Agenda item

Susan Acott (Chief Executive, Dartford and Gravesham NHS Trust) was in attendance for this item.

(1)       The Chairman introduced the item and asked the Committee’s guest to provide an overview.

(2)       Susan Acott began by giving tribute to Mr Michael Snelling, and echoed the comments made earlier.

(3)       Moving on to the substantive matter under discussion, the decision of the Co-operation and Competition (CCP) to approve the merger subject to work being undertaken around choice in urology services was one important event to have occurred recently. In response to a question, it was clarified that endocrine services were also highlighted but this is a very small practice area with only two surgeons in Kent operating in this area. The CCP looked at services purely from an economic perspective, not clinical. Urology is a big area financially and in terms of clinical activity. Urology had previously been centralised at Medway NHS Foundation Trust (MFT) and East Kent Hospitals. The conflict between clinical and financial drives was being resolved by local commissioners agreeing to monitor the situation.

(4)       More broadly than these two services, the image of a pyramid was used to describe those services which needed to be centralised in order to deliver a safe service as being at the top, and other services which could be delivered more locally at the bottom. The Trusts were aiming to make sure the line between the top and bottom of the pyramid was as high as possible. 

(5)       An Integrated Business Plan for the merger had been produced but the final approval for each Trust to merge with the other would go by two different routes. As a Foundation Trust, MFT would need the approval of Monitor. Monitor was currently reviewing the improvement trajectory of MFT in relation to a breach of its Term of Authorisation and there was a board meeting with Monitor coming up the following week. Monitor was due to conclude and make a recommendation on the merger proceeding by mid February. Dartford and Gravesham NHS Trust (DGH) was not a Foundation Trust and needed Department of Health approval. The dissolution of DGH would also be subject to a Parliamentary process. The anticipated date of merger was now late spring or June. The first meeting of the shadow/designate board had occurred this week.

(6)       A specific question was raised about estates, referring to p.57 of the Agenda. Then explanation was given that much of the MFT estate was old and not appropriate for delivering clinical services, but that it still cost money. Options were being considered, including renting rather than selling parts of the estate. 55% of the estate at DGH was used for clinical services and it was planned to increase this.

(7)       Weekend service coverage was the subject of another specific question. In response it was explained that this was an area where the benefits of merger could be set out. DGH currently provided 24/7 emergency surgery coverage for GI (gastrointestinal) bleeds but MFT did not. Merging would enable the emergency surgery rota to be covered across 8 surgeons, up from 4 at DGH currently. This would make the service more sustainable and enable 24/7 coverage of both sites.

(8)       The implications of the draft report of the Trust Special Administrator of South London Healthcare NHS Trust were also discussed. This had been a merger of three very inefficient Trusts, whereas DGH was in fact one of the more efficient Trusts in the country when measured by EBITDA (Earnings Before Interest, Taxes, Depreciation and Amortization). The future of the Queen Mary's site in Sidcup (QMS) directly involved DGH. One recommendation was for Oxleas NHS Trust, a provider of mental health and community health services to take over the site, but for other providers to provide some services there. QMS was ten miles from DGH and the working relationship was a good one. A related recommendation was for DGH to provide day surgery at QMS. The estate was of good quality and it was seen as a positive for the Trust as day surgery was less likely to be subject to cancellations as QMS did not have an accident and emergency department (A&E). This would mean more certainty for patients and the Trust. In terms of capacity, the Trust had previously been able to cope with the closure of the QMS A&E at short notice, although changes had been made to the A&E at DGH and more were planned, such as expanding the waiting area. In maternity services as well, numbers were higher than originally thought but the Trust was adapting.

(9)       More generally, lessons had been learnt from this South London and other mergers. A post-merger dip is always anticipated, but the two Trusts were looking to mitigate this as much as possible. Clinical directors ran both hospitals in service sectors, and this would be double-run for a period after the merger. In addition, the Board would have two medical directors, one from each site, to ensure the clinical perspectives of both were recognised at the highest level.

(10)     The Trust was reminded that some services at both sites were provided by other Trusts, and this would be likely to continue. Plastic surgery, for example, was provided by Queen Victoria Hospital in East Grinstead. Radiotherapy was currently provided centrally by Guy’s Hospital, but there was currently a radiotherapy review in Kent and this might lead to a federated structure with better access in North Kent.

(11)     The Chairman proposed the following recommendation:

·        That the Committee thanks its guest for her valuable contribution and looks forward to further updates at the next stage in this process.

(12)     AGREED that the Committee thanks its guest for her valuable contribution and looks forward to further updates at the next stage in this process.