Agenda item

To consider a progress report on Blackpool Teaching Hospitals NHS Foundation Trust’s strategy, including progress against strategic ambitions and the financial position.

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. He explained that the Trust was a large complex entity with a wide range of specialist and community services. Progress reports had been delivered to the Resilient Communities Scrutiny Committee in November 2015 and February 2016 when that Committee had been responsible for health scrutiny.

The strategy ran from 2015-2020 and aimed to deliver improved long-term clinical and financial sustainability.

Tim Bennett explained that the strategic ambitions 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 highlighted patient care as being the Trust’s primary goal. Mortality rates were based on average numbers of ‘expected’ deaths under normal conditions. The Trust’s rates had been as high as 120 expected deaths in previous years and were now down to 114 with a target of 100 in three years. He added that reducing deaths by even small numbers required significant resource effort to improve patient care.

Tim Bennett referred to the aspiration to improve patient experience (‘Friends and Family Test’) from the current 95.8% satisfaction rate to 98% in three years. He added that good progress had been made.

He referred to the length of stay in hospital patients had for undertaking operations. It was important to consider people’s needs carefully from admission to discharge and aim to discharge people in good time. He re-iterated comments made by health colleagues that, other than for emergencies, being in hospital was not the best environment for promoting health and wellbeing; discharging people into community care was better.

Tim Bennett reported that the current length of stay was higher than average at 4.2 days with a target of three days in five years. He explained that the target appeared a modest goal over a long period but it was a significant challenge to reduce length of stays and was a gradual process. Members noted that there were many thousands of different pathways of care for patients and that significant changes would be required particularly at admission stages for emergencies. He added that progress had been slow for elective (planned in advance) care. Complex surgery was often necessary but it was important to aim to get more people coming in just for one day.

He referred to supporting the workforce through improving staff satisfaction and reducing staff turnover. At the start of 2016, the Trust had been using a relatively high proportion of agency staff at a high cost. Agency use had been reduced by focusing more on filling permanent vacancies. Although good progress had been made continuing financial pressures meant that it had been necessary to impose a recruitment freeze (non-clinical staff) and improve ‘back office’ efficiencies. Clinic vacancies needed to be filled at appropriate times as non-clinical staff were needed to support them but were not currently being recruited. 

Tim Bennett reported that the Trust’s financial position remained at the same level two risk rating with a target to secure a better level three risk rating in three years.  Good progress had been made and would continue with greater efficiencies in back office functions.

The Chairman enquired what the Trust’s current financial position was. Tim Bennett explained that the target was to secure a balanced budget for the end of the current financial year, 2016-2017. He added that a further £22m savings had to be found by the end of March 2016. The NHS Improvement Agency had agreed to contribute £10m for sustainability purposes leaving another £12m to be found which he was confident would be achieved through a range of in-house savings.

Tim Bennett added that winter was the most challenging period with greatest service demand. Precise demand and costs varied depending on the severity of winter. Use of agency staff could also increase during winter. In response to Members concerns on the impact on patients, he gave assurance that patients’ needs came first across the Trust.

The Chairman referred to use by the Trust of the Aspire private hospital services at a cost of £9m. He was concerned about the long-term impact on in-house patient services due to use of private care at a high cost. Tim Bennett re-iterated priorities to ensure high quality care and patient satisfaction. However, NHS providers did not have full capacity to meet patient demand so had to consider all options.

Members referred to the high costs of Aspire and that the Trust previously had high levels of reserves which were now at seriously low levels and expressed concern at those in conjunction with  the growth in patient demand and the sustainability of the trends going foward. Tim Bennett acknowledged the pressures and that demand had increased for beds in acute wards so it had been necessary to use other options.

The Committee noted that patient satisfaction was currently 95.8% but staff satisfaction was only 69%. Tim Bennett acknowledged that staff satisfaction needed to be improved. Efforts were being made to achieve better staff morale but it was recognised that they worked in a highly pressurised environment.

Members referred to accident and emergency turnaround targets of four hours which were not being met and gave an anecdotal example of a poor stay experienced by a patient but apparently deemed to be a ‘normal’ experience. As part of supporting accident and emergency, they enquired how long the recruitment freeze for non-clinical staff was projected to last. Tim Bennett explained that a range of initiatives were being pursued across the health and social care sector to reduce demand for acute services and improve efficiencies The recruitment freeze would run until the end of March 2017. He added that example of poor experience being seen as normal was not usual practice and high standards were set and offered to follow up the case if details could be provided.

The Committee agreed to receive an assurance report in spring or summer 2017 on clinical care and financial performance achieved during the winter period (end March 2017).