Meeting documents

Adult, Community Services and Health Overview and Scrutiny Panel
Thursday 9 July 2009

ADULT, COMMUNITY SERVICES & HEALTH OVERVIEW & SCRUTINY PANEL

9 JULY 2009


PRESENT: Councillors Meadowcroft (Chairman), Mrs Endacott (Vice Chairman), Baskerville, Mrs Evans, Lenton, Mrs Luxton (substituting for Councillor Majeed) and Mrs Yong

Non Members: Councillors Dudley, Hilton, McBride, Penfold and Story

Also Present: Mrs Lise Llewellyn (Chief Executive - Berkshire East PCT); Mrs Janet Meek (Associate Director of Finance - South Central Strategic Health Authority); Mr Andrew Grimshaw (Director of Finance), Mrs Helen Blanchard (Director of Strategy and Resources) and Mrs Proctor (Acting Chief Operation Officer) - (Heatherwood and Wexham Park Hospitals NHS Foundation Trust) and Mrs S Holmes (Windsor, Ascot and Maidenhead LINk)

Officers: Mr A Scott and Mr Richardson
PART I

27/09 APOLOGIES FOR ABSENCE

Apologies for absence were received from Councillors Majeed, Mrs Napier and Mrs Proctor.

28/09 DECLARATIONS OF INTEREST

None

29/09 HEATHERWOOD HOSPITAL WARD CLOSURES AND THE TRUST’S FINANCIAL SITUATION

The Chairman of the Panel, Councillor Meadowcroft, welcomed everyone and explained the purpose of the meeting. He advised that the meeting had been called to seek an understanding of Heatherwood and Wexham Park Hospitals NHS Foundation Trust’s current financial position; to receive details of the Trust’s financial recovery plan; to understand how the recovery plan would impact on patients and front line services; and to consider the long term future of Heatherwood Hospital.

Mr Grimshaw, Director of Finance at Heatherwood and Wexham Park Hospitals NHS Foundation Trust, explained the reasons for the overall budget shortfall of £20M and provided a breakdown of the various cost elements. He commented upon the new national tariffs issued by the Department of Health in December 2008 and explained the significant detrimental impact they had had on the Trust’s income levels. He advised that, although costs had increased by £10M, income had only increased by £3M, which requiring £7M of efficiency savings to be found just to stand still. He also commented upon the additional £10M that had been allocated to improve the Trust’s services (£2m to replace the patient administrative system, £3M to implement the medical changes at Heatherwood, and £5M to fund the development of other services.)

He went on to explain how the Trust were addressing the current financial situation and commented upon how the savings were to be achieved. He stated that the Trust had an obligation to break even and advised that efficiency savings of £10M had been identified. He commented that the Trust were endeavouring to ensure that any savings identified did not have a detrimental impact on services and patient care.

In response to a number of questions, Members were advised that the Trust only became aware of the scale of the problem in January 2009. Mr Grimshaw explained that it had taken the Trust some time to fully consider the implications of the changes to the national tariffs, which had only been announced in December 2008. He explained that the Trust had benefitted from the changes to the previous national tariffs but explained that the Trust was in a similar detrimental position as other acute Trusts in the South Central Strategic Health Authority Area following the publication of the new national tariffs.

Mr Grimshaw commented upon the measure that had been put in place to ensure that the problems did not arise in the future. He explained that the Trust had undertaken a detailed financial planning exercise since January 2009 and a great deal of work had been undertaken to provide a better understanding of the true costs. The Trust had developed a 3 year financial model to look at key assumptions for future years and that revised processes and systems were now in place to facilitate medium and long term financial planning.

Arising from the discussion, Members of the Panel contented that the efficiency savings and price tariff implications should have been known and taken into account before the budget was approved and that poor budgetary control in previous years had contributed to the problems. However, the tightening of the budget monitoring was welcomed and assurances were sought that the exception reporting was adequate to alert the Trust early to any problems. Mr Grimshaw indicated that the Budget was being closely monitored by the Trust Board and that the Board were completely focussed on the issues to ensure that the Trust had a stable footing to go forward.

In response to a request for a copy of the Trust’s accounts and revised budget that had been approved by Board in June, Members were advised that details were available on the Trust’s website.

