We held our annual members’ meeting at 6.30pm on Wednesday 23 September 2015 at Wellington Park Hotel, Balmoral Suite, Burlington Gardens, Leyland PR25 3AB. The meeting was open to all members of the public.
At the meeting we presented a review of our 2014/15 annual report and accounts, an overview of quality developments within our hospitals and a summary of our forward plans. Our performance is summarised in an annual review.
We also presented a membership update: Membership update 2015 [pdf] 95KB
Here is a list of the questions that were asked at the meeting:
Q.1 I keep reading in the local press the deficit regarding the Lancashire Trust. Could you please explain the causes and what is the future plan to reduce it?
The reasons for the deficit had been outlined in the Annual Member Meeting presentation, in summary :
Following the global financial crisis in 2008, there has been no real term in increase in funding for the NHS. However demand is increasing, and costs continue to rise. As a result the amount of money we receive in income isn’t enough to cover the cost of providing care. Since 2008 we have made up this gap by making £60m in efficiency savings, which along with a surplus from previous years, has enabled us to balance our books.
It is increasingly difficult to make the significant savings required year on year, and we finished 2014/15 with a modest deficit of £1.6m.
In March 2015 we advised Monitor that we were predicting a deficit of £47m for the year ahead, 2015/16. This forecast deficit comprises the savings we hadn’t managed to achieve in 2014/15, which carries over to the next and future years, and we did not think we would be able to deliver all of the savings required for 2015/16 either. There were also a number of external factors that reduced our income, or increased our costs - including a change in the tariff, which is the amount we get paid for undertaking procedures and providing care; additional costs of establishing the new specialist vascular service; the national NHS pay award which increased our staffing costs; additional investment in the nursing workforce to meet safe staffing guidelines; the loss of a contract which reduced our income; and an increase in insurance premiums. As demand for emergency care increases, it costs more to look after the extra patients in our hospital due to overtime and use of agency staff, and when hospitals are full of medical patients we have to reschedule planned operations and procedures and this incurs additional cost.
Many hospitals across the country are facing similar problems, and 80% are predicting a deficit this year.
However we are working really hard to reduce our forecast deficit and balance the books.
With Monitor we have developed a short term recovery plan that is curbing spending, reducing the use of agency staff and overtime payments, and reducing our procurement costs. We are also reviewing all of the business cases we have approved in the past three years to ensure any planned spend is still appropriate. And we are continuing to identify and implement more efficient ways of working to further reduce cost.
Ensuring our longer term sustainability depends on working with partners to transform the local health and social care system. The Healthier Lancashire programme brings together all of the organisations involved in providing health, social care and wellbeing services to develop new ways of working that will reduce health inequalities, promote good health, and make sure people can get the care they need, when they need it, in the appropriate setting. By supporting people to stay well in the community and at home, and by making sure the right services are available to enable people to be discharged from hospital when they’re medically fit, we will be able to focus on providing the very specialist care that only hospitals can. This will enable us to use our expensive and valuable resources effectively in the future, and balance our books.
Q.2 Carparking – on 8 July 2015 at a public meeting the new Director of Estates, Paul Holt, advised local residents around Royal Preston Hospital that he was of the view that the new proposed multi-storey car park at Royal Preston Hospital would unlikely be used by staff as they would continue to use free parking on nearby roads. He favoured a residents parking scheme contained within a one mile radius of the hospital and was approaching Lancashire County Council to approach this possibility. He also stated he would be sending a newsletter to all residents to outline progress which is still awaited. Could you please advise as to the current progress he has made as regards this proposal?
The Your Hospitals Your Health aims to transform how hospital care is organised and provided so that patient experience and outcomes are improved, and we can operate effectively and efficiently now and in the future. We are planning a formal consultation about proposals to make the necessary changes early in the new year. Until that process is complete we can’t begin work on building a new multi-storey carpark, because we don’t know how the hospitals will be configured in the future.
In the meantime we have established a transport group to collect evidence from staff about their current and preferred travel arrangements, to inform the development of a transport strategy for staff, patients and visitors, that is aligned to the transformation programme. Carparking is one element of the transport group’s work, but we are also looking at all the other factors that affect travel, congestion, and the impact of a hospital on the local residential area. A recent staff survey shows that the main reason staff park on local residential streets is because they are not able to park on-site as the carparks are full to capacity. Very few staff say they park on local residential streets to avoid paying carparking charges, so a multi-storey carpark on-site that provides more capacity is likely to alleviate this problem.
