Agenda item

The Director of Finance and Performance for the United Lincolnshire Hospitals NHS Trust and the General Manager, Woman and Child Service Unit for the Peterborough and Stamford Hospitals NHS Foundation Trust to attend the meeting.

The Chairman welcomed Mandy Renton and Christopher Hall from the Peterborough and Stamford Hospitals NHS Foundation Trust and thanked them for attending the meeting. He informed the Panel that disappointingly a last minute apology had been received from the United Lincolnshire Hospitals NHS Trust. Notes from a meeting with the Trust were circulated for the information of Members. Although there would be no guaranteed outcome from the NHS Trusts, the DSP would be able to make recommendations to Cabinet or Council for their consideration.

Stamford

Ms. Renton gave a presentation detailing an overview of the services provided on site. She stated that there was a minor injuries unit, which was open from Monday to Friday, in-patient medical facilities, day-case surgery, outpatient services, diagnostic facilities, pharmaceutical facilities and rehabilitation facilities. Theatre specialties included orthopaedics, gynaecology, urology and general surgery; approximately 3,600 procedures are performed every year. Over the past 2-3 years there had been an increase in day-case surgery, reflecting the clinical strategy and contemporary practices in medicine where in-patient surgery was no longer normal. Of the 45,000 outpatients seen from the Stamford area across all 3 hospital sites (Peterborough District Hospital, Edith Cavell Hospital and Stamford Hospital), 22,400 were treated at Stamford hospital. Figures for the minor injuries unit for three time periods are listed below:

The east end of the estate was being used for medical purposes, the older buildings at the west end of the estate were closed because they were not used and there was no need to use them. A workshop had been held in October to find ways to use the buildings that responded to changes within medicine and to commissioning and funding patterns. Any changes that had been made were backed up by clinical changes.

Ms. Renton and Mr. Hall responded to questions from the Panel and discussed the following:

• No comparable accounts for the previous year had been included in the statement of accounts sent to the District Council because the financial year 2004/05 was the Trust’s first year as a Foundation Trust. Two sets of figures would be included in the next set of accounts produced;
• There had been a spending increase attributable to a variety of circumstances including increased employer contributions for staff pensions, additional costs associated with central government initiatives, which had not been fully covered despite an increase in revenue and increased local costs in the way services were provided, thus having to adjust to reflect the level of funding available;
• Because the Trust had become a Foundation Trust, they were subject to legally binding contracts with Primary Care Trusts (PCTs). They had over-performed in the first six months of their contract; this has meant that they have had to decrease the number procedures in order to meet contracts. The Hospital could do additional procedures but the PCT would not stand the cost. They were unable to put tenders out to the private sector or undertake any private sector work because of capping figures on the income, which could be generated through private patients to ensure that private patients were not treated to the detriment of NHS patients;
• The mandatory capital payment of public dividends equated to 3.5% of the value of assets being paid to the Department of Health, this would constitute part of the cash to fund PCTs;
• That both hospitals in Bourne had been closed, despite assurances to the contrary at the time, while both Grantham and Stamford were seeing a depletion in the number of wards open and the number of services available. The Peterborough and Stamford Foundation Trust were looking at using the estate at Stamford hospital for the provision of other health related services using a public steer. Although the Hurst Ward had closed, it did not affect service provision as a whole. It was suggested that a policy could be pursued to ensure that the hospital estate be retained for the supply of medical services;
• Plans for a Centre of Excellence in Peterborough would not affect hospital provision in Stamford. Such plans would entail an amalgamation of the two hospital sites in Peterborough City. The Hurst Ward had been taken out of medical use because it did not offer the most suitable clinical lay-out for patient care;
• 2% of Trust staff were Senior Managers, approximately 29% of staff were nursing staff. Administration staff accounted for 7.1% of total staffing numbers. This was comparable to a figure of 20.6% for the United Lincolnshire Hospitals NHS Trust;
• When hospital services are adjusted and ward closures ensue on the pretext of the establishment of a centre of excellence, there should be empirical proof that the Centre of Excellence exists; it was suggested Panel Members should attend a site visit to the Centre of Excellence;
• When discussing the driving force behind decisions, a lack of money of money to effectively use their capacity was suggested. Generally recruitment was good, although some specialists had to be recruited from outside the UK. The Trust were looking at bringing in work from other areas.

Ms. Renton stated that there had been a review of all services across the Trust, the outcomes of which were due to be published shortly after the meeting.

The Chairman thanked Ms. Renton and Mr. Hall for their attendance and their frank answers. He advised them a copy of the action notes from the meeting would be sent to them for their information.

