Agenda item

The Chief Finance Officer for the Barking, Havering and Redbridge University Hospitals Trust (BHRUT) delivered a presentation updating the Committee on its financial recovery.

Members noted from the presentation that:

·  There was no material or structural reason why the Trust should be making losses;

·  A large part of the deficit (around £30m) was driven by inadequate local health infrastructure;

·  The Trust would save around £60m if it could become as efficient as the top 25% of trusts in the country, by focusing on improving quality and reducing waste which would be better for patients;

·  Key ‘deficit drivers’ were the historic local health economy and the excess cost of employing temporary staff;

·  The Trust was implementing ‘The PRIDE Way’ which was a quality improvement method, used by the Virginia Mason Hospital in Seattle, that focussed on improving quality and reducing waste;

·  The Trust had big ambitions to become among the best integrated care systems and was working with its partners to achieve this; and

·  The Trust would be refreshing its Clinical Strategy this year which would provide a renewed focus on achieving high quality and efficiency.

In response to questions, Dr Smith, Chief Medical Officer for BHRUT stated that:

·  Whilst it was true that the Trust had a long history of high usage of temporary and agency staff, it was continually working to make progress on this; for example, the Trust had changed its offer in relation to its emergency care consultant vacancies and developed an Academy of Emergency Medicine in relation to junior positions in the Emergency Department, both which had been very successful. It had taken a similar approach to recruitment to its surgical team which had helped to fill 23 of its hard to recruit to vacancies and was now replicating this for recruitment into some acute care specialities. The Trust had also developed other clinicians to take on advanced roles and produced a Nursing Workforce Strategy. Nevertheless, the high usage of temporary and agency staff was still a big challenge for the Trust and it would continue to work hard to find ways to manage this. The Trust was not alone in facing recruitment challenges - there were approximately 50 GP vacancies which was a huge strain on the system. All key local partners, including the Council, should be working together imaginatively to make working in this part of London more attractive;

·  With regards to reducing waiting times, one of the main challenges was to reduce demand which was a health-system wide issue. The adoption of the PRIDE way had helped the Trust to look at the processes and pathways in great detail and eliminate waste, which included patient waiting times.  Much of this work related to what the Trust termed ‘reducing waste in system’; for example, it used to be the case that when a patient suffered a fracture, they would be required to come to the fracture clinic, sent away for tests, and then return to the clinic and referred for treatment – not all these visits were necessary, and amounted to ‘waste in the system’.  Furthermore, the Trust would need to look at reducing waste in relation to how it managed long term conditions and it was also in discussions with NELFT on better ways to work together for patients with mental health conditions, which was a significant issue. However, the reduction in ‘waste in the system’ could not be delivered by the Trust in isolation and would need the involvement of primary care and other key stakeholders to bring real transformation to the patient experience. This was not about turning patients away but looking at ways to streamline pathways and ensuring patients were receiving the most appropriate care at the right time, for example, one of the consultants in the fracture clinic believed waiting times could be reduced by half if he were to undertake more virtual consultations. Also, some work needed to be done to ensure its directory of specialties was very clear so patients were always referred to the right professional in the first instance.

·  The Trust accepted that according to predictions about the growth of the population in North East London in the future, and the demand this would bring for its services, it faced a huge challenge. The local health system would have to undergo transformation to bring forth the financial benefits of integrated care. In theory each extra person would attract an allowance; however, the reality was more complicated than that. The Trust would be consulting on its Clinical Strategy later this year, which would need to take future population growth into account.

Members welcomed the measures taken by the Trust to reduce waiting times; however, stated that the caveat to this was that there would always be a group of vulnerable patients for whom new approaches may not be appropriate, such as those with learning difficulties, or elderly patients, who may not be able to participate in a virtual consultation without the correct support. Members asked the Trust to ensure all departments within the Trust were aware of this and had the arrangements in place to provide the best care to these groups. Members also asked the Trust to ensure it services were user-friendly for patients who used ambulance to travel to and from their services, so that for example, they were not waiting for long periods of time after their appointment to be picked up and taken home. Dr Smith agreed that this was a very important point and assured the Committee that when reconfiguring services, the Trust always consulted its patient partners to ensure services would meet the needs of all patients, including the most vulnerable.