The Chair welcomed the team from West Middlesex University Hospital who were attending for the presentation. Jacqueline Docherty, Chief Executive of West Middlesex University Hospital, Tom Hayhoe, Chairman, West Middlesex Hospital Trust and Andrew Murphy, Turnaround Director, West Middlesex Hospital were all present. Sue Jeffers, NHS Hounslow, also attended.
The Chair proposed that members should allow Jacqueline Docherty to give her presentation and then hold questions until the end.
Ms Docherty explained that the presentation set out the plans for West Middlesex University Hospital and its future organisation. It looked back as well as forward. As the new Chief Executive she was aware of the chequered history and pressures on bed management, so it had been decided to look at a better way of working. The outcome was a two year productivity improvement programme. Year 1 involved efficiency gains and introducing a way of working to achieve savings. There was a planned deficit in Year 1.
Year 2 involved the delivery of £9m in savings and the Trust breaking even. Work had been consolidated by bringing in Andrew Murphy and his expertise. His involvement would gradually be tailed down as the plan was going forward.
However, having developed the programme, there was then a change in Government policy to take into account, aiming at the continuation of care closer to home and the consolidation of specialist services. There were issues here for West Middlesex as a general hospital.
Ms Docherty spoke of GP led commissioning. Her personal view was that this would help as it allowed a clinical focus on treating patients. She believed that there were lots of benefits from the proposals but it was a matter of how to take them forward.
Ms Docherty pointed out that the present Government and the previous administration were moving towards all Trusts becoming Foundation Trusts. There would no longer be a separate category other than Foundation Trust. The Trust was also expected to make savings of 15-20% over 4 years and sought to provide a good quality service within the financial ‘envelope’ available. Hence they were looking at tariffs and efficiency savings to consider how to make the savings happen. The Hospital was a small organisation with high overheads, partly because of the Private Finance Initiative (PFI). So the plan sought to move to low overheads. Ms Docherty noted that the Hospital had a good site, well served by public transport. They needed to consider whether to utilise the site to the maximum or to retrench from the older buildings, but it was felt that there were advantages to utilising the site to the full.
Councillor Todd asked what was meant by tariff and was informed that this referred to what the hospital got from those commissioning its services. She spoke of the level of tariff nationally without the impact of the PFI. There was a move to achieve consistent quality. In some areas the hospital was in the upper quartile for performance but the aim was to be consistent across all services. They did not wish to save money at the expense of quality. Nevertheless, it was acknowledged that when an organisation was consistently in the red, it overshadowed all that it did. It raised difficulties in the relationship between staff, commissioners and the public. For example, Ms Docherty made reference to the position of staff coming off duty late at night. Chelsea and Westminster Hospital paid for taxis home but they had a £22m surplus. The aim for West Middlesex Hospital was to generate a surplus to invest in services and develop patient care. They were also moving towards a mature relationship with the commissioners. The financial balance allowed the security to do that.
The mission was to make the hospital the local hospital of choice for the community as the key provider and they aspired to Foundation Trust status to achieve that position.
Although not in the Turnaround Strategy, Ms Docherty pointed out that they had been designated as a financially challenged Trust. So they had brought in Andrew Murphy to help to achieve delivery this year and moving forward to give priority to front line services over non clinical areas. The approach to encourage ideas for improvement was ‘bottom up’ rather than ‘top down’ so that people took ownership and were coming up with bright ideas. The aim was to decrease waste and increase value for money. Staff were buying into this and looking for different ways of working to achieve a better outcome.
So there had been forums and events to talk to staff about the Turnaround programme and to allow staff the opportunity to have their say. The programme had been changed as a result of listening to what was said.
The priorities were quality and patient safety and taking opportunities to enhance quality. For example, the changes proposed for the Clinical Board would have been done anyway to achieve improvement, even without the present drivers.
There was a 30% hit to the back office and to corporate clinical administration. Tiers were being taken out and it was important to get this right the first time. A lot of staff had gone as a result of natural wastage. They had also looked at non staff areas, for example better purchasing. They were a high user of agency staff but their aim was to fill vacancies rather than continue this spend. Skill mix changes were being looked at in the ward by the ward sisters to maximise effective use of staff.
