Response to the Secretary of State’s decision
Trust Special Administrator delivers final report
The Trust Special Administrator’s final report outlining recommendations to secure sustainable services for those served by South London Healthcare NHS Trust (SLHT) was published by the Secretary of State for Health today (Tuesday, 8 January 2013). The recommendations relate to the configuration of services and organisations across south east London – changes that are consequent to the challenges faced by SLHT are needed to secure clinically and financially sustainable services for the whole population.
The report drawn up by the Trust Special Administrator (TSA) appointed to South London Healthcare NHS Trust, Matthew Kershaw, and a team of senior doctors, nurses and health experts and advisors, includes seven key recommendations.
The TSA was appointed in July 2012 as part of the Regime for Unsustainable NHS Providers as set out in NHS legislation, aimed at enabling a rapid process of transformation in unsustainable NHS trusts to ensure safe, clinically and financially secure services for patients in the long term and the TSA’s draft report with recommendations was published on 29 October 2012.
A consultation period of a mandated 30 working days on these draft recommendations was conducted between 2 November and 13 December 2012, to which 8,224 patients and the wider public, staff and stakeholders responded which informed the development of the final set of recommendations.
The TSA has submitted his final report to the Secretary of State who now has 20 working days to review it and make a decision on the future of the NHS in south east London by 1 February 2013.
Trust Special Administrator, Matthew Kershaw, said today: “The recommendations in the final report very much build on the draft proposals set out in October, which people responded to in their thousands. We met many people and held or attended over 100 meetings during the six week consultation process.
“Whilst the final recommendations are not fundamentally different from those set out in my draft report, they have been refined and built upon in response to what members of the public, staff and stakeholders told us during the consultation. We have also refined them in response to the findings of the independently conducted Health Equalities Impact Assessment, and the contributions of the continued extensive work done by colleagues in the TSA team and across south east London.
“For example, there was a clear preference indicated in the consultation for the Princess Royal University Hospital site to be acquired by King’s College Hospital NHS Foundation Trust, and this has been taken on board in the final recommendations. In addition the consultation responses asked for more specific detail about future clinical services at Queen Mary’s Hospital, Beckenham Beacon and Lewisham which has been included in the final report. Staff, stakeholders and the general public also raised the issue of the additional capacity that would be required at some existing sites in south east London if services were to change at others, and this too has been addressed through recommendations for implementation and transitional funding.
“Significantly though, neither through the extensive consultation responses nor via all the work that has been done have any viable alternative solutions or proposals been put forward to solve the challenges faced by SLHT. I have said consistently that the status quo is not an option, and I believe these final, refined recommendations are the right ones, although I appreciate that some people will find them difficult to accept. I do believe that if implemented fully they will help deliver safe, high quality, affordable and sustainable services for the people of south east London into the future.”
Dr Jane Fryer, Medical Director for South East London’s NHS and medical advisor to the programme, said: “As a practising GP in south east London for 24 years, I believe the recommendations in this final report will ensure our patients receive safe, high quality care which will simply not be possible if the situation here continues and no changes are made.
“Making changes to emergency, maternity and planned care over the next three years, alongside the important improvements we need in primary care and community services, will deliver a transformation in the NHS locally – a service saving lives and improving health outcomes.
“Clearly, not all clinicians agree with our proposals, but overall I believe by implementing them we can transform the way the NHS delivers services in south east London, improving care for all in a long-term, sustainable way.”
The final report proposes that this transformation programme has seven elements to it:
1. The operational efficiency of the hospitals that make up SLHT needs to improve so that the Trust’s costs are in line with strong performing NHS organisations. This will mean that, over the next three years, the sites that make up SLHT need to make the full £74.9m of efficiency opportunities identified through analysis. This will require a transformation both in clinical and managerial leadership and in fundamental organisational culture.
2. Queen Mary’s Hospital Sidcup should be developed into a ‘hub’ for the provision of health and social care in Bexley, facilitated by the transfer of the required portion of the land and estate to Oxleas NHS Foundation Trust. Implementing this recommendation will deliver annual savings of £4.5m by the end of financial year 2015/16.
3. Vacant and poorly utilised premises should be exited (in the case of leases) or sold (in the case of freeholds). The NHS should engage with the local authorities in Bromley and Bexley in the process of selling surplus estate to ensure its future use maximises regeneration opportunities.
4. On an annual basis until the relevant contracts end, the Department of Health should provide additional funds to the local NHS to cover the excess costs of the PFI buildings at Queen Elizabeth Hospital and Princess Royal University Hospital.
5. In line with commissioner intentions to improve the quality of care for the local population and agreement amongst clinical leaders to aim to meet the acute clinical standards set for London, there should be a transformation in the way services are provided in south east London. Specifically, changes are recommended in relation to community-based care and emergency, maternity and elective services:
• Community Based Care – The Community Based Care strategy for south east London should be fully implemented, at pace, to deliver improved primary care and community services in line with the aspirations in the strategy. This will enable patients to receive care in the most appropriate location, much of which will be closer to, or in, their home.
