Agenda item

              The North West London NHS Hospitals Trust and Ealing Hospital Trust have approved an outline business case for merger. Members will be aware that the two trusts have been in discussions for some time on this subject and that work has been taking place to prepare the OBC setting out the merger proposals. A summary of the Outline Business Case and a report from the Hospital Trusts are included as appendices to this report.

The Outline Business Case sets out the reasons why the trusts are considering a merger at the current time. These can be summarised by looking at the commissioning landscape, the clinical vision and the financial drivers for the merger.  

Simon Crawford (SRO, Organisational Futures Project) presented this item and confirmed that the outline business case for the plans had been produced following the outline strategy that had been set out in May.  Although the plans included the merger of two health trusts, there were no proposals to make major changes to services.  The plans followed on from a high level appraisal conducted last year which sought to explore the potential of a merger.  The committee heard that the proposed merger would lead to the one of the largest integrated care services in the country and would ensure the availability of 24/7 care, better use of resources and access to equipment.  Simon Crawford drew Members to the key four chapters in the report, including the commissioning strategy in North West London, the implications for the two trusts, the clinical vision for a combined organisation and the financial evaluation.  He stated that under the current arrangements, Ealing Hospital Trust struggled to provide some specialist treatment, whilst North West London NHS Hospitals Trust had some issues in respect of emergency surgery.  It was felt that the integration of the two trusts would address these issues and help gain foundation trust status.

Simon Crawford acknowledged that the landscape of healthcare was changing and appendix B of the report set out some potential scenarios for service change.  The current proposals were to be presented to Brent Local Involvement Network (LINk) on 12 December. The next stage was to submit a final business case and more work on financial details and capital assessments were required before this could be achieved.  Following this, the decision to merge would be taken in June 2012, with implementation happening from July 2012.

Mansukh Raichura (Chair, Brent LINk) was invited to comment and he stated that a public meeting involving service users was needed to gain their views and provide feedback.

During discussion by committee, the Chair advised that a joint meeting of the chairs and vice chairs of the Brent, Ealing and Harrow health scrutiny committees and the relevant staff was to be arranged to discuss the proposals in detail and she suggested that this should take place in January 2012.  Councillor Cheese sought information on how the merger would benefit patients, particularly those in south Brent and expressed concern that changing locations of services could mean greater journey times for some patients.  Councillor Hunter commented that clarification should be sought as to what services changes patients may expect from the merger during the joint health scrutiny committees meeting.  She queried why a management level merger had been approved without public consultation and felt that the merger would inevitably lead to changes to services to at least some degree.  Councillor Daly asked whether details of an equality impact assessment (EIA) could be provided at the joint health scrutiny committees meeting and suggested that the merger could lead to a monopoly in healthcare provision which, again, may raise equality issues.  She added that some services needed to be accessed locally and that this too needed to be considered in the context of equality issues.

In response to the issues raised, Simon Crawford confirmed that he would be happy to organise a public meeting with service users and to prepare an evaluation of the services that would be provided.  He stated that the integrated care agenda being pursued would provide a greater benefit for patients and schemes such as Brent STARRS were helping to improve services.  Simon Crawford advised that any service change would be as a result of NHS commissioning plans regardless of whether the merger materialised.  Furthermore, no formal consultation with regard to the management merger was necessary as this would not have a major impact on delivery of service, however consultation had taken place with Brent LINk in accordance with the NHS Act 2006.  The committee noted that any service changes would be subject to an EIA, whilst equality issues had already been taken into account in respect of the merger.  The Co-operation and Competition Panel was currently reviewing the outline business case to assess any potential effects on patient access and choice. 

Professor Rory Shaw (Medical Director) added that services would benefit from continuing improvements to medicines and a larger trust would be more capable of providing 24/7 services and that ensuring the patient went to a location with the appropriately qualified staff and facilities was the key to providing better services.

The Chair requested that information on any areas of particular concern and an explanation of what are the benefits of being a foundation trust be presented at the January meeting of the chairs and vice chairs of Brent, Ealing and Harrow health scrutiny committees.