The strategy looked at productivity. Improved management of beds could be achieved through reducing the time patients stayed in hospital. The use of an additional theatre enabled more day cases for surgery and also freed beds. This had allowed for the closure of two wards. They had worked to ensure there was no downtime so that X ray equipment was used more efficiently.
Staff were engaged through a programme of Celebrating Success. 150 ideas from staff had saved £2m so staff were invited to a ceremony to mark their initiatives, given gift vouchers and galvanised to seek improvements. For example, one idea had been to shred paper waste rather than paying for the separate disposal of confidential waste. 550 staff had been involved and there were still ideas coming through. Ms Docherty believed that they could do more to decrease the length of stay. They were investing in new equipment such as MRI and CT scanners. These were choices which could be made if there was more financial freedom.
There was a new community dermatological service and a tender had been won to provide community sexual health services.
A recent assessment had assessed the hospital at Level 2 with 100% in over 50 categories, so Ms Docherty stressed that changes were not at the expense of patient safety or care. A compassionate care survey with Richmond Links had been written up as an exemplar. The stroke service was working well and there were low waiting times. The hospital had a busy Accident and Emergency (A&E) department and was pleased that they had maintained a 98% performance rate above target. They were proud this had been managed. There had been improvements in the national staff survey, with low sickness absence.
Other achievements were a successful simulation exercise with the use of mannequins to practise techniques in a risk free environment. The Medical School was keen to have this again. A member of staff in the Midwifery service had won Midwife of the Year and indeed the hospital had won a range of awards including the Patient Engagement Award.
They had improved care pathways and although there was still a way to go there was a good response rate from the patient survey. Work was targeted so people got used to changes. So there was improvement but slowly.
Savings in clinical administration had meant the loss of 50 full time equivalent staff. This had generated anxiety but there was the need for improvement in attendances and output. Processes could be improved. There were high cancellation rates and rates of non attendance. So it was intended to make better use of technology. There were facilities for self check in as in many GP surgeries and electronic way finding so that a patient could sit in the coffee area rather than a waiting area and be clear when they needed to come back.
They would extend main Reception with the facility to book the next appointment.
Councillor Collins asked a question on that point about how those with visual impairment or the hard of hearing would know when their appointment would be. In reply, Ms Docherty advised that there would still be people to help.
Councillor Collins suggested facilities for information to flash up in the canteen and perhaps a voice activator. Ms Docherty acknowledged this as a good idea and suggested that they might be able to relay messages via a text to a mobile phone. They would also ensure compatibility for wheelchair users and mothers with children, but she stressed that there would still be people present to assist patients. This proposal was pre-assessment. The intention was to streamline the system and make it as easy as possible. They were also looking at an automated telephone service and mail merge. The current transcription service was not fit for purpose so the aim was to improve the systems in order to make a difference.
Ms Docherty recognised that so many people used the outpatient facilities that it was essential to get the system right. She noted that there might be ‘teething problems’ but they would work through the detail to ensure that the systems were right.
The Trust had aspirations to become a Foundation Trust, but Ms Docherty pointed out that they had been a challenged Trust, but were now in financial balance because of the turnaround plan being implemented this year and next.
To achieve Foundation Trust status, Ms Docherty advised that the Trust needed to deliver financial balance as well as clinical standards, together with offering improvement to the patient experience.
They had gone to the Challenge Trust Board in respect of the application for Foundation Trust status and gone through Stage 1, as had the Primary Care Trust (PCT). There was one key condition which was that each organisation would not cause problems for the other. Previously the debt had been bounced between the hospital Trust and the PCT, so forward plans needed to ensure that there was no difference in views relating to costs between the commissioners and the hospital. The hospital Trust would go back to the Challenge Trust Board later this year for resolution of the historic debt. Then the Board would review the options for the hospital.
The Trust was looking for a twin track approach, to achieve financial viability on its own or with a partner. There was joint working with the Imperial group and a number of London Borough of Hounslow residents were treated within Imperial hospitals and also in Ealing. However, they were looking to reverse this pattern so that they might populate the site and have the option of West Middlesex University Hospital being a stand alone Trust.
Councillor Todd asked what the benefit would be of becoming a Foundation Trust. It was explained that after 2014 there would be no Trusts other than a Foundation Trust. A Foundation Trust was more accountable to the local population, with a Board of Governors made up of local stakeholders. Such a Trust could also make and retain surpluses to reinvest.
