Agenda item

Susan Acott (Chief Executive, Dartford and Gravesham NHS Trust) and Mark Devlin (Chief Executive, Medway NHS Foundation Trust), and Dr Amanda Morrice (Clinical Director of Accident and Emergency, Medway NHS Foundation Trust) were in attendance for this item.

(1)       Members of the Committee had previously discussed this topic on 22 July 2011 and the Chief Executives of both Trusts began by saying they were glad to have the opportunity to provide a further update.

(2)       The overall vision for combining the two Trusts was to develop a platform to provide health services to a combined population of around 630,000 and increase the number of specialist services available in Kent and Medway as well as maintaining current services. The broader context was that two medium sized district general hospitals such as Medway NHS Foundation Trust (MFT) and Dartford and Gravesham NHS Trust (DGH) had sustainability issues in the current climate of flat funding and reductions to the tariff coupled with a shift of emphasis towards health service provision in the community and not Acute settings. This meant the Acute sector as a whole had to be smaller but work harder. There was also a national policy drive that all NHS Trusts achieve Foundation Trust status, which MFT had achieved but DGH had not.

(3)       A number of Members made related points about the point of devoting effort to merging when there were other priorities, as well as the need to make certain that the merger did not lead to a diminution of the number and range of services currently available. The Chief Executives of both Trusts stressed that the Trusts were not looking to reduce services and focussed on four key services which would remain on both sites. These were consultant led accident and emergency departments, maternity services, children’s services and outpatient services. The population base was increasing in north Kent which meant that the services would remain viable. In addition to which any changes to service provision would need to be brought to the Committee. The aim was to repatriate some services currently only available in London. One Member indicated that many people in the area found it easier to access tertiary services in London and the reply was given that this was part of what the current consultative process was looking at. NHS representatives highlighted the need to continue to deliver services safely and indicated the evidence that combining clinical teams lead to more sustainable and effective health care.

(4)       It was pointed out that cooperation in delivering services across the two Trusts was already well established. MFT delivered the dermatology and ear, nose and throat (ENT) services at DGH and urology services had been consolidated at MFT so that while services were delivered on both sites, when a patient needed surgery, consultants went to MFT to carry it out.

(5)       One Member commented that the report provided by the Trusts was perhaps overly optimistic and requested fuller detail about the savings and efficiencies required. A number of specific points about finances came out during the debate. £30 million in savings were to come from £10 million in new revenue and £20 from savings in areas like reducing length of stay and patients missing appointments. £15 million pounds over 3 years for reinvestment in services were to be found from back office efficiencies from the two Trusts coming together and only having 1 Board, HR department and so on. In response to a specific question it was clarified that pathology did not count as a back office function.

(6)       Both Trusts had different estate related issues. The challenge posed by the £24 million maintenance backlog at MFT was highlighted by Members and the plans for better use of what were often quite old buildings conceded by the Chief Executive. Plans to move services into the main building and administration offices out of them were outlined. Darent Valley Hospital was built under the Private Finance Initiative (PFI) scheme and this meant a certain level of ongoing payment was required. The recent closure of services at Queen Mary’s hospital in Sidcup meant DGH had no spare capacity with which to undertake private work. The Trust was 1 of 22 included in the McKinsey review commissioned by the Department of health to look at those Trusts for whom the costs of a PFI was likely to be a barrier to achieving Foundation Trust status. It was 1 of 6 out of these 22 which was regarded as being able to make progress through efficiency savings which meant the Trust was receiving support, but no additional money.

(7)       Members raised the question as to whether the process was a foregone conclusion and both Chief Executives outlined the numerous stages which meant the outcome was not predetermined. The Co-operation and Competition Panel needed to examine whether the merger was anti-competitive; Monitor had a large role to play as MFT was a Foundation Trust and the Department of Health likewise with regards DGH. In response to a specific question it was confirmed that at present the timeline on p.48 of the Agenda was accurate and on track.

(8)       There was also a need to ensure patient and public engagement. It was clarified that the list of organisations on pp.52-54 of the Agenda were voluntary groups and local authorities were also being included. One Member reported that the two Trusts had attended the Gravesham Locality Board that week. There had also been two LINk meetings and Mr. Fittock undertook to provide the questions from LINk to the Trusts to Members of the Committee along with the answers when available. The Trusts’ intention was to continue the current widespread consultative exercise until 29 February next year. This would be followed by a stocktaking exercise with the process resuming towards the end of March.

(9)       AGREED that the Committee note the report and that representatives from both Trusts be invited to return on this topic at an appropriate future date.