Mr Grimshaw then provided details of the Trust’s savings programme, which was broken down into 5 broad projects as follows:-.
    1. Procurement – savings to be derived from better management of the supply chain, ensuring that best prices were obtained and costs were reduced.
    2. Clinical Productivity – involved working closely with the PCT and local authorities to ensure that people were discharged from hospital at the appropriate time.
    3. Clinical support services – aimed at ensuring that testing was kept to a minimum and tests were not undertaken unnecessarily. Some specialist tests would also be reviewed to see if they could be carried out cheaper.
    4. Corporate Services – involved back office functions being reviewed to ensure that the level of resources were appropriate. Benchmarking to take place against other Trusts and more work to be done around VAT and income recovery.
    5. Workforce – Reduction in agency costs and ensuring that the productivity of existing staff was optimised.
Members were advised that all projects being progressed had been or would been risk assessed to ensure that they did not detrimentally impact on the delivery of clinical services. Monitoring of the projects and efficiency savings was undertaken on a monthly basis at Board level. It was stressed that the Trust would not progress with any efficiency savings that would have a detrimental effect or compromise patient care.

In response to a number of questions on how the Trust were managing the changes and the reaction from staff to the proposed efficiency savings, Members were advised that staff were being engaged throughout the process and that additional resources had been identified, either through secondments or the appointment of external resources, to drive forward the changes. Although there was a general recognition amongst staff that changes were required in order to address the current financial situation, understandably there was still anxiety amongst some employees.

With regard to the long term future of Heatherwood, Lise Llewellyn, Chief Executive of Berkshire East PCT, advised that the PCT had expressed its commitment to Heatherwood as part of the Right Care Right Place consultation, and reiterated that Heatherwood Hospital was an important site for planned care and that there had been no change to the commitment previously given. She explained that the PCT regularly reviewed what was being commissioned for planned care to ensure that there was no over supply. In response to a number of questions about accountability and governance, Janet meek, Associate Director of Finance at South Central Strategic Health Authority (SCSHA), explained the role of the SCSHA and advised that, as a Foundation Trust, Heatherwood and Wexham Park Hospitals NHS Foundation Trust was accountable to Monitor and not the SCSHA.
    In response to a number of questions on the impact the efficiency savings would have on the Trusts’ plans to rebuild Heatherwood, Members were advised, as the immediate priority was to address the current financial situation, it was not possible to give any indication as to when a decision may be made as to the implementation of plans to rebuild Heatherwood. However, in the meantime, the Trust would continue to invest in infrastructure and service improvements at Heatherwood. It was noted that the Trust would also have to take into account any impact the Bracknell Health space would have on services provided at Heatherwood.

    The Chairman then took a number of questions/comments from members of the public. With regard to a question on the procurement of the new Patient Administrative System, Mr Grimshaw explained why the system had to be replaced. He advised that the current system would not be supported by the current supplier from March 2010 and also commented upon the tendering process that had been followed to procure the new system.

    In response to a comment about Patient choice, Lise Llewellyn advised the patient choice was limited to where the PCT had contracts and stated that the PCT did not have any contracts with Royal Berkshire Hospital, should people want to go there for their treatment. In response to an individual complaint about the provision of the patient holiday care service, the person was directed to the Trust’s complaints’ procedure.
      Mrs Helen Blanchard, Director of Strategy and Resources at Heatherwood and Wexham Park Hospitals NHS Foundation Trust outlined the reason for the recent Ward closures at Heatherwood Hospital. She explained the closures were planned for later in the year as part of the medical changes at Heatherwood hospital and the need to increase capacity at Wexham Park hospital, but the decision had been taken to close them earlier due to the Trust’s current financial situation. However, it was stressed that the overall bed numbers at Heatherwood had not changed. She also advised that consideration would be given to the establishment of a “suggestion box” for people to come forward with potential cost saving schemes.

      With regard to a question relating to the evaluation of the bids for the Bracknell Health Space, it was noted that the evaluation criteria used to select Ashley House and G4S Integrated Services to develop the facilities and services to be offered in the new complex was publicly available.

      A number of comments were made on the value of the hospital facilities at the Heatherwood site and the need for the site to be redeveloped in order to provide modern facilities and a greater degree of confidence as to its long-term future. Members were advised that the Trust were in early discussions with a potential partner to assist with the funding of a new facility. It was agreed that a report be presented to the meeting in November to review progress with those discussions.

      In response to a comment on recent investment at Heatherwood, Mrs Blanchard outlined recent infrastructure improvements and enhancement of facilities that had recently been carried out at Heatherwood. She also commented upon the recent decision to withdraw training accreditation from Heatherwood.

      At the conclusion of the item, the Chairman thanked the public and the Health service representatives for attending the meeting.
        30/09 LOCAL GOVERNMENT ACT 1972 – EXCLUSION OF THE PUBLIC
          RESOLVED: That under Section 100(A)(4) of the Local Government Act 1972, the public be excluded from the remainder of the meeting whilst discussion takes place on the following item on the grounds that it involves the likely disclosure of exempt information as defined in Paragraph 3 of part I of Schedule 12A of the Act.