Agenda item

Philip Greenhill (Interim Deputy Chief Executive, Kent Community Health NHS Trust), Chris Wright (Interim Director of Finance, Kent Community Health NHS Trust), Oena Windibank (Interim Director of Operations – East, Kent Community Health NHS Trust), Marie Dodd (Acting Chief Executive, Kent and Medway NHS and Social Care Partnership Trust), James Sinclair (Director of Partnerships and Social Care, Kent and Medway NHS and Social Care Partnership Trust ), Geraint Davies (Director of Commercial Services, South East Coast Ambulance Service NHS Foundation Trust), Robert Bell (Acting Director of Finance, South East Coast Ambulance Service NHS Foundation Trust) were in attendance for this item.

(1)       The Chairman introduced the item and explained that this was the third and final meeting in a series examining NHS Financial Sustainability and that the Trusts present would be invited to provide an overview from their perspective.

(2)       Philip Greenhill from the Kent Community Health NHS Trust began with the information that the Trust employed 5,700 staff and had a budget of around £200 million. They needed to find £14 million in efficiency savings. Most of the income for the Trust came from block contracts but the value of these had been reduced by 1.5% which equated to a £2.6 million cost pressure. There were also cost pressures because of pay uplifts and high cost drugs. Part of the solution was in back office savings but the biggest was in workforce productivity and this was being examined as the Trust was carrying out the largest community services staff study in England. Nationally, district nurses spend 22% of their time with patients; Kent has managed to increase this to 45-46%. Another area is improving community hospital throughput. The biggest cost pressure was identified as demand in the acute sector as the tariff increases the cost with activity. Both community services and social services have a role to play in reducing demand, as does the new 111 number which will assist in getting the entry point for patients correct.

(3)       Responding to a particular question about the hospital at home scheme run in Medway, it was explained that this did not involve a double-payment as the service was provided by Medway NHS Foundation Trust and paid for out of the tariff paid to the hospital before the patient is discharged to the care of his or her GP.

(4)       It was further explained that the £14 million which the Community Health Trust needed to find was 8% of the revenue budget. This provided part of the context within which the Trust was embarking on the journey to Foundation Trust status because attaining FT status meant there was more freedom to focus on the right financial strategies.

(5)       On the subject of the Minor Injuries Unit at Sheerness it was explained that this was only a temporary closure on safety grounds and that it was back open 9am to 9pm Monday to Friday and would be open at the weekend again soon. More broadly on the subject of community hospitals, it was explained that the whole of community services support the work the community hospitals undertake, rather than the hospitals causing funds to be diverted from elsewhere.

(6)       Marie Dodd outlined the issues for the Kent and Medway NHS and Social Care Partnership Trust as being roughly similar to those in the community health sector. The block contracts were also facing a 1.5% reduction in value and there was a 4% savings, with £13.2 million efficiency savings to find and a £2.9 million QIPP negotiation with commissioners in order to find money for reinvestment. Similarly there were also pay uplifts. There was also a need for investments in Information Technology; currently there were two systems, a paper and an IT record system and this needed unifying.

(7)       The main policy drivers were in early intervention, with money invested in a second Crisis Resolution Home Treatment Team in East Kent last year as coverage there had not been as full as in Medway and West Kent. NICE guidance around the use of dementia medicine earlier has had a £3 million cost impact. Work is ongoing with the Police and Ambulance Trust on making sure people did not end up in the wrong place; there had been a big rise in the use of 136 suites, but only 20% of people ended up being detained under the Mental Health Act. There was also a project being undertaken with Kent County Council involving housing and support to move people from inpatient facilities to community ones. The Trust had 3,600 staff with 90 off on long term sick leave.

(8)       The issue of sick leave at the Trust was picked up by Members, specifically around long term sickness rates within the Thanet teams. Marie Dodd undertook to find out detailed information and pass it on to the Committee Researcher. More broadly, the long term sickness rate at the Trust was 4.5% which was higher than the NHS as a whole, due to staff being attacked on duty, but average for the mental health sector.

(9)       Moving forwards, money for mental health would still reside within the NHS and useful discussions were underway with future GP commissioners; they had, for example, approved the move from Ashford to Canterbury. The Strategic Health Authority had approved the capital spend for the St. Martin’s development for 2013.

(10)     On dementia services, the Mental Health Trust picked up referrals after it had been identified by GPs and had fully trained staff for assessments. The Community Services Trust explained that community nurses were trained to identify dementia and early intervention was being included in the training programme.

(11)     Geraint Davies gave a short overview of the situation of the South East Coast Ambulance Service NHS Foundation Trust. As part of achieving Foundation Trust status, the organisation needed to have a 5 year viable plan. The turnover is £165 million and has a £10 million cost improvement programme. The Trust has around 3,000 staff.

(12)     The Ambulance Trust is looking to build on the work it has undertaken with NHS Pathways to provide a single point of access service directing people to the right place at the right time. It was currently talking to Primary Care Trusts on this and the 111 service would be tendered under the Any Qualified Provider model. The ambulance service was paid for on cost and volume contracts rather than block contracts, and a local PbR tariff was being developed.

(13)     In response to a question on the co-responders scheme with the Fire Service, Geraint Davies explained that the Trust had funded the scheme to the sum of £90,000, but it has been decided not to continue with it because it was not best for patients.

(14)     Dealing with some specific questions on the ambulance service, it was explained that the Make Ready programme had been funded from the Trust’s own resources. If necessary, a Foundation Trust was able to borrow money, under strict controls.

(15)     Across all Trusts there was a feeling that the block contract was not the most helpful funding mechanism and there was a need to hold the whole health economy to account for delivering complete pathways of care. This would help ensure efficiencies with patients seeing the right people at the right time.

(16)     The Chairman thanked the Committee’s guests for the useful and open discussion and asked Committee Members to forward any suggestions for recommendations on NHS Financial Stability to the Officers supporting the Committee.

(17)     AGREED that Members delegate authority to the Head of Democratic Services in consultation with the Chairman, Vice-Chairman and Group Spokesmen to prepare a list of recommendations to present to a future meeting of the Committee for discussion and agreement prior to their submission to the NHS for a response.

(18)     AGREED that Members assist this process by suggesting recommendations to the Committee Officers following each meeting.