To advise the Committee of the work of the Trusts in the preceding year and future plans and thoughts.

The Committee had invited the Chief Executives of the Herefordshire Primary Care Trust (PCT) and the Hereford Hospitals NHS Trust (HHT) to advise the Committee of the work of the Trusts in the preceding year and future plans and thoughts.

 

The Committee had been provided with the Trusts’ Annual Reports 2004/05 and their respective strategies: from the PCT its “Strategy for Success a Statement of Intent” and from HHT its Strategy for 2005-2010.

 

Presentation by Mr Peter Harper, Medical Director and Deputy Chief Executive of the HHT.

 

Mr Harper, attending on behalf of the HHT Chief Executive, gave a presentation to the Committee.  He commented on the Trust’s strategy development, its two star performance rating from the Health Commission, clinical services, workforce, challenges faced, perception of the future (2006-2008) with the stated aim of achieving Foundation Trust Status by 2008, and the future beyond 2008.

 

He advised the Committee that HHT’s vision was excellence in the delivery of secondary care services to the local population, through partnership with patients, the public and other organisations.  This was to be delivered by being the provider of choice for patients and partner organisations, the employer of choice and the provider of excellent, high quality, innovative, patient centred, clinical and support services.

 

In relation to clinical services he highlighted the following points:

 

·          The partnerships which had been developed in the provision of vascular surgery, Ear, Nose and Throat Services and Cancer Services.

 

·          Length of stay in hospital noting that this was 80% of the national average, with hip replacements now having a 5 day average stay (down from a 10 day average), a high day case rate, with 80% of cases dealt with in a day compared with a national average of 65%.

 

·          The excellent service provided by the Charles Renton Cancer Unit.

 

·          The establishment of a dedicated stroke unit, whilst noting that the Unit could not provide a full rehabilitation service.

 

In relation to challenges he highlighted:

 

·          The pressures on clinical and non-clinical staff.

 

·          Infection rates, noting that whilst these were relatively low a team was actively engaged in keeping the level down, although it had to be recognised that infection was a fact of life.

 

·          The financial pressures facing HHT.

 

·          The requirement to meet targets, noting that improvements were being made with the time in 2005 between referral to treatment down to 62 days and the time from decision to treat to treatment down to 31 days.

 

·          Recruitment and retention of staff.

 

·          In terms of diagnostics he reported that there was a very long waiting list for MRI scans and some considerable waiting times for neurophysiology which was a particular problem because of the difficulties in recruitment.  However, some inroads were being made into the problem and waiting time for an ultrasound scan, which at one point had been well over a year, was now down to a few weeks.

 

·          The major pressures on the accident and emergency department.

 

·          The pressures on trauma and orthopaedic services, noting that in the case of the latter whilst good results were being achieved demand was so high that it could not be met.  Whilst efforts were being made to increase resources to meet need demand appeared endless.

 

·          Whilst the Paediatrics department worked hard it was a small department and the HHT was seeking to improve it.

 

He commented on the constant change in the NHS involving further reorganisation, the development of a patient led NHS, the plurality of provision of care and patient choice, all of which meant competition.

 

He also outlined the features of Foundation Trust status, in particular the prospect of greater local autonomy and enhanced borrowing capacity especially for capital investment, and the work which would need to be undertaken if the application for Trust status were to be successful, the aim being to achieve this by 2008.

 

Looking beyond 2008 he highlighted the following issues: development of patient choice, development of the national NHS IT project, the development of a medical/surgical assessment unit, the need to build replacement wards and clinical units, the need for a new cancer unit, more clinical linkages, increased day case work; and developing stronger links with Powys.

 

In response to questions Mr Harper commented as follows:

 

·          It was asked whether the provision of services to patients from Powys had any adverse implications for the services provided to Herefordshire residents.  In reply Mr Harper explained that services were currently provided through block contracts with the Powys Health Board.  New contracts would have to be negotiated in response to the introduction of payment by results.  It was acknowledged that the work provided valuable income for the hospital.

 

·          That the hospital would need to employ additional teams of staff if the capacity to deal with hip replacements were to be expanded.

 

·          That there were many contributory factors to the increasing pressure on the Accident and Emergency Department, including changing patient expectations.

 

·          There was a distinction between medical and general training with work on wards, for example, counting towards medical training for Junior Doctors. General training programmes were in place for Junior Doctors, nurses and support staff.

 

·          That there were some recruitment difficulties locally, in common with the experience across the Country.  As specialisation increased it would not be possible to offer some services locally.

 

·          He acknowledged that there could be benefits in the providers of the GP out of hours service being located alongside the Accident and Emergency Department, but this was not feasible at the moment.

 

 

Report by Paul Bates, Chief Executive of the PCT

 

Mr Bates reminded the Committee of the PCT’s remit: commissioning healthcare, providing some healthcare directly, notably the mental health service,  from a budget of some £200 million and its role in managing the commissioning of £100 million worth of specialist services on behalf of other PCTs in West Midlands (South) Strategic Health Authority area.

 

He expressed his disappointment that the Trust’s star performance rating from the Health Commission had been reduced from a three to a two star rating.  This was attributed in part to an increase in the number of patients waiting more than six months for treatment.  In general terms, however, he considered that the Trust had performed as well as it had in the previous year. 

 

He noted that the Mental Health Service provided by the Trust had improved its performance rating from one to two stars and was a good, but not excellent, service.  The patients survey specifically for this service had shown significant improvements across the board, one slight weakness being the preparation of care plans.

 

The general patients survey about the PCT focused on practitioners and showed good results.  However, these were not as good as he thought that they could be.  The PCT was not in the top 20% of Trusts for every service and he believed it should be in the top 5%.  There was clear potential for improvement.

 

In dentistry there were excellent results but it was clear that access to a NHS dentist was a major problem which needed further work by the PCT.  It would not be possible to achieve the desired improvement in the current financial year.

 

The response to the outbreak of Legionnaires Disease in 2003 had been the subject of a major review with successful outcomes.  The PCT was now regarded by other Trusts as a source of expertise in dealing with incidents of this type.

 

The PCT’s financial position was in balance comparing favourably with the position of number of Trusts across the Country who were facing substantial debts.  However, the challenge facing Herefordshire was greater than it ever had been and he thought that pressures would increase in the coming years.

 

There was considerable enthusiasm for measures to improve public health.  Resources had been ring fenced for work in 2006/07 and 2007/08 but it was not feasible to bring investment forward into 2005/06 despite the wish to do so.

 

Other issues included the extension of patient choice, implementation of the system of payment by results and the development of the national ICT system for the health Service.

 

He noted that the Contract for the provision of GP out of hours services was up for renewal adding that while the service was different from that previously provided the benefits in terms of higher morale of GPs and recruitment and retention were clear to see.

 

Work continued with the Council to develop a Childrens Trust and pool funding where appropriate.

 

The growing number of migrant workers was changing the face of Herefordshire and it was important to ensure that their health needs were being met.

 

Finally he commented on the Strategic Health Authority’s review of the configuration of NHS Organisations and the potential implications of this both for the future of the PCT and its role as a direct provider of services.  He noted the danger of the PCT being distracted by these matters and the measures being taken to ensure management focused on delivering the PCT’s objectives.

 

In response to questions Mr Bates acknowledged the potential significance of the links across the border in Wales.  He reported that efforts were being made to improve the effectiveness of the relationship with Welsh colleagues, following a period in which working arrangements had been less strong than previously.

 

He also noted the scope for Councillors to work with the PCT within their Wards to promote public health initiatives and the potential to improve public health.