Thursday 15 January 2015


Merger proposals for 7-day working

A high profile national goal for the NHS is so-called '7-day working' and all hospitals are thinking how to achieve it. Clearly it will be very expensive in an environment where all NHS Trusts are strapped for cash and many are in, or heading for, a deficit. Many studies have shown that quality of care in the NHS is much reduced at weekends and death rates are higher and so ensuring that care is as good at weekends as in the week is extremely important: that is what 7-day working seeks to achieve.

The Royal Surrey has studied its position and would find it extremely difficult to achieve 7-day working albeit there might be little choice in the medium term. Ashford and St Peters are in the same position. The assertion is that, by merging, 7-day working becomes a viable proposition. For example if RSCH has 2 consultants in a specialty getting than to accept that one of them must always be present in the hospital and doing ward rounds etc. on Saturdays and Sundays would be difficult if not impossible. To recruit further consultant resource would be expensive even if recruitment was practical. However if ASPH also had two consultants in that specialty and there was a merger, then a rota between 4 consultants becomes possible. Thus goes the argument.

It is important to understand what 7-day working means. Much of the merger documentation uses this term without explanation leading some with the impression that the whole hospital would work exactly the same every day of the week. That is no so. Outpatient Departments would not change. 7-day working refers to inpatients and essentially to consultants being available on one or other of the sites and doing ward rounds etc. (plus necessary support functions e.g. diagnostics). It also does not refer to all specialties. Merger documentation currently refers to stroke, GI (gastrointestinal) and interventional radiology although others might come on board.

Thus the merger benefits of 7-day working as currently described are  limited but nonetheless very worthwhile. They might have to be realised anyway without a merger but with more difficulty and greater expense.


Merger progress

The process for seeking authority for the Royal Surrey and Ashford & St Peters to merge proceeds steadily. The Final Business Case is scheduled to be complete in February and will then be put to the Board for their approval and put to the governors for comment and support. A small delay of about a month has occurred due to the Competition and Mergers Authority whose approval is a necessary first step. There is no reason at present to believe that approval will not be given on the first pass but if the CMA requires a second pass a significant delay would occur. I will report as and when there is news.

I represent the RSCH on the joint 'Stakeholders Committee'  which deals with communications with the public, staff etc. They have decided to hold back on a big communications thrust until CMA approval has been given. Plans are being firmed up and I expect to help staff a stand in the Friary Centre before too long. I would like also to see a stand staffed in Tescos near the hospital and Burpham Sainsburys and await to see if that proves possible. Similar plans are being prepared for other places in the joint catchment area.
A & E

The BBC in a recent programme stated that the Royal Surrey had declared a Major Incident re its A&E. That is incorrect and the BBC has been informed. The Royal Surrey like all hospitals in the country, is under extreme pressure but nevertheless is coping well and meeting the 95% target for maximum 4 hours from arrival to discharge or admission. Whereas the hospital has missed this target on a few occasions it has done so only marginally. Recently its A&E was judged amongst the best in the country - let us hope the winter pressures do not change that position.