Jacqueline Docherty informed the Panel that the Annual Public Meeting would be held on 19 July as part of the Trust’s approach to reach out to the community. They wished people to come and welcomed all members of the Panel. Ms Docherty explained that there was often a good turnout for this meeting, which provided an opportunity to engage the general public in the work of the hospital. Next year they hoped to hold more events.
Having reached the end of the presentation, Jacqueline Docherty invited questions.
The Chair welcomed Sue Jeffers to the meeting. He also congratulated Councillor Ellar on his election as Chair of Overview and Scrutiny and welcomed Councillor Poonam Dhillon and Councillor Todd who were attending as members of the Overview and Scrutiny Committee. He then moved to questions.
Councillor Collins had a question for Ms Docherty about patient choice. He recognised that the team were here to extol the virtues of West Middlesex Hospital, which was laudable, but pointed out that there were reasons why residents, including himself, chose to use the Imperial facility at Charing Cross Hospital. He commented that the government proposals for the way forward were about patient choice. He understood why West Middlesex Hospital wished to be a stand alone organisation but asked why this should impinge on choice, especially for those living in the east of the borough.
Ms Docherty replied that there was no intention to impinge on choice, but choices were often made on the basis of a GP’s recommendation. The hospital’s historic reputation did not benefit it in this respect so the Trust was now saying that GPs needed to provide advice in the context of the current position. That way it meant that patients had a more open choice but she recognised that it was always a choice.
Councillor Collins explored what had been said about day care surgery. He noted that in the days of the Patient Forums there had been concern about back up. He asked whether there would be in patient beds available in case anything went wrong. Jacqueline Docherty reassured him that this would absolutely be the case. She explained that better bed management meant that each night there would be lots of beds available.
Councillor Ellar referred to page 12 of the report and reference to £287k in savings from operating a five day ward. He understood how money was saved by not having the ward in operation at weekends but asked whether this compromised quality and how it worked to clear patients on Friday evenings.
Andrew Murphy explained that generally patients were out by Saturday mornings, so they now planned bookings so that they needed fewer beds at weekends. They tried to avoid the use of surgical beds over the weekends so that they were in the best position on Monday mornings to admit patients for elective surgery.
Councillor Ellar questioned the extra cost of the PFI and whether the Trust had lobbied the government to get acknowledgement that this was a higher cost rather than the flat rate payment. He asked why there had been no acknowledgement of this fact.
Ms Docherty replied that there had been acknowledgement now. The Department for Health was looking at the cost of the PFI for 22 Trusts. This was a piece of work to be undertaken over the next three months. It would consider what the PFI meant for the Trust and then monitor the costs against a peer group. The Trust would look at whether it was possible to close the gap through increasing productivity. If this could not be done the organisation needed to reconfigure services or merge or look at additional tariff. The Department for Health had recognised that for some organisations the PFI costs were disproportionately high for the size of the Trust, as was the case for West Middlesex University Hospital.
Councillor Ellar noted that at page 18 of the report it was stated that it was unlikely the Trust would close the gap remaining and would need to make further savings. He asked what the impact on the care offered would be of large, unspecified savings.
Andrew Murphy explained that the situation had improved since the paper had been written, so they were now reasonably confident that they could close the gap in Year 2 of the programme, whilst recognising that they were always in a risky position.
From Year 3 and 4 onwards, they hoped to utilise the hospital fully to provide better services to local residents and gain potential money from private companies as well. This would be the advantage of fully utilising the site.
Tom Hayhoe, Chairman of the Trust, advised that they would continue to look at what was happening for Years 3. 4 and 5. However, the local market share was less than they expected it to be. Hence part of the challenge was to achieve a better reputation so residents in central Hounslow and Isleworth would look to West Middlesex for treatment rather than elsewhere.
Councillor Ellar asked what the partnership with a private company would be. Ms Docherty explained that there was some capacity to fill the site so that they could tender for a private patient partner. There was some private practice in the hospital at present but this was difficult without separate facilities so some theatre and bed capacity would be provided on site. There was a market in the area, as shown by the Syon Clinic. Consultants were doing private work elsewhere so this proposal would utilise the site. The margin made would then be reinvested back to the Trust to develop services.
