Agenda item

Please find enclosed a presentation.

The chair asked NHS colleagues to introduce themselves:

·  Alan Goldsman – Chief Financial Officer, Kings College Hospital NHS Foundation Trust

·  Andrew Bland – STP Lead, Chief Officer for Southwark CCG & AO for Southwark, Greenwich and Bexley CCG

·  Angela Bhan – Chief Officer, Bromley CCG & STP SRO for Urgent & Emergency The chair invited NHS colleagues to run through the presentation circulated with the agenda papers. The committee was then invited to ask questions.

A member asked what figure the Trust is being fined for not meeting targets. The chief financial officer said it was about 4 million. A member said that they thought this was perverse, particularly when there are matters outside of the control of King’s: e.g. winter pressures and delayed discharge. He asked if there was more that local authorities could do to alleviate the pressures though social care and public health, while noting that councils obviously have their own pressures. He said that in particular he understands that in the region of 20% older people are not being discharged promptly, therefore perhaps collaborative work to improve this would be helpful.

CCG officer said that the fines are usually imposed in the context of a commissioner reinvestment; the CCGs do try and mitigate the impact, but they cannot speak for national NHS commissioner plans and policy. They did agree that variations and failures frequently reflect system failures. In terms of improvement discharge is important; however delayed transfers are in the region of 10 per day - not 20 %. The CCGs have a number of admission avoidance schemes to keep people well in the community, and CCGs also have work streams focused on complex patients. The member clarified that he was referring to 20% of older people facing delayed discharge. The CCG officer agreed that older people do have a range of complex needs that often need to be met and this can increase delays.

A member asked how the non – executive voice is engaged. The Trust has an Audit Committee. Is there any consultancy? The NHS do have PWC involved supporting the Trust with financial planning.

A member asked if there was enough due diligence with Princess Royal University Hospital (PRUH), given King’s is a big business. She asked if the Trust have people of the right calibre. Kings said that they are presently conducting a wide consultation on the plan to improve the Trust’s financial position, in order to encourage clinical and managerial engagement and accountability. The Chief Financial Officer said that it is important to be transparent, and discuss issues openly. They intend to continue to secure the present high level of clinical and management engagement. He said there is short term financial input and the Trust is working to strengthen the financial function going forward, this will focus on developing the Trusts own capability by training people and also through a new appointment.

A member asked about capital capacity in the PRUH. She said that she understands that there are shortfalls in resuscitation, which means that ambulance crews are not able to turn around faster enough. This is an issue of safety, treatment and ensuring that ambulance crews are back out in the field quickly. Is this caused because of a shortfall in capital investment? The Chief Financial Officer that that there is a lack of capital available - however the plan does include capital investment. The CCG commented that the Emergency Department outcomes for patients are in the top quarter for both PRUH and King’s. The member commented that in local government we do spend to save. She said that she would feel more reassured if she heard this; while understanding the scale of the Trust’s financial pressures.

A member commented on the recent departure of Bob Kerslake as Chair of the Trust and a conversation he had with him where he reiterated his public remarks that the NHS needs a drastic rethink and to increase resources to meet growing urban demand. The member said that he does not think it is possible to remove the deficit. Kerslake has a huge reputation. The member commented that he would encourage King’s to do whatever is possible; however it is not possible then scrutiny would expect to hear from you . He added that he thought that PWC were very expensive. The Chief Financial Officer said that they are members of NHS groups and networks; these indicate that there are opportunities to improve the Trust’s value for money. He said our aim is to be the most efficient and best value business.

The CCH leads said that performance is not just about the hospital but also the wider system. We need to collectively think about our 90 years olds and how we can promote wellbeing and independence. There are also public health issues like smoking and obesity. A CCG officer said that he had also had a conversation with Bob Kerslake and there are questions about whether a realistic length of time was given to reduce the deficit, however there are efficiency benchmarks and we cannot say that King’s are as efficient as they could be. They may need to be a longer time for return on investment: it is probably more realistic to think about more 5 years rather than the current two years to eliminate the deficit.

A member asked about the STP and orthopaedic plans and if NHS colleagues anticipated any adverse financial impact from the recently announced expanded Guys & Thomas with Johnson& Johnson orthopaedic care service. NHS officers said that there would not be. The CCG advised that the STP plan has moved to a partnership model. The orthopaedic network does fit within the partnership; sovereign bodies still have the ability to make decisions.

Members commented that that some boroughs have lost 56 % of public health grant, while seeing a significant rise in poverty. All the pre-determinants of health are going the wrong way. Councils are able to do return on investment; however there is very little that can be realised in the present set up. The CCG lead agreed but remarked that initiatives to reduce isolation can have an immediate effect. She added that if the health system does not undertake programmes to reduce acute demand then even more people will arrive at A & E.