Agenda item

(Mr Mark Devlin, Chief Executive, Ms Susan Acott, Director of Performance and Service Development, and Ms Jenny Kay, Director of Nursing and Workforce, Dartford & Gravesham NHS Trust, were in attendance for this item)

(1)       The Chairman welcomed Mr Devlin, Ms Acott and Ms Kay to the meeting. 

(2)       Mr Devlin referred to the paper produced by the Trust, which had been circulated with the agenda for the meeting, and gave some background to the Foundation Trust application.  He stated that he was primarily looking for views on the Trust’s proposed service strategy in terms of the areas of service that the NHS Overview and Scrutiny Committee might like to see developed.  He pointed out that it was proposed to give the County Council the opportunity to be represented on the Foundation Trust’s Council of Governors.

(3)       Members then asked Mr Devlin and his colleagues a number of questions in relation to the financial status of the Trust, the rationale for Foundation Trust status and the future relationship of a Foundation Trust with the NHS Overview and Scrutiny Committee as regards accountability.

(4)       Mr Devlin gave assurances about the financial status of the Trust and stated that the Trust Board would not be proceeding with the Foundation Trust status application if they were not confident of their financial situation. He confirmed that the Trust had moved from a £4 million in-year deficit (equivalent to 4% of turnover) in 2005–6 to an in-year surplus of £250,000 in 2006–7. The Trust still had a £1.8 million underlying deficit (resulting from the Resource Accounting and Budgeting regime, which had now been removed from the NHS), but anticipated clearing this in the next two years by means of achieving further in-year surpluses. An in-year surplus of £500,000 was anticipated in the 2007–8 financial year. Responding to a question on what management action had been taken to move from deficit to surplus, Mr Devlin explained that this had had a series of strands. Expenditure on pay had been curtailed by means of reducing temporary (bank and agency) appointments, carrying out a workforce review and making a number of posts redundant.  Mr Devlin said that a very aggressive programme of redeployment had meant that few individual members of staff had been put at risk of redundancy.  In response to a question on what arrangements there were if a Foundation Trust went into deficit, Mr Devlin replied that the NHS would still act as a guarantor regarding repayment of any debts and that the Foundation Trust would have to demonstrate to “Monitor”, the regulatory body, that they could service any loans that they sought.  He emphasised that as a PFI hospital they had only a small number of assets that they actually owned and therefore the issue of the Foundation Trust being able to sell off assets would not arise.

(5)       Mr Devlin was asked whether the Trust would be aiming for services currently provided at London hospitals to be provided by Darent Valley Hospital.  He confirmed that the Trust had good links with the London teaching hospitals of Guy’s and St. Thomas’s, which were also run by a Foundation Trust, and that his Trust shared consultants with those hospitals.  He stated that his Trust wanted to maintain links with them while aiming to offer more services at Darent Valley Hospital.

(6)       In response to a question on the impact of the Trust’s PFI contract on its finances, Mr Devlin said the PFI had given the Trust a 21st-Century building in which to provide 21st-Century healthcare. He confirmed that he had modelled the costs of the PFI contract on the future budget and he was confident that they could manage the costs. The PFI contract represented a fixed cost and the Trust’s income was growing. A few years ago, the cost of the PFI contract had amounted to 19.5% of the Trust’s turnover; that figure was now 17.5%.

(7)       Mr Devlin said that the Trust was sincere about its relationship with local government. This was shown by the fact that it had offered two places for local authority representatives on the Council of Governors – which they did not have to do.  Ms Kay confirmed that the Foundation Trust would still have a duty to consult on service reconfigurations and such consultation would involve the NHS Overview and Scrutiny Committee.  She reminded the Committee that their history had been one of openness and engagement and they were intent on carrying this on.

(8)       The Chairman stated that the issue of appointing Governors to represent KCC was not a matter for the Committee but that the appointments would be made by the Council’s Executive.  Mr Devlin confirmed that he was not expecting a decision on this from the meeting but had mentioned it to keep the NHS Overview and Scrutiny Committee abreast of progress.  The aim of bringing this paper to the meeting was to give the Committee the opportunity to influence matters.

(9)       In response to a question on the statutory “cap” on the amount of money that could be made from private patients by Foundation Trusts, Mr Devlin said that this was to stop Foundation Trusts “privatising by stealth”. There was no scope for his Trust to grow this part of their service and they had no intention of doing this anyway, as they wanted to provide an NHS service for their patients.

(10)     Regarding the impact of market forces arising from Patient Choice, Mr Devlin stated that, while patients did have a choice, his Trust and the Medway NHS Trust (which was also on the way to becoming a Foundation Trust) actually co-operated closely and did not seek to destabilise each other.

(11)     In relation to the Trust’s membership strategy, he confirmed that in order to engage with potential members,  forums had been held in a number of pubs in the area; and when people came to the hospital they were given the opportunity to become members.

(12)     He stated that the staff in Darent Valley Hospital were proud of their hospital and would like to have the opportunity to be the first Foundation Trust in Kent – which would be motivating for staff, and help retain and attract staff.

(13)     Mr Devlin reaffirmed that his Trust worked in partnership with other hospital Trusts and was not looking to take over, for example the specialist cancer services that were provided in Maidstone.  The aim was that elements of care that could be provided locally should be and that specialist care would still be provided in specialist centres.  He stated that the watchword was “partnership”.

(14)     Dr Robinson stated that the Trust had not had much time to develop since its 2006 Foundation Trust status application, but it was providing excellent services.  It had repatriated cancer services, developed a Heart Centre and expanded maternity services, with a new midwife-led unit opening.  He believed that this was the sort of thing that the Committee should be looking at in relation to the Foundation Trust application and that the Trust should be congratulated on these developments.  Mr Devlin confirmed that the areas of service that the Trust had developed and grown were for local people and were flexible.  The Foundation Trust would invest in services and the question that the NHS Overview and Scrutiny Committee was being asked was whether these were the right services to provide.

(15)     The Chairman stated that he would like to have further discussion in relation to the outstanding issues regarding accountability of Foundation Trusts; and that the matter of appointment of Governors would be referred to the Executive.  On the issue of the accountability of the Trust and the role of the Committee, he expressed his thanks to Mr Devlin for saying that he wanted to work closely with the Committee. If the Trust was successful in its application, the Chairman looked forward to seeing him back at a Committee meeting.  In relation to the appointment of Governors, a feedback mechanism to the Committee should be established.

(16)     It was noted that further comments from parish councils, submitted after the papers for the meeting had been despatched, had been tabled.

(17)     The Chairman moved that the Committee reassert its unanimous decision made in 2006 to support the Foundation Trust application by Dartford and Gravesham NHS Trust.  The matter was put to the vote with 10 votes for the motion, three abstentions and one vote against.

(18)     RESOLVED that the Committee reassert its support for the Foundation Trust application by Dartford and Gravesham NHS Trust.