Agenda item

(To receive a report from North West Anglia NHS Foundation Trust, which provides the Committee with a clinical and financial update.  Caroline Walker, Chief Executive of North West Anglia NHS Foundation Trust, will be attendance for this item)

The Chairman welcomed to the meeting Caroline Walker, Chief Executive, North West Anglia NHS Foundation Trust, who provided a clinical and financial update for the North West Anglia NHS Foundation Trust.

The Committee was advised that the North West Anglia NHS Foundation Trust oversaw the running of Stamford and Rutland Hospital, Peterborough City Hospital and Hinchingbrooke Hospital in Huntingdon.  The Trust also ran outpatient and radiology services at Doddington Hospital, Princess of Wales Hospital, Ely and North Cambs Hospital, Wisbech.  The Committee was advised that the last two years had been challenging, as the Trust had only formed on 1 April 2017 and was then inspected by the Care Quality Commission in June/July 2018. 

Details of the Care Quality Commission inspection at the Hinchingbrooke Hospital and Peterborough City Hospital were shown on pages 46 to 49 of the report presented.  The published report from CQC in October 2018 gave the Trust the overall rating of 'Requires Improvement.'  The Trust had been very disappointed with the rating.  Prior to the report's publication, the Trust had responded to the draft CQC report with more than 100 pages of factual accuracy amendments, only to find that many of the inaccuracies were still published in the final report.  

The Committee was advised that since the inspection, the Trust had resolved the 'must improve' actions; and the lessons learned from the recommendations were being applied across all the Trust's hospital sites.  The Committee was advised further that work continued against a detailed action plan of remaining improvements against the said plan and that the plan was reviewed monthly.  It was highlighted to the Committee that the plan had been submitted to the CQC on 3 December 2018 to show the Trusts compliance against key areas highlighted in their report.

It was reported that the Trust was continuing with its own CQC-style inspections of ward areas across all three acute sites to maintain assurance that services were consistently being run to a high standard of care.  The Committee noted that the said in-house inspections were called CREWS (Caring, Responsive, Effective Well-led and Safe).  The Trust also had senior–level walkabouts across the hospitals to see first-hand improvements, and that these were led by the Chief Nurse.

The Committee was advised that the Trust was anticipating a re-inspection of services in the next few months.

It was reported that for 2017/18, the Trust had achieved its control total of £39.9m; and as a result had received a System Transformation Funding Budget of £5.7m.  However, due to increasing cost pressures in 2018/19; at the end of the first quarter of the financial year 2018/19 the monthly spending rate was on course to be £10m higher than the control total set of £46.5m.  It was highlighted that some of the increased spending had been the result of greater activity and additional staffing costs through agency and staffing banks.  The Committee was advised that the Trust had seen increased activity from Lincolnshire which had resulted in extra bed capacity being needed.  The Committee was advised further that by the end of the financial year the Trust would have a £15m overspend.

The Trust had also struggled with recruitment and currently had 100 doctor vacancies and 200 nurse vacancies.  The Committee was advised along with other NHS organisations, the Trust had been taking note of national guidance and preparing for any potential impact of a 'no deal' exit from the European Union.  The Trust had been working with its 500 highly valued EU staff on supporting their plans to settle in the United Kingdom and continue working for the NHS.

It was reported that the Trust had plans in place to meet the ambitions set out in the NHS Long Term Plan.  The Trust was looking forward to working with partners, to turn the NHS Long Term Plan ambitions into real improvements in services for local people.

During discussion, the Committee raised the following points:-

·         Page 48 - That Out Patients had not been rated.  The Committee was advised this was because this was a Vanguard operation.  It was noted that Vanguards had been introduced by the NHS to help develop better models of patient care;

·         Private Finance Initiative (PFI) – One member asked how the Trust had been compensated for being a PFI hospital.  The Committee was advised that the Trust received an element of support to cover its PFI costs.  In addition, part of the deficit was as a result of late payments from other Trusts.  The Committee was advised that the Trust engaged with the Department of Health and social Care regarding this issue.  The Committee was advised that ambulances were bringing more patients from Lincolnshire to Peterborough City Hospital's A & E.  Although this might only be one extra patient a day, these patients were often complex cases and as a result at about one patient a week, and often there was a strong possibility that the patient would be admitted.  The Committee was advised further that the Trust received fantastic support from Lincolnshire Adult Care when patients were discharged.  The Committee was surprised that more patients were being taken to Peterborough A & E, as this contradicted what the Committee had previously been advised.  The Committee was reminded that the patient had choice.  When ambulances arrived with patients from Lincolnshire the handover was good.  It was noted that sometimes it was the ambulance driver's choice, which at peak time caused an escalation.  The Chairman advised the Trust that the Committee would be interested to see the numbers of patients coming from Lincolnshire.  It was highlighted that the acute trusts needed to work together to plan and re-negotiate the contract for more activity going forward;

·         Impact of TASL – The Committee was advised that TASL had caused the Trust to have some extra costs, however, these had improved.  The Trust had spent several hundred thousand pounds on private ambulances.  This had been caused by the way the NHS discharged.  This had now been changed;

·         One member asked whether the Trust had any views on the proposal for an urgent treatment centre at Stamford (part of the Healthy Conversation 2019).  The Committee was advised that the Trust had been consulted on the proposal and that the Trust were fully in support of it as it supported other services already being provided at the Stamford Hospital.  The Trust was unsure whether the provision would be 24 hours, or 8am – 8pm, and also whether it would be seven days a week or only Monday to Friday;

·         A question was asked what impact the additional NHS funding would have on improving the Trust's deficit and improving services further.  It was felt that the funding would not improve the Trust's deficit, but would have a positive impact on patients;

·         The Committee was advised that the Trust was in deficit and was being charged interest on the money borrowed from the Government.  The new money allocated should help reduce the deficit to £5m.  It was being able cope with the cost of recruitment to meet need and investing in Neighbourhood Teams that was important going forward;

·         In response to a question on whether the Children and Young People Services at Pilgrim Hospital, Boston was having on the Trust, the Committee was assured that this was not having a negative impact on the Trust; and

·         It was also confirmed in response to a question that the Trust was spending a significant sum supporting non-emergency patient transport, as a result of the performance of the Thames Ambulance Service in Lincolnshire.

The Chairman extended thanks on behalf of the Committee to the Chief Executive of North West Anglia NHS Foundation Trust for her frankness and for the excellent report; and for the steps being taken to make the improvements raised by the CQC; and that the Committee requested a copy of the detailed recovery plan once it becomes available.

RESOLVED

1.    That the Committee receives a copy of the detailed recovery plan in response to the Care Quality Commission's report, once it becomes available.

2.    That the update report on the developments at North West Anglia NHS Foundation Trust be noted.

3.    That the Committee receives details of the number of patients from Lincolnshire attending Peterborough City Hospital A & E, together with the number of admissions.

The Committee adjourned at 12.35pm and re-convened at 2.00pm.

Additional apologies for absence for the afternoon part of the meeting were received from Councillors M T Fido, R J Kendrick, P Howitt-Cowan (West Lindsey District Council) and Mrs R Kayberry-Brown (South Kesteven District Council) from 2.30pm.

A further apology was also received from Councillor Dr M E Thompson (Executive Support Councillor for NHS Liaison and Community Engagement).