Agenda item

(To receive a report on behalf of United Lincolnshire Hospitals NHS Trust, which provides the Committee with an update on Financial Special Measures)

The Chairman introduced this item, and advised that attached to the report for the Committee's information were two Appendices.  These Appendices related to:

·         Appendix A - Update on Quality Special Measures; and

·         Appendix B – Mortality rates at United Lincolnshire Hospitals NHS Trust.

The Committee were asked to primarily focus on the issue of Financial Special Measures at ULHT.

The Chairman advised further that he had received requests from two members of the public to speak on this item.  The Committee was advised further that the requests had been received from Melissa Darcy and Liz Wilson. 

The Committee was advised that it was proposed that each speaker would be allowed a maximum of three minutes to speak on the issue of Financial Special Measures first; this would then be followed by a presentation from Jan Sobieraj, Chief Executive, United Lincolnshire Hospitals NHS Trust and Karen Brown, Director of Finance, United Lincolnshire Hospitals NHS Trust.

In their presentations to the Committee, the two presenters made reference to: the emails and letters from United Lincolnshire Hospitals NHS Trust staff; the continued overnight closure of the A & E Department at Grantham Hospital and to the continued lack of any progress towards its re-opening on a 24 hour basis; the proposed intention to remove Orthopaedic trauma from Grantham Hospital and the effect that would have on the survival of the Grantham Hospital A & E.  Reassurance was sought that consultation would be undertaken before the removal of Orthopaedic trauma from Grantham Hospital; the record of ULHT and its approach to public information and consultation; and due to the small amount of progress made by ULHT, what was the Trust Board's recovery plan; and what action the Health Scrutiny Committee would be taking to ensure that accurate, and timely information was provided, and that consultation occurred to ensure that services were preserved.

The Chairman of the Health Scrutiny Committee for Lincolnshire advised that United Lincolnshire Hospitals NHS Trust had stated that no changes to orthopaedic trauma had taken place at Grantham Hospital, or were planned to happen in the near future.  This particular item was not for discussion as part of the agenda, but would be discussed further as part of the Lincolnshire Acute Services Review; and that the Committee would consider any proposals for Grantham Hospital following that stage.  It was also highlighted that if any changes were implemented on the grounds of the health and safety of patients, the public or staff, these would be considered by the Committee as a matter of urgency, and as yet no such changes had taken place or were planned.  It was also highlighted that the Committee had made two referrals to the Secretary of State in relation to the Grantham Hospital A & E Department.  The Committee also noted that the Acute Service Review would be considered by the Committee at its 16 May 2018 meeting.

In response to the issues highlighted, the Chief Executive of United Lincolnshire Hospitals NHS Trust advised the Committee that closure of the Grantham A & E service was as a result of patient safety, and not as a result of financial measures.  The Committee was advised further that it was the intention of the Trust to provide a better orthopaedic service at Grantham, similar to that being provided at Louth County Hospital.

The Chief Executive of United Lincolnshire Hospitals NHS Trust introduced the Financial Special Measures Update, which advised the Committee of the financial position of United Lincolnshire Hospitals NHS Trust, and the steps that were being taken to become financially sustainable.

The Committee was advised that a Turnaround Director had been appointed; and KPMG had been engaged to provide support in delivering a recovery plan to become financially sustainable; and to exit Financial Special Measures.

The Director of Finance, United Lincolnshire Hospitals NHS Trust advised that the recovery plan agreed with NHS Improvement was to deliver £16m of efficiencies in 2017/18.  It was highlighted that the Trust was forecasted to deliver an £82.4m deficit for 2017/18.  This figure was £5.4m greater that the revised control total of £77m agreed with NHS Improvement in December 2017.  Paragraph 1.4 of the report identified the items that were responsible for the increasing deficit, which included winter pressures; contract challenges; additional cost of external support, and interest changes due to Financial Special Measures loan rate.  It was noted that winter pressures had also had an effect on the amount of elective surgery being carried out; which had resulted in a loss of income for the Trust.

