Change of Chief Executive

At the end of this month Nick Moberley the current Chief Executive will leave to take up the post of Chief Executive of Kings College Hospital. He has been an excellent leader who has always been immediately available to governors. He will be missed.

Because of the proposed merger it is intended to have an interim Chief Executive to act until the merger is complete (if it happens of course). The proposal is that Peter Dunt the current Chairman of the Board should take up the post. This will have a knock on affect for the Board and plans are being laid to deal with that.

The current time table is that the final Full Business Case for the merger will be put to the Council of Governors 26 November. As chair of the governors Merger Working Group I am arranging for governors to have the opportunity to see and comment on it before it goes to Monitor (the body which oversees Foundation Trusts). Monitor will undertake a risk assessment. If they see little risk then all will steam ahead. If Monitor see significant or considerable risks then all will slow or even stop. Assuming Monitor s clears the case a resolution to merge will be put to a Council Of Governors in May next year. If governors approve then the complicated processes of actually merging will be set in train.

Thank you

I am delighted to hear that I have been re-elected as a Governor for Guildford. Thank you to all those who voted for me - it's very greatly appreciated.

The next 9 to 12 months are going to be extremely busy because the Competition and Mergers Authority have cleared the proposed merger with Ashford and St Peters and the hospital is now gearing up to finalise the Business Case to submit to Monitor (the body responsible for Foundation Trusts). When I know the time table I will post it.

The job of Governors is to ensure that the hospital Board does two things

• engages effectively with the public (which includes patients and staff)
• acts with due diligence i.e ensures all its claims are based on solid evidence and defendable.

If the Board fails in either then Governors are entitled to vote against the merger. They are not legally entitled to vote against simply because they don't  like it!!!!

I will be doing my best to ensure the Board meets its obligations as I have been doing from the start. The Governors' Working Group which I chair will be a key feature in challenging the hospital wherever necessary.

It is now time for the Hospital(s) to actively engage the public and I will push for this to be done comprehensively and in a transparent way.

Thanks again for re-electing me

Two pieces of good news.

First the Royal Surrey has been successful in bidding to lead a collaborative Surrey-wide service for the treatment of chronic Hepatitis C – one of only 15-20 such services nationally. The new service is a great example of developing strong partnerships and builds on existing collaboration with other Surrey trusts. It means that Surrey patients will be able to access state of the art therapy for liver and biliary tract disease locally without needing to travel to London.

Secondly the Royal Surrey been named again as one of the top 40 acute trusts nationally in the Health Service Journal’s “Best Places To Work” awards.

Mortality performance

 

The latest national figures for performance related to deaths have just been published. The Royal Surrey has performed extraordinarily well. It was ranked 4^th best in the country (of 137 hospitals) and had 20% less deaths than would be expected given its case mix. This is even better than reported 3 months ago when it was 7^th. It now routinely out-performs its peers – Frimley Park was ranked 22^nd and Ashford and St. Peters 26^th. The processes and checks which the hospital has adopted over the last year or so are now extremely effective and warrant the performance it now achieves.

Outcome of chats with patients in St Lukes out-patients

 I and a fellow governor recently chatted with 30 patients in St Lukes Out-patients. We did so on two different days to learn of their experience. This was a follow-up to a similar exercise 6 months ago.

 

All patients thought their treatment was excellent and that the staff were professional and friendly – that is good and the important bit. However there were negative aspects:

·         Waiting times for pharmacy prescriptions from the St Lukes pharmacy were often far too long sometimes well in excess of an hour. The hospital used to engage a specialist company to deliver drugs to patients’ homes but the service was withdrawn about a year ago because of safety concerns – this was missed.

·         Waiting times to see the consultant/registrar/nurse specialist were often too long. It is not uncommon for waiting to be over an hour and up to 2 hours. Whilst patients were extremely understanding and tolerant this is not good enough.

·         Waiting times for blood tests and the opening times of the St Lukes phlebotomy clinic has improved since our chats 6 months ago but still a worry.

·         A number of patients did not know their Cancer Specialist Nurse (CSN)

·         There was lack of knowledge about the Fountain Centre.

 

Our report is being appropriately pursued with a number of people but the waits for pharmacy and waits to be seen were in particular raised by me at the Council of Governors meeting 16 July.