Councillor Pam Fisher commented that the positive comments she had heard in the presentation were ‘music to her ears’. She was an acknowledged advocate of West Middlesex Hospital’s services and had tried to offer support. She had heard that the hospital would not be sustainable on its own but she believed it could be and supported that approach. She had a number of questions. She asked:
Jacqueline Docherty advised of a campus idea for the site. There were plans for an Urgent Care Centre by the PCT at the front end of Accident and Emergency (A&E) and for three GP practices on the site. The maternity facility currently handled 4,700 births but could do 6,000 without a step change from where it was situated. She spoke of 90 hours obstetric cover. There were issues of patient choice and this would trouble some organisations, especially Ealing.
Imperial had an existing unit on site for sexual health. They would like to double capacity by taking the existing unit and bringing it to the administrative block.
Indeed there were a range of things to look at to develop services. They was dialogue with commissioners, for example, about providing community rehabilitation services. There was also the potential of work with Chelsea and Westminster Hospital on paediatric dentistry. There were open opportunities to work with others to achieve development on site.
Tom Hayhoe spoke of marketing. He advised that the organisation was becoming more efficient, they were addressing performance and services to patients and becoming more cost effective. But they had also learned the importance of people knowing what they were doing. A new non Executive Director to the Board had a commercial marketing background and would raise the profile of the hospital among patients and non patients, the general public and GPs. However, this took time. They could not be seen to be putting too much money to marketing compared with the services provided.
Jacqueline Docherty agreed that they looked to Richard Tyler to assist with the community profile via joint work.
Councillor Todd commented that it was difficult to absorb the detail. He also commented on the entrance to the hospital and the existence of overpriced shops.
He referred to the discussion of the income from tariffs matching the cost of the PFI and the fact that this was a huge site. He asked whether there had been full use of the site and proper development. He referred to consideration by the Audit Committee and suggested that the procurement savings were modest.
Ms Docherty explained that the Trust sold land, the funds from which went back to the general health economy and were not kept by the hospital. They had looked at better use of the land and would bring work to it. If the Trust were to sell more land, this would be more advantageous if they achieved Foundation Trust status as otherwise they would not get to keep the receipts. They would retrench if necessary. They looked to establish capacity, including the capacity to expand if they wanted through the estate rationalisation strategy.
Picking up the point about procurement, Tom Hayhoe advised that Stephen Clarke on the Board had run large procurement programmes. Mr Hayhoe had also been responsible for private sector procurement. He and Mr Clarke had sat with the procurement team to see whether they were doing all that might be expected. He noted that facilities management was large and prosaic. However, the conclusion the Board members had reached was that although there might be new areas to explore the team was doing a professional job. There were not many opportunities they could see and there was a lot of collaboration with other NHS organisations to achieve the best deal.
Andrew Murphy spoke of the scale of savings. They had saved £9m last year and there would be £21m that needed to be saved over the next two years. A 20% turnover was fairly substantial. Mr Hayhoe agreed that this was a tall order compared with the private sector.
Councillor Todd raised the issue of a £15m debt year on year, but Ms Docherty advised that they hoped that this would be paid off through the present programme.
Councillor Ajmer Grewal commented that as a regular user of the hospital she believed that they did a fantastic job and did her best to champion them as did Councillor Pam Fisher.
Councillor Grewal noted that the LA assessment showed 100% for patient safety. She asked whether the decrease in nursing staff numbers would have a detrimental effect on this figure. Ms Docherty advised that they asked for a risk assessment with all savings plans. If issues were identified then these would be addressed or the savings proposals substituted. They had held a day session to present risks and staff had said if they felt that the cut went too far. So they were not compromising patient safety. However, they would keep listening to comments as matters could change.
Councillor Grewal asked when the LA assessment had been done and was advised that it was around October 2010.
Councillor Liz Mammatt referred to Councillor Todd’s question about procurement as she felt that the answer given was nebulous. She asked whether they liaised with the Imperial Trust to procure as a body, as was often done between government departments.
Jacqueline Docherty explained that West Middlesex Hospital was part of the London Procurement Partnership which provided sources from which to buy. This route was used where appropriate for procurement in the areas of agencies, transport and consumables, although there were some items which needed to be procured elsewhere.