• Emergency care – Emergency care for the most critically unwell patients should be provided from four sites - King’s College Hospital, St Thomas’ Hospital, Queen Elizabeth Hospital and Princess Royal University Hospital. Alongside this, services at University Hospital Lewisham, Guy’s Hospital and Queen Mary’s Hospital Sidcup will provide urgent care for those that do not need to be admitted to hospital. Emergency care for those patients suffering from a major trauma (provided at King’s College Hospital), stroke (provided at King’s College Hospital and Princess Royal University Hospital), heart attack (provided at St Thomas’ Hospital and King’s College Hospital) and vascular problems (provided at St Thomas’ Hospital) will not change from the current arrangements.
• Obstetrician led maternity care – Four obstetric led delivery units should be provided at King’s College Hospital, Princess Royal University Hospital, Queen Elizabeth Hospital and St Thomas’ Hospital. In addition, five midwifery-led birthing units should be provided: one at each of those four hospitals and one at University Hospital Lewisham. All other maternity care will continue to be provided in a range of locations across south east London.
• Paediatric emergency services and inpatient units should be co-located with all acute admitting units and paediatric urgent care should be provided at University Hospital Lewisham, Guy’s Hospital and Queen Mary’s Hospital.
• Elective care – An elective centre for non-complex inpatient procedures (such as hip and knee replacements) should be developed at University Hospital Lewisham to serve the whole population of south east London, managed by a partnership board of representatives of all provider organisations. Alongside this elective day cases procedures should continue to be provided at all seven main hospitals in south east London; complex procedures should continue to be delivered at King’s College Hospital, Princess Royal University Hospital, Queen Elizabeth Hospital and St Thomas’ Hospital, and specialist procedures at Guy’s Hospital, King’s College Hospital and St Thomas’ Hospital. Outpatient services should be delivered from a range of local locations.
6. In order to deliver this transformation programme, South London Healthcare NHS Trust should be dissolved and other organisations should take over the management and delivery of the NHS services it currently provides. In addition to the proposals for Queen Mary’s Hospital Sidcup outlined above:
• The Queen Elizabeth Hospital site should come together with Lewisham Healthcare NHS Trust to create a new organisation focused on the provision of care for the communities of Greenwich and Lewisham.
• Princess Royal University Hospital should be acquired by King’s College Hospital NHS Foundation Trust, which would enable the delivery of service change, enhance the services offered at the site and strengthen the capacity of the site to deliver the necessary operational improvements.
• It is important that these new organisations are not saddled with the issues of the past. To facilitate this, it is recommended that the new organisations are not faced with any repayment requirements relating to historic debts, and that the Department of Health should write off accumulated debt.
7. Transitional funding will be required for Oxleas NHS Foundation Trust, King’s College Hospital NHS Foundation Trust and the new organisation combining Lewisham Healthcare NHS Trust and Queen Elizabeth Hospital, to cover the in-year finances while the recommendations are being implemented. It is estimated that the level of support required will be in the region of £55.3m in the three-year transition period. If the recommendations are accepted, further work between the Department of Health and the Trusts to agree these figures will be a crucial element ahead of implementation. There should also be a Programme Board under an independent chair appointed by and reporting to Sir David Nicholson, Chief Executive of the NHS Commissioning Board, and David Flory, Chief Executive of the NHS Trust Development Authority. The programme board will work with all south east London organisations to ensure change is delivered.
The final report from the Trust Special Administrator and details of the results of the public consultation and responses to it can be downloaded from: www.tsa.nhs.uk/document-downloads.
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Notes to Editors
1. Mathew Kershaw, formerly National Director for Provider Delivery at the Department of Health, has worked in the NHS since 1993, latterly in key senior leadership roles in acute trusts, most recently as Chief Executive Officer at Salisbury NHS Foundation Trust and in national policy development and implementation for the Department of Health. In particular, he has led work supporting NHS trusts become organisations providing sustainable high quality services to patients efficiently and therefore, achieve Foundation Trust status.
2. As Trust Special Administrator Matthew Kershaw is accountable to the Secretary of State for Health and became the Accountable Officer for South London Healthcare NHS Trust on Monday 16 July, when the Unsustainable Provider Regime was enacted. He has assumed the duties and responsibilities of the Board which was automatically suspended on enactment of the Unsustainable Provider Regime.
3. The use of the term ‘Trust Special Administrator’ as set out in the legislation for UPR in the Health and Social Care Act of 2006, does not equate to the role of a legal Administrator outside of the NHS. The trust is not ‘in administration’ and insolvency legislation is not applicable to NHS Trusts. South London Healthcare NHS Trust and all other NHS organisations referenced in the report continue to provide services and treatment to patients in south east London as now – business as usual prevails. This is a report that has been submitted to the Secretary of State for Health and no decisions have yet been made about the future of services. The Secretary of State for Health will make a decision on the final recommendations in the report in early February 2013.
4. The legal timeframe for the UPR at South London Healthcare Trust is: a 75 working day phase developing recommendations and drafting a report; a 30 working day public consultation period on that report and its recommendations; and a 15 day period to finalise the report of recommendations for the Secretary of State for Health. The report was submitted to the Secretary of State on 7 January 2013. The Secretary of State now has 20 working days to consider the report and make a decision on the way services will be delivered in the future.