Grantham

The Chief Executive commented on the notes he had produced from a meeting with representatives of the United Lincolnshire Hospitals NHS Trust. Key points from that meeting included:

• At Grantham Hospital in a year there would be over 30,000 patients treated in the Accident and Emergency (A&E)Department, 7,000 planned surgical operations, 6,000 emergency admissions and 80,000 outpatient visits;
• A&E would continue to be a 24-hour, 7 days a week service;
• Patients who need urgent medical treatment would continue to be cared for at Grantham;
• Patients brought to the A&E requiring treatment in a major trauma centre would continue to be transferred to Sheffield or Nottingham (this had always been the case);
• A change had been proposed regarding Level 3 Critical Care services; where patients were known to the Trust, they had previously been and would continue to be redirected to hospitals that could offer the appropriate standard of health care required. Where the condition of patients already in hospital had deteriorated, they would be transferred as soon as possible, previously they would have been held for 24-hours. The change was proposed as a result of a clinical safety review;
• Haematology day-care patients would continue to be treated at Grantham. The service would be enhanced through integration into county-wide provision;
• There is the potential for service improvements at Grantham, including capital investment in the development of breast care services within the Trust, the appointment of a senior doctor who is a leading expert in the country at using MRI technology to diagnose heart problems and the application by the Trust for Grantham to be the site for an innovation unit for the whole of the East Midlands;
• The Trust were in a financial transitory period to the implementation of payment by results. This would lead to a code to cover every medical service. This would not be implemented until 2008. Interim arrangements were causing difficulties;
• Data from the Department of Health said the reference cost of United Lincolnshire Hospitals had been higher than the target. The 2003/04 reference cost was 109, which would need to be reduced to 98 by implementing efficiency gains. Historically Lincolnshire hospitals had not received equivalent levels of funding compared to elsewhere in the country while facing the additional costs incurred in delivering a service to a rural area with a low infrastructure of community service. One key aspect in improving efficiency would be to reduce the average length of a stay within hospital, which had been 8.7 days in 2003, to 5.5 days;
• The deficit of £4.9m on a turnover of £287m had arisen because of historical borrowing to close the gap between the service required and the resources available. From 2006/07, the Department of Health had agreed to increase funding for Lincolnshire, from 8% below the national average to 2% below the national average. However, as a condition to this funding, the Trust would need to increase its efficiencies and pay off its debt;
• A large number of issues raised by the Trust and points of mutual interest between the Trust and the Council, it was suggested that the Hospital should be invited to become a full member of the Local Strategic Partnership. As Chairman of the LSP, The Leader was tasked with consulting Members.

Panel Members were concerned about some of the points raised at the meeting and suggested that they would like the opportunity to question representatives from the United Lincolnshire Hospitals NHS Trust at a future meeting. Questions and discussion included the following points:

• If critical care beds were moved from Grantham, where would they go?
• Despite being told that there would be an increase in high dependency beds across the District, no mention had been made as to where these would be;
• A lot of people who “block” beds cannot be discharged because there would be nobody to look after them. It was suggested that there should be increased liaison with social services. As people are not able to be discharged, efficiency targets would not be met;
• The proportion of administration and estates was seen as being particularly high (21% of the total work force), while healthcare staff had decreased by 9.2% and staff costs had increased by 13.4%. The Panel would require an explanation of the numbers;
• Hospital provision is important for ensuring the sustainability of the community, this would be particularly important in Grantham’s aspiration to become a Sub-Regional Centre;
• With the depletion of critical care beds, Members were concerned about what would happen in the event of a pandemic;
• The financial pressure under which the hospital is operating could incentivise the sale of land for housing purposes. The Panel suggested that protections could be put on the land using the Local Development Framework, classifying hospital land and putting stringent controls on development, it was also suggested that the Council may be able loan the Hospital the money it would need to pay off the deficit or make representations on its behalf;
• More information would also be required on the structure and availability of support staff; this would be particularly important because of the increase of care within the community.

It was felt that an increased knowledge and understanding of critical care and high dependency would be beneficial, so representatives with financial and clinical knowledge should be invited to the next meeting. If no one would be available to come, it was suggested that the Healthy Environment DSP should go to meet with the Trust.

CONCLUSIONS:

1. That the Panel visit any Hospital claiming to serve as a Centre of Excellence for people within the District;
2. That clinical and financial experts from the United Lincolnshire Hospitals NHS Trust should be invited to the next meeting of the Healthy Environment DSP on January 17^th 2006;
3. That accounts and financial statements should be sought from other Health Service Trusts for comparison;
4. That the future Local Development Framework should include policies to protect existing sites of medical/health infrastructure for that use only. Such facilities are considered to be of fundamental importance to the future well-being of the towns, and the District as a whole, and that their loss to alternative development should be restricted;
5. That the District Council should explore the possibility of offering a loan to cover the deficit.