Agenda item

(5 mins response to questions raised at previous meeting; 5 mins update presentation; 10 mins Members questions)

Satish Mathu (SM), Commercial Director, Heatherwood and Wexham Park Hospitals NHS Trust (HWPHT) and Paul Robinson (PR), Chief Finance Officer, HWPHT outlined a report setting out the current position regarding the Trust’s Strategic Plan ”Getting Better Together” and summarising the Trust’s  financial position to the end of August, 2010. 

PR discussed the statement of comprehensive income and advised that the reported in month deficit was in line with Plan.  In year the Trust had reported a deficit of £8.5m which was £600,000 behind the Plan.  There were clearly pressures within income pay and non-pay and the elements driving this related to the resolution of data quality issues following the implementation of PRP in late April.  There had been an £0.2m overspend on pay and it was noted that medical pay expenditure had increased steadily.  Long term sickness costs had driven up locum cover costs and there was a continued dependence on higher cost agency staff in midwifery.  The development of detailed plans would ensure that the current adverse position was recovered across the remainder of the year and there would be focus on areas such as maximising income recovery for work undertaken for the PCT. 

SM outlined a report on ,’Getting Better Together’ and reminded the Panel that in June 2009, HWPHT had identified a £20m deficit in its budget and financial forecasts for the current year.  Cost improvements had already been realised but the Trust still ended the financial year 2009/10 with a deficit of £9.9m.  The Trust was now in a position to proceed with the Strategic Plan which was refreshed in May 2010 and supported by ‘Monitor’, and which if successfully implemented would return the Trust to full financial viability and stability over next three years.  The strategy would realise a saving of £46.3m over three years and would place the Trust in a position of achieving a small surplus at the end of the period. 

It was anticipated that approximately 470 positions within the Trust would no longer be required as a result of cost efficiencies, restructuring, and process improvements that would be necessary to bring the organisation back to financial viability.  Measures in place to achieve these included tight management, the removal of bank and agency staff, the control of permanent and non-permanent recruitment and the approval of appointments to vacant posts. The Trust would seek to minimise compulsory redundancies and redeploy staff where possible. It was anticipated that the number of employees potentially displaced without roles in 2010 would be significantly lower than 470.  Consultation on the Turnaround Plan would last for 90 days and each proposed organisational change within the consultation would have a template showing the before and after proposals where there was an impact on permanent roles inside the Trust. 

Preventative measures had been put in place in July which included the cessation of all unnecessary spending across the Trust and for example, non-essential training had been stopped.  It was highlighted that there had been a freeze on clerical and admin staff since the beginning of the year.

The Panel thanked Mr Mathur and Mr Robinson for the updates provided.

In the ensuing debate Members raised a number of comments / questions as follows (responses in italics):-

• Of the potential 470 displaced staff, how many of these positions were administrative or managerial?

SM advised that he was unable to disclose the numbers until the process had been completed. 

• What percentage of the staff employed were from agencies?

SM did not have the figure to hand and this fluctuated on a daily basis.  He would provide a response and this would be circulated to Members.

• There was anecdotal evidence that there was sometimes a conflict between the amount of medication the hospital provided on release and the amount GPs provided.  Also an example was cited where a person had been asked to visit their GP for a blood test rather than have this at the hospital.  SM was asked to comment on this.

SM advised that he was very surprised if any such measures would be taken to save costs and the hospital was obliged to provide a number of days medicine when the patient was discharged.  He advised that he would look into this matter and provide the Panel with a response. 

• In what way had a large saving been made on drugs?

PR advised that the income was lower by £600,000 because less drugs had been prescribed. 

• How many vacancies were there within the 470 positions.

SM did not have this information to hand and would be forward it to the Panel.

• Of the 470 displaced positions, how many related to lower paid staff and how many to managers? 

SM was unable to disclose this information because although the positions had been examined, the process was at a sensitive stage. 

• How many vacancies were there amongst the 470 redundancies?

This figure was not available but it was not anticipated that 470 redundancies would be made.

• Within the paragraph on mitigation, what was meant by non-essential training? 

A lot of training was mandatory particularly nursing training.  An example of blocking non-essential training would be external courses provided for admin staff where the subject was not mandatory to deliver services.  Essential training covered areas such as health and safety where there was no option other than to provide the training. 

• How would the Trust respond if the government made further cuts in future years and what provision had been made for this?

SM advised that the aim of the Turnaround Plan was not only to eliminate the existing deficit but also to tie in with future required expected savings.  PR advised that the aim was to bring the organisation into balance and present a sustainable organisation at a reasonable cost.  Measures had been  included in the Plan going forward so that income in future years would be stable.

• Of the 470 positions that had been identified as no longer being required as a result of cost efficiencies – what percentage was this number of the total number of employees?

There were 3,500 full time equivalent employees; 470 equated to 12% (13.4%).

• There was evidence that a costly antiseptic wash was being used for patients – what was the related cost of this?

SM advised that he would forward the response to this question.

• There was evidence that Wexham Hospital employed agency porters – why was this necessary?

SM was unable to respond to this question as he did not have the detail to hand but would forward his response to the Panel.

• How far short was the Trust in meeting its savings for this year?

PR advised that the unmet savings would be recovered in the latter part of the year. 

• It had been disclosed that a number of Consultants were initially unhappy about the changes that would be implemented through the Turnaround Plan – were the Consultants still of the same opinion?

It was evident that some Consultants still had some concerns but it was felt that their reservations were not as strong as they were six months previously.  It was highlighted that the Trust was not closing beds and that of the 558 total bed stock, the beds would  be opened and closed depending on demand.  Traditionally in summer months the demand  reduced and beds would be closed in these circumstances.

• What mechanisms were there in place to act in response to Clinicians concerns?

SM advised that there was an open approach with all stakeholders and a monthly meeting was held with Clinical Directors.  There was a continual two way discussion to review key issues and the Chief Executive and Chairman of the Trust were available to staff at any time  to discuss matters of concern. It was reported that the Secretary of State had visited the Trust on that morning and met Consultants. The  visit had gone well.

• It was hoped that where people expressed a desire to not continue working that this would be facilitated?

It was confirmed that this would be the case.

Resolved -  That the Panel notes the update provided and requests that the Commercial Director provide a written response to the following questions, some of which remain outstanding since the June Panel meeting:

a)  How many of the proposed 470 posts at risk are vacancies and how many of the 470 posts are being covered by agency staff?

b)  How many agency porters are being used by the Trust and what percentage is this of the total number of porters on-site?

c)  How many staff are likely to be affected by redeployment?

d)  What is the agreed procedure for the taking of blood tests and the provision, timescale and analysis of those results?

e)  Are sufficient quantities of drugs being supplied to patients at the time they are discharged so that they are not required to seek additional top-up supplies of those drugs from their local GP?

f)  To give a written assurance that patients are not being and will not be discharged earlier than medical advice recommendations.

g)  How many patients are readmitted within 30 days following discharge?

h)  What is procedure relating to the locating of sterilising hand scrub bottles and the Trust’s subsequent policy and method of the discharge of bottles and at what point are they replenished (i.e. when each bottle is 50% empty, 75% empty, etc)?