Andrew Murphy clarified that with the need for savings nationally this was something which they were going through, recognising that others might use different suppliers offering best value. For example, with medicines they went through and compared deals so that sources of supply would be constantly refreshed. Ms Docherty explained that they also looked at basic savings, such as the use of tap rather than bottled water on wards.
Councillor Mammatt welcomed the confirmation that they did proceed with neighbours in respect of procurement. She noted the points raised about decreasing the time a patient stayed in hospital but suggested that there could be penalties if sending someone home too soon meant they were readmitted. She observed that there might be waste at weekends when patients were monitored, fed and watered but not receiving active treatment and were then discharged on Monday.
Councillor Mammatt suggested that savings could be made for appointments through the use of email with the facility to acknowledge receipt rather than posting letters.
Referring to the closure of wards, Councillor Mammatt asked whether wards might be re-opened if the hospital was able to take more patients.
In reply, Jacqueline Docherty commented that Councillor Mammatt was quite correct to highlight the issue of readmission. For acute cases, performance in this area was very good, but they were looking at the situation with complex cases amongst the elderly, working with social services. Sometimes patients in this category had been discharged too early and the consequences resulted in readmission. Within the North West Sector, the reality was that if such admissions were too high, organisations were fined but the hospital worked with the local authority to achieve joint solutions so that readmission did not happen. Ms Docherty stressed that no one wanted readmission as this was a failure of care.
Picking up the point about weekends, Ms Docherty advised that most organisations worked on a cost rota fully planned for 5 days. However, changes to the skills mix enabled, for example, nurses to provide physiotherapy at weekends. The Real Time arrangements they were introducing allowed for discharge on a Saturday as on a weekday and they were also looking at extending this to Sunday.
Andrew Murphy agreed that there was waste in the appointments process. He believed that in the future the default could be electronic mail, or information via the GP. The mail service was being managed to reduce the postal costs.
On the point raised about readmissions, Sue Jeffers explained that all acute Trusts had to have a Plan on readmission by the end of June. The use of money had been agreed, with combined use to prevent readmission happening.
Councillor Reid asked how important the Urgent Care Centre was in the Turnaround Plan. She also referred to the reduction in downtime through maximising the capacity of equipment and asked how much room for improvement there was in this respect.
Councillor Reid also thanked Ms Docherty for raising the issue of use of bottled water, which was also relevant to the Council and savings.
Andrew Murphy explained that they had taken into account the income from the Urgent Care Centre if it happened. It would have a neutral financial impact. Tom Hayhoe added that the Urgent Care Centre created space for an exceptionally busy A and E department. The department had the best performance for the length of time people had to wait but was simply not designed for 110,000 people. More space would enable patients to have a less unpleasant experience. The quality of care was excellent but there was a need for the extra space the Urgent Care Centre would create to accommodate the number of people using the services comfortably.
Ms Docherty spoke of the proposals to improve productivity through fully utilising expensive plant. They were looking at running longer days in the form of three sessions a day into the evening to support services. For example, the more effective use of CT scanners could make for quicker diagnosis and quicker turnaround. This was not to suggest that there would be over-reliance on the use of such equipment without clinical decision making but better use would enable the part of diagnostics to continue over the weekend. The Real Time system was helping and social services had access to allow them to see where the patient was in the process. Identifying a patient in this way could accelerate discharge.
Sue Jeffers also spoke of the Urgent Care Centre. There had been a small response to the public consultation to date but analysis of the first cut of the data suggested there was generally strong support from the public.
Councillor Reid asked about maximising room and the impact of length of stay compared with other hospitals. Andrew Murphy replied that West Middlesex Hospital compared reasonably favourably, especially with the number of community beds in the area. There was room for improvement. The key was how they worked with social providers and social care. He also explained that for other areas of therapy and radiology there were not proper benchmarks. There was the opportunity for improvements and had been significant areas of improvement in the use of equipment and increased productivity.
Jacqueline Docherty explained that they had concentrated on long stay but there was also a need to concentrate on the middle cohort. For those staying 20 days, being able to shave one day off made a real difference.
Councillor Reid asked whether those patients for whom there was longer stay were older and was advised that this was predominantly the case, plus also patients with complex difficulties.