The head of pharmacy produced an excellent response. Waiting times for 94 patients had been analysed. The average was 36 minutes but the longest was 1 ½ hours. 12% were in excess of 1 hour. Whilst dispensing of often complex prescriptions can be time consuming this was not satisfactory.

However more staff are now being recruited and a full review is underway which will be part of much wider review of processes in St Lukes. It was agreed that there would be the following quality performance targets

·         10 minutes simple medicines

·         30 minutes oral chemotherapy medicines

·         45 minutes clinical trial medicines.

 Additionally possible ways of delivering medicines direct to patients’ homes or perhaps to nearby local pharmacies will be explored.

I considered this a swift and very satisfactory response. A further report on the position will be given to the Council of Governors meeting next January to ensure progress.

Churt event change of venue

I have been tod that the event in Churt (see previous blog) has been changed due to a double booking of the venue. However the hospital has managed to secure another hall and the event on the 30^th June 2015 will now be held at Farnham Maltings, Bridge Square in Farnham, Surrey GU9 7QR.

Member meetings schedule

I am delighted that the hospital has decided to run a number of meetings for members all around its catchment area. Hopefully more people will find it possible to attend. The meeting will cover a range of general matters but will also cover the proposed merger with Ashford and St Peters. The schedule as it presently stands is below so please hold the date best suited to you.

Waverley

30/06/2015 - Churt Village Hall, Crossways Churt, Farnham, Churt, Surrey GU10 2JA from 1900hrs to about 2030hrs

Guildford

22/07/2015 - Surrey Sports Park, University of Surrey, Richard Meyjes Road, Guildford, Surrey, GU2 7AD  from 1400hrs to 1600hrs

Woking

28/09/2015 - St Hugh of Lincoln Church Hall, 95 Victoria Road, Knaphill, Woking, Surrey, GU21 2AA from 1900hrs to about 2030hrs

East Hants

21/10/2015 - Grayshott Village Hall, Headley Road, Grayshott, Surrey, GU26 6TZ from 1900hrs to about 2030hrs

Elmbridge

25/11/2015 - Cobham Village Hall, Lushington Drive, Cobham, Surrey, KT11 2LU from 1900hrs to about 2030hrs

Chichester

26/01/2016 - Fernhurst Village Hall, Glebe Road, Fernhurst, Haslemere GU27 3EH from 1900hrs to about 2030hrs

Mole Valley

23/02/2016 - Dorking Christian Centre, Church Street, Dorking RH4 1DW from 1900hrs to about 2030hrs

Waverley

21/03/2016 - Bramley Village Hall, Hall Road, Bramley, Surrey, GU5 0AX from 1900hrs to about 2030hrs

Cancer meeting

I have just returned from a meeting on Cancer at the |Royal Surrey organised for members of the Trust. It was well attended and a very good event - as other have been. It would be impossible to summarise but three aspects stuck in my mind

• The nurses in oncology/St Lukes have all been adopted as Macmillan nurses - the biggest unit in the country to do so.
• The Royal Surrey leads the country on design and implementation of Enhanced Recovery Pathways which improve preparation for surgery, care after surgery and discharge processes leading to better quality of outcome and less time in hospital. The Royal Surrey is one of only 4 Centres of Excellence for Enhanced Recovery.
• the radiotherapy equipment is state of the art and a new very sophisticated linear accelerator of the latest design in currently being commissioned for use.

As chair of the Royal Surrey's Merger Working Group of Governors I have completed a survey of governors to capture all their questions and concerns about the merger. As a result a full day has been organised for 13 May when members of the Board and the hospital's executive will address all the issues raised as part of the governor's duty to scrutinise what the Board is doing.

Also as the hospital's governor representative on the so-called advisory Stakeholders Group comprising individuals for a wide range of bodies (e.g. local government, health commissioners GP Patient Participation Groups) I attended a recent meeting to encourage the two hospitals to put more energy into preparing literature to inform and engage the public assuming that the Competition and Mergers Authority gives the go ahead in a few months time. I will be joining a few others to review any such literature to ensure it is straight forward without jargon. Watch this space!

Refurbished Maternity Unit

I have just attended the official opening of the newly refurbished maternity Unit. It is a very splendid place and cost about £0.5 million. It features a new high dependency Unit and a high dependency area with birthing pool. Additionally a new education facility was opened for the unit at the same time. This will allow top class training within the unit itself. When the NHS as a whole and the Royal Surrey itself are under great financial pressure it is heartening to see they are still managing to invest.

 

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.