We have no authority to instruct staff where they can and cannot park off-site, but we do regularly remind them to be considerate if they do choose to park on local residential streets, and in particular to ensure they don’t obstruct access to streets or driveways.
We aren’t responsible for the implementation of parking restrictions or designation of resident parking zones in local residential streets – that is the responsibility of the local authority – but we would actively support any such requests made by local residents.
We are maintaining dialogue about congestion and parking with local residents via local councillors, and will publish updates on our website as and when there are developments rather than printing and distributing a newsletter, to save costs.
Q.3 Sleeping out – it is shameful that ‘sleeping out’ of patients is still a major issue within the Royal Preston Hospital. after many years of repeated failures to address the issue, patients and relatives are still greatly inconvenienced with inappropriate moves. When pressures emerge why not close the hospital doors and redirect admissions to other hospitals as is practised elsewhere?
Local people quite rightly expect our doors to be open, and we fully believe it is our duty and responsibility to make sure we have enough capacity to be able to admit emergency patients who need urgent treatment. On occasions the hospitals can be very busy, generally because there has been a marked increase in the number of emergency medical admissions; or because we are unable to discharge patients who are medically fit; or a combination of both of these factors. When the hospitals are very busy we need to make difficult decisions to ensure we can provide a high standard of care both to inpatients, and those who require urgent admission. This may mean postponing some planned procedures to free up beds, staff and other resources. Whilst we always aim to ensure every patient is accommodated in the setting that specialises in their condition throughout their stay in hospital, at times we have no other option but to accommodate or move patients to other areas, to create space for new admissions. We have a robust protocol in place to ensure that our clinicians are involved in making decisions about which patients can be safely accommodated in another ward, that patients are not moved multiple times, that patients are not moved during the night unless there are absolutely no other options, and that patients with dementia or learning disabilities aren’t moved. When patients are moved we always explain the reasons, and endeavour to ensure a swift transfer to the appropriate setting as soon as space is available. The clinical team that specialises in the patient’s condition remains responsible for their care and will see the patient wherever they are in the hospital. We agree that looking after patients in a setting that doesn’t specialise in their condition is not ideal, and is something we only do when we have no other option, but our priority must always be to ensure we can admit patients with serious conditions who require immediate treatment.
Q.4 Trust management – given the two recent highly critical reports on the management and numerous failures of the trust by the Care Quality Commission and Monitor, could you please advise as to whether each board member is currently considering their respective positions with a view to resignation?
The recent Care Quality Commission inspection report judged Lancashire Teaching Hospitals to be requiring improvement. The inspection report was not highly critical, and highlighted that every patient the CQC saw was treated with dignity and respect. The CQC found many areas of outstanding and good practice, and no areas that were inadequate. ‘Requires improvement’ means just that – it does not mean ‘inadequate’. The Care Quality Commission observed that the main reason the organisation was judged to be requiring improvement was because the hospitals have been exceptionally busy, and this creates a challenging environment in which to provide care. The CQC recommended that the whole health economy – the hospitals, other healthcare providers, social services and our commissioners need to work together to improve services locally so that people can access primary and urgent care when they need it, and can be discharged promptly from hospital when they are medically fit. We are actively involved in the Healthier Lancashire programme and are making good progress with the Your Hospitals Your Health transformation so we are developing good foundations to make the necessary improvements.
80% of hospitals are forecasting a deficit this year and it is inarguable that the NHS is facing a significant financial challenge. The reasons for our predicted deficit position have been outlined in the presentation to the Annual Members Meeting and in previous questions. Our financial position is largely driven by factors outside our control but we are taking responsibility for doing everything we possibly can to reduce spending, maximise our income, and balance our books.
The CQC judged our leadership to be ‘good’ so we are confident we have the right team in place to work along with our partners to affect the necessary changes that will improve the health of our local population, provide the services and support that people need to remain well and independent, and enable the hospitals to focus on providing the specialist care only hospitals can. We are working hard to continue to provide the highest standards of care, and transform how services are provided so that we are sustainable for the future, and if anyone on the board thought they weren’t up to that task they wouldn’t have to be asked to consider their position because each and every one of us wants the organisation to be successful and to deliver the care our local communities deserve.