Merger special web site

A special web site has been set up to inform the public about the proposed merger between the Royal Surrey and Ashford and St. Peters. It include Frequently Asked Questions. Go to http://www.working-together.org/index.html

Merger delay

The first step in achieving a merger is to gain clearance by the Mergers and Competition Authority (CMA). The case for merger was put to the CMA a while ago. The process is that the CMA has a short time either to approve  or to submit the case to more detailed appraisal. Today the CMA decided  that there was 'a realistic prospect of a substantial lessening of competition in a number of inpatient and outpatient specialties' and therefore withheld a decision until more work is undertaken. This will take a minimum of 6 months and thus the merger proposal programme has been moved back 6 months including planned wide ranging engagement with the public which would otherwise have started in a few weeks.

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.

Merger note on an Electronic Patient Record/digital hospital

Having an Electronic Patient Record across both hospitals has been billed as a substantial benefit of the merger of the Royal Surrey and Ashford and St Peters. This blog seeks to help understanding of the extent to which it will be realised, when, and its cost and benefits

A digital hospital

A merger project is considering the broader matter of how to achieve a digital hospital within which a fully (or partially) paperless electronic patient record would be part. It will include electronic communications with outside bodies e.g. GPs. It will facilitate immediate access to accurate and comprehensive information for all a patient’s carers in the merged Trust and allow electronic communication with GPs and other carers e.g. community clinicians.

To date

·         Systems in USA have been seen albeit they are generally, at their core, billing systems and very complex and expensive to adapt to UK NHS practice.
·         A baseline review has been completed of systems in use in both Trusts
·         workshops involving large numbers of clinicians have been held.

The way forward has been agreed.

 Way forward

·         Each Trust uses different systems and in the first 12 months after merger the best of each will be installed across both e.g. a very good system comprising a simple electronic patient record is in use in St Peters.
·         In the first 2 years of merger harmonisation and documentation of core processes (administrative and clinical) will be achieved. This is an essential and very difficult first step for implementing any IT (IT is generally not very flexible and needs to be told what the process is and then demands that everybody abides by it or, alternatively, the chosen IT is already built on the basis of standard processes and everyone has to adapt). Achieving this in one Trust which is used to its processes is difficult enough – doing so across two merging Trusts is very challenging (but necessary irrespective of IT).
·         After the above has been achieved there will be a better understanding of how to progress to a digital hospital.

It will thus be two years after merger before any proposal on to how to proceed to realising a fully digital hospital will be formulated and a full business case with costs and time lines produced. Costs could be around £10million or more.

Summary

In the first two years of merger harmonisation of existing systems and of clinical and administrative process will be the focus. Whereas the ambition will be to create a digital paperless merged Trust, it will be at the earliest 2 years after merger before the way forward will be determined and a Full Business Case with cost and time lines produced for approval.

Does this need a merger?

A merger is not necessary to achieve a digital Royal Surrey - the hospital would need to achieve that in the future anyway since it is presently somewhat behind the pack. However merger will release funds which would make a digital hospital feasible in a shorter time frame and it is expected (albeit without substantiation) that costs will be smaller if spread across two hospitals rather than one.

The proposed merger.

A good deal of Governors' time and that of the hospital Executive and Board is being devoted to the application to merge with Ashford and St Peters. The timetable has slipped a little but the hospitals hope that, if approved, the merger will come about in the middle of next year. Approval is required by several central bodies and of course by both hospital Boards and by both sets of Governors.

I chair the Royal Surrey Merger Working Group of Governors. The WG's task is to assist governors     

• in understanding the processes such as the legal grounds on which governors can turn down the proposal,
• in keeping in touch with what is going on
• in interpreting various voluminous and complex documents
• in ensuring the hospital meets its legal responsibilities to inform the public (and staff) and take account of any concerns and to ensure they undertake 'due diligence' in all aspects of  the business case for the merger i.e. they do it properly in a well researched and honest way.

The main advantages foreseen for the merger are

• a secure financial position of being in surplus avoiding the possibility of both hospitals otherwise slipping in to deficit
• '7 day working' in a number of specialties
• improved cancer services from an increased catchment area
• the creation of a digital merged hospital including electronic patient records
• more research projects.

The Merger WG is critically examining these matters as details emerge and I will report what I can in my blogs.

My main concern at the moment, which is shared by most governors, is that far too little has happened about communicating with the public and Trust members and about formally capturing and taking account of their views. I and one other governor  represent the Royal Surrey governors on a so called Stakeholder Committee which draws together internal staff members and representatives of external bodies to advise on communications. I have made known my opinion that too much effort is being devoted to producing and updating a strategy for communications and too little in actually doing it - time ticks on!! I shall continue to make this point.