Agenda item

Representatives of the Stockport NHS Foundation Trust will attend the meeting to update the Scrutiny Committee on the implementation of the Trust’s Financial Improvement Plan and provide an update on developments with Urgent Care.

Officer contact: Jonathan Vali, 0161 474 3201, jonathan.vali@stockport.gov.uk

Ann Barnes (Chief Executive), Sue Toal (Acting Chief Operating Officer) and Feroz Patel (Director of Finance) from Stockport NHS Foundation Trust attended the meeting and made a presentation on (i) the Trust’s ongoing work to improve urgent care flow and improve performance against the 4-hour admission target, and (ii) the implementation of the Trust’s Financial Improvement Plan.

The first part of the presentation covered the following areas:-

·         The challenges at Stepping Hill were reflective of national and Greater Manchester trend, with the health and care system under increasing pressure.

·         The types of work being done to address performance relating to the target included preventing unnecessary admission at the Hospital included enhanced triage arrangements, expanded ambulatory care provision, ‘decongestion’ of the Emergency Department during surges in attendance, and streaming patients more quickly to appropriate clinicians. This had been facilitated through external support and excellent internal engagement with staff. The new building at the hospital had improved the flexibility within the site to deploy staff where needed.

·         Performance had been on an upward trajectory since September, and it was anticipated that performance in November will have been at 80% of target.

·         There was an ongoing challenge of increasing attendances, and significantly finding appropriate facilities/ support into which acute patients could be discharge. A whole economy approach was needed to address this latter challenge, although the Trust itself was taking steps such as planning discharge on admission and ‘discharge to assess’.

Councillors asked questions and made comments, including:-

·         How sustainable were the initiatives/ improvements that had been put in place? In response, it was stated that these initiatives were not short term fixes but were expected to provide long term sustainable improvements. Provision had been made to allow the hospital to better respond to increases in demand.

·         Concerns were expressed about ‘discharge to assess’ and where the balance was between discharging and not when a patient had complex needs. In response it was stated that the process was not intended to discharge patients into a permanent care setting, but rather into a more natural environment for them so as to better understand their needs, be that in their own home or an intermediate setting, rather than an acute hospital bed which often led to additional challenges such as deconditioning.

·         Had there been a culture change at the hospital that had contributed to the changes? In response it was acknowledged that this was the case, which had partly been the result of changes in leadership. The new building had allowed for the co-location of urgent care facilities to improve responsiveness.

·         How engaged and supportive were staff in the change process? In response it was stated that those staff immediately affected or involved had been very supportive as they were able to see the benefit of the changes, although it was acknowledged that work would continue to involve staff in the transformative agenda. The physical changes to the configuration of the hospital had also contributed to the sense of improvement as the quality of the accommodation now matched the high quality of the staff.

·         How was the Trust managing the expectation of patients, given the changing focus? In response it was stated that working with the Emergency Care Improvement Programme and their Safer Start campaign, the hospital were using the steps to better understand the needs of patients and for staff to overcome their natural inclination to ‘keep hold’ of patients beyond the point at which their hospital stay was beneficial.

·         Was there sufficient capacity within the processes to cope to the expected winter surge in demand? In response it was acknowledge that the scheme had only recently begun, and recruitment was ongoing, but that early indications were that over the course of the winter the hospital would be able to ‘hold its own’.

·         What was the scope for horizontal integration to share capacity with other local hospitals in the area when Stockport faced particular pressure due to the demographic profile of local residents? In response, it was acknowledged that serious outbreaks of infection, such as flu, would often put strain on planned care as resources were moved toward critical care which was why there was such an emphasis on prevention. Work across Greater Manchester was ongoing to standardise hospital services and Trusts often transferred patients to specialist services in case that warranted it. A challenge to the type of horizontal integration being suggested was the problems it may create for visitors, and the consequential impact the isolation of patients from loved ones may have on recovery.

·         The importance of intermediate care to facilitate and support patients following discharge or to prevent escalation of need was emphasised. In response the value of third sector support was acknowledged. One of the first elements of the Stockport Together changes was to commission support services from the Third Sector to support discharge, working with patients even before admission.

·         Experience of being referred to hospital radiography demonstrates the scope for all parts of the health and social care system to work better to find the most appropriate and efficient care pathways. In response it was stated that this was the very point of Stockport Together. The possible creation of the accountable care trust would further overcome the silos that parts of the system still operated within, and allow for more efficient allocation of resources. As a single care organisation the current services provided to primary care should become even more efficient.

·         Although there was significant publicity given to the 4-hour admission target, were there other measures that should be considered or given greater consideration? In response it was stated that one of the key aims of Stockport Together was to move toward an outcome based system that took account of a wider set of metrics that would include quality measures. However, it was emphasised that there was evidence that those who spent longer than 4 hours for admission had less good final outcomes, and this measure was also a good indicator of wider system performance. As different contractual arrangements for population level care were entered into, greater emphasis would be given to outcomes rather than simply focussing on services output measures. Ensuring appropriate care in an appropriate setting was a key measure to ensuring that flow was managed through the system.

The second part of the presentation covered the following areas:-

·           The Trust’s current financial situation, including the forecast deficit prior to the start of the Cost Improvement Plan.

·           The historic performance of the Trust, and the changing pattern meaning that cost/ expenditure/demand were outstripping income leading to a cumulative deficit.

·           There had been a growth in demand at the hospital, but income from this had not been as high. Due to regulatory requirements relating to minimum standards this might require the use of more expensive agency staff.

·           The need to provide unplanned crisis care displaced planned activity that was the source of the Trust’s income.

·           The Trust had overachieved on its deficit target up to October, although it was anticipated that expenditure would increase and the planned deficit target had therefore been revised. In recognition of the positive performance steps taken to address the deficit, the Trust would be receiving approximately £5m from NHS England.

·           The challenge for the Trust was to address a cumulative deficit while managing increasing demand and pressure on resources.

Councillors asked questions and made comments, including:-

·         What was the impact of the KPMG involvement delivering the Financial Improvement Programme? In response it was stated that following the decision of the Trust Board to seek support to address the challenging control target, the additional support from NHS England and KPMG had provided additional focus or ‘grip’ within the Trust on tackling expenditure in a range of areas and in differing ways, some of which would be recurrent, others not. The Trust, with support from KPMG had been able to implement efficiencies in a range of areas, such as control of agency spend, that was seeing dramatic improvements in financial performance but also in safety and quality.

·         Was the deficit reduction activity recurrent or non-recurrent savings? In response it was stated that the savings could be seen as falling within three broad areas: immediate non-recurrent savings; medium term savings through better resource utilisation and controlling spend, and long term savings through to transformative work such as Stockport Together.

RESOLVED – That Ann Barnes, Sue Toal and Feroz Patel be thanked for their attendance and presentation.