The Committee noted that the Trust had identified £19.7m of efficiencies for 2018/19.

Paragraph four of the report provided details relating to the three required elements to be completed to exit Financial Special Measures.  Paragraph five highlighted the support being given to the Trust.

It was reported that the Trust had an ambition to deliver £30m of efficiencies in 2018/19; and was working to identify and implement additional schemes to increase the already identified £19.7m.  Paragraph 6.4 provided details of the High Level 18/19 Financial Turnaround Programme.

Note: Councillor R A Renshaw wished it to be noted that he was an outpatient with Lincoln County Hospital.

During discussion, the Committee raised the following issues:-

·         The support for the campaign to keep Grantham Hospital A & E open.  It was reported that a signed petition with some 60,000 signatures was due to be delivered to the Prime Minister on 5 July 2018;

·         Whether there was a plan in place to keep track of the money being spent.  The Committee was advised there was a spreadsheet and tracker identifying where all the money was being spent;

·         Reduction on agency staff – The Committee was advised that there had been a recruitment problem for many years; and there had been a reliance on locum and agency staff.  It was reported that in the previous year there had been a positive recruitment campaign, which had resulted in a more positive position;

·         Costs – It was confirmed that the Trust had to cover the cost themselves.  Confirmation was also given that the Trust had to pay interest on the loans; and that there was a higher interest rate applied as a result of being in special measures.  The Committee was also advised that external support was also an additional cost.  One member requested the total cost associated with non-medical management.  Some members felt that there needed to be a group looking at costs in more detail;

·         The need to promote that the NHS Trust was improving its quality of care.  Page 35 and 36 of the report detailed some of the achievements made during the year;

·         Confirmation was given that the Trust was spending £2.5m a month to improve fire safety of their building for staff and patients.  The Committee was advised that this was capital money being actively spent to improve the working environment;

·         The need to establish what was happening with the STP;

·         Paragraph 2.2 - breakdown of costs – Reference was made to the need to ensure that efficient buying was practised.  The Committee was advised the Trust used the Purchase Price Index Benchmarking Tool, which was used by the whole of the NHS.  Confirmation was given that the NHS pursued all opportunities;

·         Some concern was expressed as to the costs associated with Senior Manager level;

·         Further concerns were expressed to the neglect of patients and staff with regard to Fire Safety, to warrant the issue of two Fire Enforcement Notices;

·         An explanation was provided as to the definition of Hospital Standardised Mortality Ration and Summary Hospital-level Mortality Indicator; and

·         The need to lobby MPs for fairer funding for Lincolnshire's health services.  Confirmation was given that Lincolnshire was unique; and that any support from the Committee would be greatly appreciated.

In conclusion, the Committee agreed to the setting up of a Working Group to have an in-depth look into the financial position of United Lincolnshire Hospitals NHS Trust.

The Chief Executive of United Lincolnshire Hospitals NHS Trust advised the Committee that paediatric services at Lincoln Hospital and Pilgrim Hospital Boston had become very fragile, but at the moment were safe; and that efforts to recruit suitable staff were continuing.  It was noted that there had been a reduction in the number of children's beds at Boston.  The matter would be considered by the Trust Board on 27 April and it was agreed that a paper would be presented to the 16 May 2018 meeting for the Committee's consideration.

The Chairman extended thanks on behalf of the Committee to the two presenters.

RESOLVED

1.    That the information presented on the Financial Special Measures of United Lincolnshire Hospitals NHS Trust be noted.

2.    That the update on Quality Special Measures (Appendix A to the report) would be subject to a further report to the Committee on 13 June 2018.

3.    That the update on Mortality Rates at United Lincolnshire Hospitals NHS Trust (Appendix B to the report) be noted.

4.    That a Working Group be set up to have an in-depth look into the financial position of United Lincolnshire Hospitals NHS Trust.  That the above said Working Group comprise of Councillors C J T H Brewis, P Gleeson, Mrs R Kaberry-Brown, C S Macey and M A Whittington.