To receive a joint presentation by Mike Proctor (Deputy Chief Executive, YTHFT and Interim Chief Executive, SNEYHT) and James Hayward (Director of Facilities, SNEYHT)
Minutes:
The Committee received a presentation by Mike Proctor, Deputy Chief Executive of York Teaching Hospital Foundation NHS Trust and Chief Executive of Scarborough and North East Yorkshire Healthcare Trust in respect of the context and benefits of the proposed integration of the two Trusts. Mr Proctor began by explaining how much the NHS had changed over the last 20 years in terms of the sub-specialisation of medicine, technological advances, payment by results according to numbers treated, better informed patients and higher patient expectations. These changes had adversely affected Scarborough Hospital as a small, remote district general hospital. He referred to a number of interrelated factors: the geography and demography (large rural area, small population and high percentage of elderly patients); the ageing estate some of which dated back to before the NHS; the difficulty in recruiting and retaining doctors and nurses because of the small teams, lack of specialist services, remote location and limited private practice; clinical quality issues caused by small teams/single consultants, difficulty covering rotas, heavy dependence on locums and low procedure volumes ; and the additional financial support required to address these clinical quality issues. In terms of the strategic context, a strategic review in 2009 had concluded with commissioner and provider agreement on which services must be delivered at Scarborough, that is, Accident and Emergency services supported by a number of other services, such as trauma, general and elective surgery and obstetrics. Professor Mascie-Taylor’s North Yorkshire Review of 2011 argued for investment in improved health and social care community services and a shift from acute to community care which further undermined SNEYHT’s ability to cover costs and maintain an adequate emergency response. Mr Proctor then outlined the benefits of a merger in terms of recruitment/retention, clinical mass, cost and governance. He cited the example of Scarborough Hospital’s single breast surgeon who could provide a service for some 40 weeks of the year; however, he had resigned to join a larger team in Hull. Because of the difficulties in finding a replacement, a team of surgeons from York now provided this service for both hospitals, ensuring the service was delivered 52 weeks a year, as part of a larger team with higher volumes of work, and standardisation of clinical practice through agreed clinical guidelines and protocols. To have a viable out of hours rota, a minimum of six consultants was required, and when they were not on call, they needed enough elective work to keep them busy. Members then questioned Mr Proctor. He explained that although a team of breast surgeons serviced a hospital, there would still be continuity of care, so that once a patient was treated by a consultant, she would continue to see the same consultant. He also alluded to the opportunities for further specialties to be delivered at Scarborough, if there was enough volume of patients, and for services to be repatriated to York/Scarborough from South Tees and Hull, making the whole organisation more viable. He confirmed that he believed the merger would assist in recruitment and retention, not only because of the attractiveness of the town, but because of the advantages of being part of a larger team of consultants and the prestige of working for a teaching hospital. In respect of the difficulties which lay ahead, there were the logistics of merging two organisations, and the financial challenges which the NHS faced nationally. He understood that SNEYHT’s historical debt would be addressed by the overall financial support package which underpinned the merger. A further challenge would be to repair Scarborough Hospital’s reputation, which he believed could be achieved in the medium term. The most recent performance data showed that SNEYHT was currently meeting all its targets, with particular success in reducing hospital acquired infection. The new organisation would employ 7000 staff, but because of efficiency savings required in the NHS, he expected this number to reduce in the next 18 months, although there was no blueprint yet. He hoped staff reductions could be achieved through natural wastage, since staff turnover amounted to 10% a year. A decision had not yet been made on when the merger would come into effect – this could be April, or maybe later in July. Mr Proctor confirmed that he had been in talks with the Scarborough and Ryedale Clinical Commissioning Group. He believed there were the volumes to make a newly merged Scarborough Hospital viable, with the opportunity to increase activity. Community services could also be improved through better integration between providers. SNEYHT would continue to be in the market to provide services at Malton and Whitby hospitals, but this would be a decision for the Clinical Commissioning Groups. Lastly, Mr Proctor commented that a reason why patients could be referred to a range of sites for treatment was to meet the target to treat patients within 18 weeks of referral, and to keep different sites busy, but patients did retain some degree of choice over where they were treated and the SNEYHT was moving towards an appointments system where an appointment time was agreed with the patient by telephone. The Chairman thanked both Messrs Proctor and Hayward for their attendance.
RESOLVED that the presentation be received.