Tom Hayhoe advised that the hospital was good as far as short stay patients were concerned and met national best practice. There was also a lot of attention on those whose stay was 20 days plus, but they now needed to focus on the 2-3 weeks patients where there were things which could be done to improve the position materially. There was a lot of work going on, but there were material areas for continued improvement over 2-3 years.
Councillor Ellar followed up on the point made about the Urgent Care Centre and the Accident and Emergency department. From his own experience of using A&E he was aware that the waiting room was small and that a lot of the treatment took place behind. He asked where the Urgent Care Centre would be located and whether this would be in the present car park. It was confirmed that it would be as the Centre took the form of a modular building. In response to further questions from Councillor Ellar, it was confirmed that the Urgent Care Centre would deal with easier cases. It was acknowledged that the rooms in the current A&E suite built under the PFI were small. They had been planned 12 years ago and although it was recognised that they could be problematic, it was difficult and expensive to change arrangements agreed under the PFI. Tom Hayhoe also commented that the facility had been designed for a lot fewer people attending as the aspiration had been to reduce the number attending A&E. Sue Jeffers agreed that it had been designed for 60,000 but now dealt with 110,000 per year.
Councillor Pam Fisher queried why this was the case as there had always been a large population in the vicinity of the hospital. Councillor Ellar suggested that this was related to the closure of Ashford Hospital A&E, with a knock on effect on the waiting room.
Ms Docherty explained that every admission that was not via an ambulance would come through the Urgent Care Centre and the area would be reconfigured with more resuscitation facilities. Tom Hayhoe added that the aspiration was that there would be fewer waiting and faster treatment.
Bob Hardy-King, Co-opted Member, noted that it had been suggested that there should be a practice for three GPs in the front of the hospital. Ms Docherty explained that the PCT was looking to re-house a GP practice and create a car park next to the Sexual Health unit not the Urgent Care Centre. Mr Hardy-King hoped that the hospital would be charging the PCT rent for the Urgent Care Centre.
Councillor Todd noted that his own perception was the London Boroughs of Hounslow and Ealing had the worst out of hours facilities in the UK. So he was concerned that the hospital might be ‘picking up the tab’ for the GPs.
Ms Docherty replied that the hospital was a highly emergency driven service, with 70% emergency and 20% in patient work. So she agreed that sometimes the hospital did pick up the slack and that Councillor Todd was not alone in thinking this and it was a public perception.
Sue Jeffers explained that a 20% rate of conversion to admission was not uncommon for a district general hospital.
Tom Hayhoe noted that the issue of out of hours cover had been a matter of concern previously and he recalled it as unfinished business from as far back as 2000.
Councillor Collins asked about Care Pathways for long stay patients. He asked for confirmation that the needs of longer stay patients were now being picked up via a care pathway in order to decrease bed blocking.
Jacqueline Docherty explained that the needs of long stay patients were being picked up better through the use of the Real Time system. What they had started for care of the elderly was a plan of care rather than a care pathway for all. She also pointed out that via the Urgent Care Centre the management of patients with long term conditions could be picked up and linked with community care so that their needs were directed back to care at home. They were developing a care pathway but they were currently picking up needs and monitoring stay and tracking discharge.
Councillor Collins asked whether they were in communication at a higher level in respect of public health. For example, he asked whether they were engaging with community pharmacies so that low level ailments might be dealt with there and kept away from the hospital.
Ms Docherty spoke of their work with the Winter Plan and the Pandemic Flu Plan at this higher level but also pointed out that people migrated to use the Heart of Hounslow facilities, Accident and Emergency and the GP. It was about educating patients to the right places for their needs. They did try to sign post patients at the hospital to explain that they should be seeking treatment elsewhere.
Councillor Collins referred to the fact that West Middlesex was a University Hospital. He asked whether they were confident that the hospital would be able to attract the highest level of staff, especially in surgery and asked about the opportunity to use the university facilities.
Ms Docherty noted this as a valid point. There had been good reviews from the deanery for undergraduate teaching. Indeed the hospital had been asked to take more students because they received a first class experience. Ms Docherty pointed out that more people did want to work with West Middlesex but they were concentrating on day surgery and how to keep up that positive experience. There were links with the Imperial Trust and complexities in those arrangements to keep the experience. She believed that the hospital had good reviews of its training and good people coming forward.
