Agenda item

Silas Nicholls, Chief Executive, Southport and Ormskirk Hospital NHS Trust, to attend.

Silas Nicholls, Chief Executive, Southport and Ormskirk Hospital NHS Trust, was in attendance from the Trust to report on recent developments at the Trust and to give a presentation to the Committee.

Mr. Nicholls gave a presentation on the Acute Sustainability Programme that outlined the following:-

·         The Case for Change;

·         The Clinical Senate Report;

·         Acute Sustainability – Workshop Structure;

·         Emerging Clinical Scenarios; and

·         Delivering Transformation for Sefton and Cheshire and Merseyside.

Mr. Nicholls reported on his background and experience within the NHS, indicating that he had been approached by NHS Improvement to work at the Trust. He hoped to bring stability to the organisation and to improve clinical performance, as some concerns were held particularly around A&E and older people’s care.

Mr. Nichols made reference to the recent open letter he had shared with key stakeholders and to the most recent Care Quality Commission rating for the Trust of “requires improvement”. Some questions regarding viability surrounded certain services provided by the Trust such as maternity, which fell short of the number of births per year for a clinically viable service. The Trust had also faced challenges to maintain good outcomes regarding stroke services as it was particularly reliant on a single clinician, which could leave the Trust in a vulnerable position if that clinician left the Trust. The demographics of the area also brought challenges to the Trust with numbers of over 65s predicted to represent one in three in a few years’ time. Numbers aged 85 and above were also rising, together with the challenges this presented as this age group tended to have multiple long-term conditions.

The financial situation of the Trust was causing concern as the Trust was facing a deficit of some £28m which had caused a gradual degradation of services with services not being invested in. Vacant posts in Orthopaedics had not been recruited to and this was now considered to be a false economy, the vacant posts now having gone out to recruitment.

Reference was made to the positive approach that Mr. Nicholls was taking, particularly regarding staff morale and the need to emphasise in future that staff were an important asset and that the Trust was a good place to work, with a good quality of life in the area.

The Southport site required re-development although a new development would have its advantages as it could provide a blue-print for future district general hospitals in England. An initial meeting had been held with NHS England and NHS Improvement and a positive reaction had been received. The next meeting would take place on 14 September 2018 and a further meeting would take place with NHS England on 25 October 2018. If agreement was reached regarding investment, consultation with the public could commence in late May/early June 2019, with a possible commencement of April 2020 for any changes. The Clinical Commissioning Groups would lead on the consultation, if changes proceeded. This Committee would need to be consulted if substantial variations to services took place.

Members of the Committee asked questions/raised matters on the following issues:-

·         Were women choosing alternative locations for maternity services?

Not significantly. Birth rates were falling in the Southport and Ormskirk area. If necessary, transfers to Liverpool Women’s Hospital NHS Foundation Trust took place in emergencies and a greater alliance could be built with Liverpool for higher risk cases.

·         Reference was made to patient choice for elective services.

GPs, particularly in West Lancashire, were choosing to transfer patients elsewhere, partially due to waiting times and the reputation of the Trust. There was a need to win some of this financial income back and to improve clinical efficiency in order for patients to have a good experience.

·         What was the plan to claw back some of the deficit?

There was a need to improve the cancellation rates for procedures and to consider improvements for efficiency in the schedules in theatre. The Ormskirk site was currently under-utilised in terms of beds, etc. and could be a planned elective treatment centre, providing procedures to neighbouring areas too.

·         What challenges faced the Trust as an NHS hospital, other than NHS pensions?

There was a need to keep services sustainable with a clear accountability framework and a more comprehensive clinical workforce strategy.

·         In light of the deficit at the Trust, did auditors voice concerns regarding the Trust’s financial position?

It was estimated to take 4-5 years to make a significant impact on the deficit, with the Trust having to borrow finance at the moment. There was a need to look at the bigger picture across the region and to recognise that issues would not be solved in isolation, such as the need to influence GPs as to where to send patients.

·         Had Mr. Nicholls faced similar problems at his last post in Manchester?

Some core problems were universal for hospital trusts, although staff morale was probably worse at Southport and Ormskirk Hospital NHS Trust.

·         Reference was made to the slide on “Emerging Clinical Scenarios” and further information was requested, such as distances patients would be required to travel for the different scenarios.

·         Staffing issues were raised, together with the link to Edge Hill University for training purposes.

Mr. Nicholls had previously worked at Wigan and had built up the relationship with Edge Hill university then. Staff at the Trust would be receiving a message of investment and a vision of the future of the Trust. Shared job plans with Liverpool hospitals could be considered in the future.

·         The recently opened Discharge Lounge was mentioned and the fact that it operated from 9.00 a.m. – 5.00 p.m. during week days.

The Discharge Lounge was predominantly catering for bedded patients and their discharge to nursing homes. Once the Trust was confident it was working well, it was hoped that a financial case could be submitted for extending the opening hours, probably into weekends.

·         Reference was made to the hydro-therapy pool at the Southport Hospital site and its future use.

The pool was not open to staff, rather it was used for past and present patients with spinal injuries. Mr. Nicholls was open to looking at different options for use, provided use was appropriate for an NHS facility.

·         The consultation undertaken by the Clatterbridge Cancer Centre NHS Foundation Trust during its review of services some time previously had been considered to be excellent in terms of its approach to change management.

RESOLVED:

That the document and information provided by the Chief Executive, Southport and Ormskirk Hospital NHS Trust, be noted and Mr. Nicholls be thanked for his attendance at the Committee.