Agenda item

Lesley Dwyer (Chief Executive, Medway NHS Foundation Trust) and Glynis Alexander (Director of Communications, Medway NHS Foundation Trust) were in attendance for this item.

(1)       The Chair welcomed the guests to the Committee. Ms Dwyer began by stating that the Trust last provided an update to the Committee in October 2016 prior to the Trust’s exit from special measures. The Trust had been re-inspected by the CQC in April and May 2018 and the inspection report was anticipated in June. She noted that there were no areas of immediate concern. She reported that whilst the Trust was not consistently meeting the constitutional targets, particularly in relation to A&E performance, there were early signs of improvement. She highlighted the closure of an escalation ward which had been open since December 2014 and the Trust’s work with system partners to reduce the number of delayed transfers of care (DTOC); the Trust now had one of the lowest DTOC figures in the country and was sharing its learning with other systems.

(2)       Ms Dwyer noted that workforce and vacancies had been an issue for the Trust. The Trust’s ability to recruit had been particularly impacted when the Trust was in special measures. She reported that there had been a 3% increase in the number of substantive staff and a 11% decrease in the use of agency staff. She stated that the Trust had a challenging financial position with a reported £66.4 million deficit in 2017/18 which was one of the worst NHS deficits. She reported that the Trust had agreed a control total of £46.7 million for 2018/19 with NHS Improvement. She explained that the Trust was working with commissioners about services to be provided within the available budget. The Trust had developed a three-year recovery plan to return to a breakeven financial position.

(3)       Ms Dwyer reported that the Trust had commissioned a fire safety report from Kent Fire & Rescue Service which identified a number of risks and actions required which the Trust had implemented. She highlighted the Trust’s Better, Best, Brilliant improvement programme. She stated that she was confident that the Trust’s challenges could be addressed but stressed the importance of the wider healthcare system working together. 

(4)       Members enquired about integrated discharge planning, international recruitment, Kent & Medway Medical School and NHS bursaries.  Ms Dwyer explained that the Trust worked in conjunction with Virgin Health, Medway Community Health, the local authorities and commissioners to improve patient discharge. Ms Dwyer explained that the Trust had undertaken international recruitment campaigns, for nursing vacancies, via local, national and international routes. She noted that recruitment from the Philippines had been particularly successful; the Trust had provided support packages to integrate overseas workers into the community and to support language and fluency skills. She reported that the Trust had played an important role in influencing a change to the English Language Test set by the Nursing & Midwifery Council to ensure it was more realistic. Ms Dwyer noted that the new Medical school would help to attract aspiring doctors within the local community to build their career in Kent and would help to address the recruitment and retainment issues of skilled medical professionals within the South East region. Ms Dwyer stated that the impact of the removal of the NHS bursary had not yet been felt; the Trust was supporting clinical support workers who were converting to nursing with study leave.

(5)       In response to a specific question about the Medway area being identified as one of 32 risk areas due to below-average health outcomes and deficit-running NHS trusts, Ms Dwyer stated that in an area of increased health needs, in a system where there was a paucity of primary care services people would access services through the Emergency Department which would increase pressure on the Trust as there would be an increase to the number of people it delivered care to. Ms Dwyer noted that whilst Trust had a primary care practice on the hospital site, placing a GP surgery near the hospital, could help support the Trust. She reported that the Emergency Department saw an increase of 44 patients each day.

(6)       A Member sought assurance that the closure of escalation beds and reduction in capacity would not impact on the Trust’s ability to provide adequate services to the community. Ms Dwyer explained that hospitals operated most efficiently at 85% capacity. She confirmed that the 53 escalation beds had been closed to reinstate the day surgery at Medway Hospital. She noted that 90 of the Trust’s 154 surgical beds had been used by medical patients who could have been better cared for elsewhere. Ms Dwyer noted the Trust’s aspiration to be the site of a Hyper Acute Stroke Unit. She reported that the Medway site was the only unit currently seeing the correct number of patients and provided services to the largest conurbation in South East and had a demographic need. The Trust had appointed an additional Stroke Physician to improve performance for the local community in the interim whilst the decision was being made. 

(7)       Members enquired about support provided to new staff including accommodation. Ms Dwyer explained that the Trust initially provided short-term on-site accommodation for staff; as part of its support package, international staff were given advice about National Insurance contributions, private renting and banking. Ms Dwyer highlighted an initiative with the University of Greenwich, whereby nursing staff in the Emergency Department were able to gain credits towards a Masters, which had reduced turnover.  She noted that the Trust currently had nine physician associates and highlighted the role of nurse associates.

(8)       Members enquired about the deliverability of the financial recovery plan.  Ms Dwyer explained that the Trust was required to save £20 million each year for the next three years to breakeven. In order to do this, service reconfiguration would be required, and the Trust would not continue to provide all the services that it currently does. She noted that the Trust’s savings, in month two, was ahead of its financial recovery plan. She reported that additional areas of savings included pay ceilings for temporary staff across Kent and Medway and reduction in the number of administration roles through the use of technology. She confirmed that the Trust met regularly with the unions as part of the Trust’s Transformation Group.

(9)       The Chair congratulated the Trust on its progress in many areas but expressed concerns about the risks associated with the Trust’s financial recovery and the impact it would have on services.

(10)     RESOLVED that:

(a)       the report on Medway NHS Foundation Trust be noted;

(b)       the Trust be requested to provide a detailed report to the Committee on its financial recovery plan at the earliest opportunity.