Councillor Collins noted that historic debt had been mentioned. He noted the fact that there was underfunding in the borough in respect of the amount of population the borough was perceived to have compared with the actual figure. He asked whether with the new Government, all Trusts had been to the Minister to ‘beat the drum’ to seek capitation to be based on actual facts rather than historic facts. For example, he understood there to be payment on a figure of 212,000 when the actual figure was around 242-271,000.
To clarify, Sue Jeffers advised that in respect of capitation, the PCT received the funds on the basis of a registered population of 259,000, not the resident population. She also clarified that in terms of the closeness of payment to capitation for any PCT, it was correct that Hounslow was the closest. Ealing was 7% above in respect of capitation whereas Hounslow’s was much lower. This was an issue for the borough but the purpose of North West grouping of 8 PCTs was to even out capitation. It was clear that Hounslow was closer to capitation than other PCTs.
Jacqueline Docherty picked up the point about historic debt and explained that with the loan from the PFI the Trust had not balanced its books year on year. The PCTs had got together to top slice in order to resolve this debt but the Trust needed to show its capability to manage its finances going forward. Ms Docherty was confident that they could do so.
Ms Docherty also reported that they could see a change in staff attitude and behaviour. Originally some had thought that overspend was a ‘victimless crime’. Now there was an understanding amongst staff of the need to deliver services on budget and peer pressure to achieve this.
Tom Hayhoe explained that the first stage of a two stage process had been to write off the debt and it was anticipated that this would be written off later in the year. Sue Jeffers confirmed that both organisations, the hospital and NHS Hounslow, needed to break even and be stable economically.
The Chair invited last questions before he drew the debate to a conclusion.
Councillor Reid’s question followed on from the discussion of length of stay. She noted that the longest stay tended to be amongst elderly patients. She asked whether this was higher than average at West Middlesex hospital.
Ms Docherty explained that this was a question they struggled with. She spoke of the size of the population being a disproportionate number in size compared with the number of beds they had. This applied to 4-5 wards but she did not think there were any differences in the wards. The aim was to ensure that the wards did not accommodate patients who did not need, or want, to be there. Nevertheless, she reassured members that no patient would be sent out if hospital treatment was required.
Councillor Pam Fisher noted that there were a lot of proposals for achieving savings and some of them were risky. She asked what the Trust had in place as Plan B.
Ms Docherty responded that they did have a Plan B. Andrew Murphy explained that work was done on savings every two weeks to identify slippage. The plans were over two years so if there was slippage there was the opportunity to bring other plans forward from a reservoir of savings ideas. This was monitored very closely.
Councillor Fisher asked what they saw as the greatest area of risk and was informed that this was in the proposals for clinical administration. These plans affected over 200 staff and had the largest impact on customers. It was a risky endeavour but had been planned from October with the momentum for change from patients. There had been a long consultation with the staff affected and others and changes had been developed as a result. Implementation would take place from now until August. With the technological changes they sought to plan them correctly in order to minimise risk. In concluding this explanation, Mr Murphy also confirmed that there was a reservoir of other improvements if there was slippage.
Councillor Mammatt picked up on the point made about wishing to attract people to choose West Middlesex hospital. She noted that Charing Cross and Imperial had particular specialist expertise, such as the heart specialism at Hammersmith. She noted that West Middlesex was a good hospital overall but asked whether it needed to be best in a specialist area.
In reply, Ms Docherty stressed that they were a district general not a specialist hospital. There were things which the hospital did well such as its maternity care and endoscopy, where positive reports were passed by word of mouth. She spoke of being linked to a specialist centre, for example for stroke, so that they could take people back appropriately. She stressed that the hospital would not be a site of specialist provision as the Imperial group but could be linked to tertiary specialist provision. Services might be reconfigured to allow this.
Tom Hayhoe further explained that there were links for all cardiologists joining from Imperial so that a patient might be seen by the same consultant as in an Imperial hospital. There were clinical links which provided real benefit and it was confirmed that over 20 consultants were joint funded with Imperial.
The Chair thanked Jacqueline Docherty, Tom Hayhoe, Andrew Murphy and Sue Jeffers for their time and thanked them for attending. They left the meeting at this point.