Decision details

Mr Tim Bennett, Deputy Chief Executive and Director of Finance, Blackpool Teaching Hospitals NHS Foundation Trust presented a progress report on the Trust’s strategic ambitions, targets and financial position. Previous progress reports had been delivered to the Resilient Communities Scrutiny Committee in November 2015 and February 2016 and the Health Scrutiny Committee in December 2016.

Members had requested an assurance report after March 2017 on clinical care and financial performance achieved during the winter period. They had highlighted concerns on performance impact from winter pressures including acute and emergency services and availability of beds. Finance issues had included staffing concerns (costs of agency staff).

Mr Bennett explained that the Strategy ran from 2015-2020 and aimed to deliver improved long-term clinical and financial sustainability. He added that the Strategy did not operate in isolation citing that it needed to be delivered as part of the wider Accountable Care System which involved a range of partners working together.

Mr Bennett referred to the strategic ambitions which had measurable targets to: improve quality of care (reduce mortality rates and improve patient experience); reduce the length of stay for operations; to develop the workforce (improve staff satisfaction and reduce staff turnover); and improve financial robustness. He emphasised that progress took time. The targets were either medium term with three years allowed to achieve targets or long-term requiring five years.

Mr Bennett noted that mortality rates were still too high at 114 deaths per year. However, steady progress was being made towards the target of no more than 100 deaths per year. When the Strategy started in 2015, mortality rates had been 120 deaths per year.

Mr Bennett referred to the length of stay for operations which was above the average for comparable neighbours. Work was developing through the Accountable Care System involving primary care and social care partners. It was important to eliminate the numbers of patients incurring delayed ‘transfers of care’ (moving from one form of care to another) and also having efficient hospital discharges. A range of options were being explored.

Mr Bennett confirmed that financial challenges remained and would continue. Although the NHS was getting funding increases these were outstripped by increasing patient and population demands. Financial targets had been achieved for 2016-2017 although there had been some additional one-off funding assistance.

Members noted the reported surplus of £3.3m for 2016-2017 and queried whether this had actually been a deficit as additional one-off funding may have created an apparent surplus. They referred to NHS Improvement who had provided nearly £10m for promoting innovation and efficiencies. They also queried whether a similar sum in the region of £10m from Blackpool Council’s Investment Fund had been included in the 2016-2017 figures. Mr Bennett explained that the £10m from NHS Improvement had been included in the figures. However, £9.2m loaned from the Council was a one-off cash payment not included within the balance sheet. He pointed out that the £3.2m was a reasonable outturn given that the Trust had a budget of nearly £400m and had returned significant deficits in the last two years. He added that the Trust had sizable funds tied to buildings and other assets so were not readily accessible. It was important to have access to cash (liquidity) to invest and improve clinical outcomes. However, there were restrictions on operational areas such as wards but external funding allowed for investment in areas such as car parking allowing returns to be reinvested. The £9.2m loan from the Council would form part of the Trust’s Capital Programme for 2017-2018. It was important to achieve long-term transformation.

Members queried the progress made with managing and preparing for Accident and Emergency attendances during the winter period. Assurance was given that winter planning was in place. Mr Bennett agreed that the last winter period had been challenging with services stretched. However, there were some innovations which would help alleviate pressures. ‘Primary care screening’ was the first stage for Accident and Emergency admissions and assessed whether a person needed to be in Accident and Emergency.  Better patient pathways management was also being pursued again to help ensure patients were getting the right treatment in the right place and at the right time. Of most importance was ensuring that people who did not need to be in hospital were directed appropriately.

Members queried whether the staff recruitment freeze had been lifted and cited that agency staff costs were higher than for permanent staff. Mr Bennett confirmed that there was still some recruitment freeze and a reliance on agency staff. He explained that vacancies were mainly for non-clinical staff not clinical staff. He added that staff costs would be reduced through a number of measures such as merging back-offices which some hospital trusts had done.

Ms Turner-Birchall noted that patient information transfers between hospitals could be an issue. Mr Bennett agreed that this could be an issue within and across institutions. However, one of the Sustainability and Transformation Plan aims was to improve IT systems connectivity within Lancashire and South Cumbria. Some wards within the Trust were already improving connectivity.

The Committee noted the progress made and planned work.