The average length of stay
in a nursing home is at present 1.5 years; it is 3 years in a residential
home.
- The 100% NHS funded
continuing care beds paid for through the pooled budget are have
not had their funding increased sufficiently to deal with inflation,
putting more pressure on the pooled budget.
Activity
- The ORH is reducing
the average length of stay for patients, which increases pressure on
SCS from delayed transfers of care. To keep within the available resources
3 additional placements a month were planned; places that were planned
for allocation in August are being used in June.
- An additional
16 clients are receiving home support than planned for.
- Following the
closure of the RI beds and the reduction of the delayed transfers of
care, clients will be coming through to social care services at a faster
rate than would have been the case previously.
- These pressures
are all evident very early on in this financial year, and they will
continue and have a cumulative impact. The continued closure of beds
and the increased throughput inevitably means that there will be continued
and increasing pressure on SCS resources.
ORH Proposals
for the Horton Hospital, Banbury
- The proposals
for changes to the Horton Hospital, Banbury, are developed from the
strategic review of services for Banbury and the surrounding areas.
As a small acute hospital the Horton is facing a number of pressures
which, in the view of the ORH, means that some of the Horton’s services,
particularly services for women and children, and emergency and trauma
services are not clinically sustainable in their current configuration.
- The rationale
for many of the proposals for the Horton Hospital is based on the training
requirements of doctors and other professions in a range of specialities.
They also refer to the qualification requirements and staffing levels
required to operate out of hours and emergency services for paediatrics,
gynaecology and obstetrics which, in the view of the ORH, are unaffordable
and are judged not to be sustainable in the medium term.
- The proposed changes
are summarised at Annex 1.
The total recurring revenue savings anticipated are between £1.1million
and £1.4million, depending on the options presented. Investment of £230,000
is identified and a number of projects for further investment are still
being evaluated. The proposals also avoid future costs of between £2million
and £2.3million, which in the main are also recurring revenue.
- The proposals
for the Horton are very controversial for people in Banbury and its
surrounding areas. The fundamental concern is that the changes will
profoundly undermine the role of the Horton Hospital in the provision
and the accessibility of health care services for people in the north
of Oxfordshire and surrounding areas.
Conclusion
- Some of the service
changes and proposals are positive and contribute to the overall development
of hospital services that are responsive and accessible and which support
a range of community and local services for the support and treatment
of older people. These include: rapid access to diagnostics and assessment
services; greater opportunity to avoid admission to hospital and nursing,
residential and other high cost social care; support for integrated
services with primary care; and better support for people living in
their own homes.
- However, these
proposals and service changes must be seen in the context of all the
services that are necessary for the delivery of effective, safe, and
efficient services for supporting older people in the community. Many
of these services are provided through SCS and the consequences of the
service cuts on the directorate are clear. Primary care and the community
nursing and other services provided by the PCT(s) are also necessary
for the service changes and proposals to be delivered effectively and
safely. The services changes that are being introduced and the proposed
changes may be effective in dealing with the financial crisis in the
ORH, but they appear to have been prepared and published without any
consideration of the impact on other agencies’ ability to respond.
- In addition, Oxfordshire’s
PCTs are also undergoing major changes with the amalgamation of five
into one, and they too have to achieve major service cuts to achieve
the £17.95million that has been identified for this year. This will
limit their ability to respond effectively to the changes being introduced
by the ORH and, as with the ORH, it seems that there will only be limited
consultation on the changes that these cuts will result in. They will
however also impact SCS and will result in further pressures.
- The financial
pressures have been evident for a number of years and there has been
ample opportunity for the changes currently being implemented or proposed
to be discussed and planned with SCS and other key partners. The timing
of the changes and the proposals is unfortunate and changes of this
magnitude would have been better discussed and formally proposed when
the financial pressures were not so severe.
RECOMMENDATIONS
- The Cabinet
is RECOMMENDED, whilst acknowledging the necessity for financial stability
and balance to be achieved in the health sector, to:
- call
on the Strategic Health Authority to halt the cuts that Oxfordshire’s
PCT(s) will be required to make until a full review can take
place;
- seek
a full consultation on any proposed changes in the provision
of or arrangements for the provision of NHS services in the
community;
- register
with the Oxford Radcliffe Hospitals NHS Trust in the
strongest possible terms the County Council’s concerns about
the consequences of their service changes on the Council.
CHARLES
WADDICOR
Director for
Social & Community Services
Contact
Officer: Nick Welch, Head of Planning and Partnerships, Tel (01865)
815714
Background papers: "Performance Improvement and Cost Reduction Programme"
Parts 1 & 2; Oxford Radcliffe Hospitals NHS Trust June 2006.
July
2006
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