John Goulston, Chief Executive, Croydon Health Services NHS Trust (CHS) was in attendance for this item to present to the Committee the
Trust's update in relation to the financial recovery plan.
The Committee were interested to learn more about the "new ways" of delivering services and that were being explored by the Trust how this
would be achieved with a reduced budget. Members also asked what options had been considered during the option appraisal.
The CEO reported that there had been a period of tighten expenditure controls especially around reducing agency costs by £40K a week. This was achieved by working with the London procurement partnership who offer a lower agency nurse rate. In addition the Trust took a hard look at agency usage resulting in a directive to department whereby they are only authorised to cover 50% of a vacancy using agency cover. Maternity and accident and emergency would be exempt from this costing saving measure. The general shift in agency patterns would come from the community.
It was further reported that the governing body NHS Improvement had required all CEOs to individual sign off all agency use costing more than £120ph, the Trust reported that currently 80% of the controls were already taking place with the Trust.
Further examples were given regarding the use text messaging appointment reminders to patients. The message includes the cost to the Trust if a patient did not attend (DNA). This has resulted in success in dermatology of around 7% less DNAs and in physiotherapy around 16% reduction in DNA rates; the Trust is looking to roll this out across all areas. Members agreed that this was a good initiative and wondered if the vacant appointments were being reallocated. The Trust reported that they were looking into procuring appropriate software that could delivery this.
The Trust are investigating ways to achieve a paperlite environment. A team consisting of the chief clinical information officer, lead nurse, medical director and director of operations are working hard to realise this initiative. The health environment has all records on a system which are not always easy to extract required data. The team are seeking ways to improve the access to information using a system which would cost around £15K. This would reduce the current contract expenditure for off-site storage of around 40%.
The Committees asked what the rates of instances are around readmission and how many of these are due to early discharge, and could the readmission have been avoided if the appropriate care package had been in place. The Trust reported that there was no incentive to readmission as this generated no income for the second admission, it was not in any bodies interest to readmit patients, the Trust want to get it right first time. The national readmission rate is 1 in 10, the Trust's readmission rate is currently 1 in 5. Unfortunately readmission is an inevitable outcome in some cases and could not realistically be reduced to zero. An audit by a west London team concluded that 40% of patients occupying an inpatient bed could have been managed differently with 30%, not requiring admission at all. There is scope to save money and Croydon continues to challenge the norm.
The Trust were asked to comment on the financial recovery plan regarding measureable actions it could take. It was reported that one area
investigated was in theatres and how best to reduce under usage. CHS are in discussions with both Kingston and St Georges ENT and Urology
consultants as these clinicians are shared across the sector, which could result in some operations being diverted back to Croydon.
The Committee discussed managing risk in relation to the success of the sustainability and transformation plan which will be submitted to NHS England on 21 October 2016. CHS will work closely with CCG colleagues to deliver the plan.
Member asked CHS how after setting a budget within 3 months management were struggling to stay on target and if NHS Improvement had not intervened would the Trust have the internal capacity to produce a sustainable recovery plan; would the executive team to keep a stronger watch on the budget.
Officers reported that yes the executive team are keeping a stronger watch on finances, however the expertise and support would not have been available without being placed in special measures. We didn't say no to controls set but we had some outstanding issues with CCG around funding. The Trust executives meet with Clinical directorates more regularly to discuss a bottom up approach to cost improvements.
The Committee raised concern related to the financial impact of a bad winter in terms of flu, CHS assured Members that the Trust would be allocated additional funding to cover this scenario.
The Trust are due to submit the first draft of the recovery plan to NHS improvement on 24 October 2016. To facilitate an update from the Trust the Committee had held a date in the diary to convene an additional meeting on Thursday 8 December 2016. The Trust were in agreement that this date would be workable within their timeline.
The Committee AGREED to receive a presentation from CHS in relation to the recovery plan and were confident and convinced the Trust were on the way to financial recovery at a specially convened meeting of 8 December 2016.