To Follow.
Minutes:
The Sub-Committee received a presentation from Matthew Trainer, Managing Director: Princess Royal University Hospital (PRUH) and South Sites and Lisa Hollins, Executive Director: Transformation and ICT (King’s) providing an update on the progress of the Trust and the PRUH Improvement Plan.
King’s College Hospital NHS Foundation Trust had been placed in Financial Special Measures by NHS Improvement on 11th December 2017 due to a forecast year-end deficit of £92.2M for 2017/18, compared to a planned year-end deficit of £38.8M. The deficit had increased as a result of many factors including overly optimistic planning assumptions for income growth and cost savings for 2017/18, and operational challenges for non-elective and urgent care caused by increasing demand for services. Work was underway to address the deficit including Financial Planning for 2018/19 and the development of a five year strategy for the Trust. A programme had also been launched in partnership with the NHS Improvement Productivity Team with the aim of delivering rapid quality and productivity improvement across Trauma and Orthopaedic services, with subsequent phases planned for Ophthalmology, Neurosciences and the Back Office. An update on the Productivity Improvement Programme would be reported to a future meeting of the Health Scrutiny Sub-Committee.
With regard to the PRUH, Emergency Department performance continued to improve with an aggregate performance of 84.9% in January 2018 against 76.3% on the previous year, although this was not a like-for-like comparison. Performance against the 62 day GP referral target for cancer treatment was 89.3% in January 2018 which exceeded the 85% target, and performance was being maintained across Referral to Treatment times, with the number of patients waiting over 52 weeks for treatment decreasing significantly over the past year to just three patients in January 2018. The Trust had a national ranking of 19 out of 123 Trusts which placed it in the top fifth of Trusts in terms of performance, and had performed well on the national Summary Hospital Mortality Index with a score of 90.5% as at December 2017. Friends and Family test satisfaction scores remained high across the Trust at 90% and 86% for Inpatient and Outpatient services respectively for September 2017. Recruitment continued to be an area of key focus and the overall vacancy rate had reduced to 12.1% for January 2018. A “Future State” vision had been developed for the planned transformation of Outpatient’s services, and a range of key local digital drivers had also been identified to support the completion of the full integration of Electronic Records across the Trust, which included local care records and electronic prescribing. A recent Care Quality Commission Inspection of the PRUH had found no ‘Inadequate’ services and had rated the majority of services as ‘Good’ with one ‘Outstanding’ area, although the overall rating remained ‘Requires Improvement’.
In considering the update, the Chairman asked how the financial position at the PRUH might affect service delivery. The Managing Director: PRUH and South Sites confirmed that whilst there may be future changes to some services, there were no plans to reduce the core service offer of the PRUH which encompassed a wide range of provision including the Emergency Department, elective surgery and maternity services. On a recent visit, Health Education England had described the Paediatric Department as the “jewel in the crown” of the PRUH following significant investment in the service. A number of key capital investment programmes had been developed for the PRUH with the aim of improving efficiency and performance. This included an expansion of the Emergency Department to increase the number of resuscitation bays and critical care beds, and works to provide additional ambulance bays and improve car parking facilities. The Executive Director: Transformation and ICT (King’s) reported that additional capital funds had been made available to the PRUH for the 2017/18 financial year. Work was underway to identify if these funds could be carried forward to support key capital investment programmes for 2018/19, but if this was not possible the funding would be invested in other planned projects including the purchase of specialist equipment.
In response to a question from a Member, the Managing Director: PRUH and South Sites confirmed that it would be very difficult to address the projected deficit of £92.2M, particularly as demand for health services in South East London continued to increase. The Trust would continue to engage with the Sustainability and Transformation Plan for South East London and to lobby for funding which reflected the level of service demand; however, there was also a need for the Trust to work closely with Social Care services to ensure that people received the appropriate level of support for their health and care needs. A Member highlighted that there were some areas of historical deficit relating to under-charging between the Trust and clinical commissioning groups across South East London, and stressed the need for key programmes to continue to be supported, including the Better Care Fund. The Managing Director: PRUH and South Sites advised that the PRUH would continue to work closely with all health and social care partners including the Bromley Clinical Commissioning Group, Local Authority and GP Alliance to deliver a robust health and social care offer across the Borough, and that programmes such as the Transfer of Care Bureau had been very effective in reducing unnecessary hospital stays. Another Member emphasised the high number of Emergency Department attendances by a cohort of frail older people, and suggested that this be addressed through further developing the community services offer across the Borough, including specialist nursing home provision.
The Chairman led Members in thanking Matthew Trainer and Lisa Hollins for their presentation which is attached at Appendix A.
RESOLVED that the update be noted.