Agenda item

An update on the merger of Ealing Hospital NHS Trust and North West London Hospitals NHS Trust is attached.

David Cheesman (North West London Hospitals NHS Trust) introduced this item and reaffirmed that there was a sound clinical argument for the merger, however the full business case had been deferred as NHS London wanted further discussion on it, however it still supported the merger in principle.  The main reason for deferral of the full business case was that there was not yet sufficient financial assurance and the originally proposed merger date of 1 April 2013 would not now be achieved.  A new proposed date for the merger was yet to be identified whilst the trajectory of the move was still in the process of being set out.  David Cheesman emphasised that it was important that the full agreement of NHS London was achieved before it was replaced, as otherwise discussions would need to start afresh with the new organisation.  In the meantime, integration planning and developing opportunities for as much joint working as possible with clinical and support services between the two Trusts continued and shared IT and joint procurement functions were being considered. 

Turning in more detail to the financial aspects of the proposed merger, David Cheesman advised that the full business case had identified required savings of £73.2m over two years, with £30m identified for 2012/13 and £43.3m for 2013/14.  Members were informed that as of end of September, the Trusts had achieved £9.8m savings, slightly behind the £11m target to date, however it was still forecast that 2012/13 savings target would be achieved as most savings had been back ended for the second half of the year.  Pressures on the savings included having to use more agency staff for nursing posts and increased medical products due to rising demand in the number of patients.  David Cheesman added that the merger was essential in achieving recurrent savings.

Tina Benson (North West London Hospitals NHS Trust) then provided an update with regard to recruitment for the Accident and Emergency (A and E) unit at Central Middlesex Hospital (CMH).  She explained that five international candidates were to be interviewed for middle grade posts and another candidate at consultant level.  It was hoped that the A and E vacancies could be filled in time for winter when patient demand was always historically higher.  Tina Benson advised that a single recruitment agency was now being used which would bring more stability to the A and E unit.  Members noted that Northwick Park Hospital (NPH) was becoming busier as winter neared, particularly at weekends, whilst CMH continued to become less busy with an average of around 30 patients a day at its’ A and E unit.  Tina Benson advised that discussions were also taking place with NHS London and NHS Harrow with regard to handling patient numbers, particularly as there were physical capacity factors to consider in respect of NPH. 

During discussion, Councillor Hector enquired why recruiting agency staff was problematic and were there insufficient middle grade staff available to recruit from.  She also asked how the ambulance service was coping in bringing patients from the south of the borough to NPH in view of the distances involved.  Councillor Gladbaum enquired whether high standards could be maintained in view of the increasing patient numbers, particularly for NPH.  Councillor Hunter enquired whether the financial issues facing the two Trusts would put the merger at any risk of going into administration, considering that this had happened to the South London Healthcare NHS Trust.  With regard to A and E, Councillor Hunter commented that patient visits were often found to be unnecessary and in view of the rise of patients to NPH, she enquired whether there were any initiatives to promote visits to GP practices or other health facilities for non-urgent matters.  Councillor Leaman enquired what the largest threat to merger was, whether there was any possibility that it would not be undertaken in 2013 and were there any alternative plans should the merger not happen.

The Chair sought further details of how NPH would cope in view of the increasing numbers and the possibility of CMH A and E closing in the evenings.

In reply to the issues raised, David Cheesman explained that there were numerous job opportunities for agency staff in London and this made recruiting for posts more difficult.  He acknowledged that rising demand in patients, particularly at NPH, represented a challenge in maintaining high standards of healthcare, however clinical outcomes at NHP remained good and stroke case outcomes were amongst the best in London.  The biggest impact was on waiting times which were becoming longer. However, the Trust Board had stated that there must be no compromise in quality of services.  David Cheesman informed Members that Harrow LINk had also expressed concern with regard to NPH’s ability to cope with extra demand and consultation was taking place with the North West London cluster of Trusts as to how to address this, particularly in respect of improving patient access. In terms of the NPH, consideration was being given as to ensure that it was fit for capacity, including whether space on the site currently occupied by a third party could be used for clinical purposes. 

David Cheesman felt that the merger would still go ahead in 2013, subject to final financial assurance and a joint management team was being put together as part of the merger preparation.  There was no alternative plan at present should the merger not happen, however in such eventuality, possible options could include offering the Trust to a third party management.  David Cheesman stated that the Trust was aware of the potential risks posed by the financial situation, however the situation was far removed from any kind of regime failure that had led to the South London Healthcare NHS Trust going into administration and there were also no clinical issues.  In respect of signposting patients to prevent unnecessary visits to A and E units, David Cheesman confirmed that the 111 health telephone line was due to be launched in January 2013 and there would be a big national campaign to promote this.

Tina Benson advised that there was a national shortage of A and E doctors as the 24/7 nature of it was less attractive than other roles and it also did not allow the opportunity to specialise in the way that other disciplines did.  With regard to improving capacity at NPH, Members noted that this had also been raised as an issue as part of the post consultation of the Shaping a Healthier Future programme.  In the event of the A and E at CMH being closed, the majority of patients were unlikely to go to NPW and were more likely to go to a hospital closer to the south of the borough.  It was noted that the ambulance service would identify the most appropriate hospital to take the patient to depending on the nature of their case.

Dr Ethie Kong (Chair, Clinical Commissioning Group) advised that winter planning and early sign posting were critical and also that health professionals were aware of the appropriate health service depending on need and the role of organisations such as Brent Short Term Assessment, Reablement and Rehabilitation Service (STARRS).