Agenda item

 

• Kerry Rogers, Executive Director, will be in attendance to discuss announced job cuts;
• Quality Accounts (report attached).

Rotherham Foundation Trust

 

Matthew Lowry, Acting Chief Executive, Rotherham Foundation Trust, attended the meeting to discuss the recent press headlines with regard to potential job losses at Rotherham District General Hospital.

 

The scale of the financial challenge faced by the Foundation Trust was driven by 2 factors; an assumption made nationally that the contracts the Trust was commissioned for would make an efficiency saving each year of 5% and secondly (2) an agreed Strategy with commissioners, particularly with the NHSR and the emerging CCG, that it needed to shift the balance away from the hospital.  A combination of the 2 was creating a sizeable financial challenge for the Trust.

 

The hospital had to save £50M over 4 years and were nearing the end of the second year; to date, £20M of savings had been made.  Currently plans were being drawn up and as yet no formal announcement had been made with regard to redundancies.  The Trust was working very closely with the staff side and Trades Union and expected to start the formal consultation process with staff on 14^th December, 2012 as to how to try and make savings within the organisation for 2013/14. 

 

There were a number of areas where the Trust did less work and, therefore, needed to reduce its capacity to reflect that situation as well as commissioners commissioning less work.  It was also important to recognise that where savings were sought, it was based upon very detailed and focussed work within the organisation and balanced between the need to make savings whilst maintaining the quality of service.  Discussions with commissioners were imperative for their help and support to manage transition from the historical model health care and the model service moving forward.

 

Discussion ensued with the following issues raised:-

 

-        The efficiency savings of 5% was a national position and would be a challenge.  In terms of the further savings, some were unique to Rotherham.  Rotherham was at the upper end of the reliance on bed care and the town’s historical model of care was admission to hospital.  There was now an opportunity to make the transition with the help of the commissioners

 

-        It was hoped that the vast majority of the £3-4M services leaving the hospital would transfer into funding for services in the community – negotiations were currently underway.  As a minimum it would be expected to be £1-2M.  The Trust was pressing very hard to invest as much in the community as possible which would enable the pace of change.  There was a need to move services away from the hospital to the most appropriate setting

 

-        It would be a decision for the local Clinical Commissioning Group

 

-        Services potentially moving from the hospital included a number of out patient services and tests that could be conducted in GP surgeries or by Community Nursing staff in the patient’s own home

 

-        There were a number of long term conditions where patients repeatedly went to hospital.  This was an opportunity for work to take place with the patient in their own homes/GP practice and provide the same level of care but would be more convenient for them

 

-        There were a number of discreet services where consideration would be given to outsourcing i.e. non-clinical back office services.  The best use of resources available to the Trust had to be found

 

-        3 issues had to be balanced – control, quality and value for money – all really important and each had to be taken into consideration for every individual service

 

-        There was no intention to outsource cleaning and the laundry service

 

-        Close work was taking place with the Trust’s main commissioners i.e. NHS Rotherham and the Clinical Commissioning Group to identify what services the hospital provided and what it could safely cease.  A good example was the 25,000 follow up outpatient appointments that could be done differently or not at all.

 

-        Work with hospital clinicians to identify things that could be safely done in a Primary Care setting

 

-        The level of reliance upon urgent care in Rotherham was high compared to other areas of the country

 

-        The vast majority of the costs for Electronic Patient Records had been 1 off Capital.  There were some licence costs for the software but that had also applied for the range of different softwares previously operated.  It was recognised that there had been issues with the new system which had been made a priority for resolution

 

-        A proportion of the savings would come from Management and Administration (10%) but it should also be noted that it was also expected to make savings across the entire organisation including medics and nursing staff.  Where savings to front line services were made, it would be as a result almost entirely of the Trust doing less work e.g. follow up outpatient care

 

-        The Trust had engaged external expertise to help with the 2013/14 plan

 

-        The future of the Walk in Centre was a matter for the Clinical Commissioning Group

 

The Chairman thanked  Matthew for attending the meeting.

 

Resolved:-  (1)  That the Acting Chief Executive attend a future meeting of the Select Commission once it had been agreed which services would be transferring into the community.

 

(2)  That a letter be sent to the Clinical Commissioning Group enquiring what funding would be transferred from the Hospital into the community.

 

Quality Accounts

 

Dr. Patricia Bain reported that previously annual progress reports had been given to the Select Commission and its predecessor prior to decision making as to which quality improvement programmes the Trust should include in the following year’s Programme.  It had been decided that progress should now be reported bi-annually and in time to fully consider the Programmes of work, their current status and what Programmes the Commission would consider for inclusion in the 2013/14 Quality Accounts.

 

Good progress had been made in meetings the targets for 2012/13 and the Trust was confident that they would all be achieved by March, 2013.  She particularly highlighted:-

 

Quality at a Glance Measures

-        Q1 reflected 1 MRSA bacteraemia – agreed to be community acquired

-        Rate of patient safety incidents per 1,000 admissions had increased although the % where serious harm was caused had decreased

-        Nutrition assessment performance dropped below baseline whilst completion/calculation of fluid balance charts had increased

-        SHMI (CHKS Live – in hospital deaths only) had increased slightly

-        Overall IR1 - reporting was down although still likely to exceed the target of increased reporting year on year if volumes continued at the present rate

 

Improvement Programmes

-        Medications Management had improved on 2^nd audit with only 2 areas not reflecting improvement

-        Safety Thermometer data submissions reflected on the Trust intranet

-        Liverpool Care Pathway metrics reflected an improvement

-        Dementia CQUIN due to commence data capture in Q3

 

CQUINS and Mandated National Quality Board Indicators

-        Safety Thermometer monthly data submissions had been successful so far

-        Slight improvement for inpatient CQUIN and Community Universal Services template

-        Performance against the relevant domains of Indicators, selected by the National Quality Board, was generally on par or exceeding National Peer performance

-        Hip surgery Patient Reported Outcomes Measures slightly below national average

-        C.Difficile rates – strong performance

-        Reporting of patient incidents per 100 admissions had increased but below the national average

 

Internal and National Benchmarking – Safety Thermometer

-        Falls performance internally good with only Urology falling below 95% no harm target

-        Community North Team the only team not to achieve the 95% target in relation to pressure ulcers

-        Several locations within Acute and Community had not achieved targets in relation to Urinary Tract Infections

-        Falls resulting in harm also performed strongly against national and SHA cluster peers

 

-        Overall Harm Free Care – slightly behind national and SHA cluster peers

 

Discussion ensued on the report with the following issues raised:-

 

-        Better position than last year – important to maintain the improvements during the period of change

 

-        The number of pharmacy staff had been increased on the Ward

 

-        Care Pathways – a common complaint was when someone did not fit into a certain Pathway and could be waiting some time for a diagnosis

 

-        The Trust was moving to provide a diagnostic 7 days service rather than the current 5 days.  It would not only apply to tests but also have experienced decision makers being on the Wards for longer periods Monday-Friday and consultants available at weekends as well

 

-        Staff training

 

Dr. Bain requested that the Select Commission consider where it would wish to see the focus next year.

 

Resolved:-  (2)  That the Select Commission consider where it would wish to see the Trust focus it works in 2013/14.