| 3 | Members were informed that a new Regional Ambulance Service became operational on 1st July, with the launch of the new West Midlands Ambulance Service NHS Trust. The new West Midlands Ambulance Service had been created as a result of a merger of existing Ambulance Service Trusts in Coventry & Warwickshire, Hereford and Worcester, West Midlands and Shropshire. Staffordshire Ambulance Service will work in partnership towards amalgamation with the new Trust at a later date.
The Chief Executive of the West Midlands Ambulance Service NHS Trust conducted a presentation which updated the members on the following aspects of the Trust:
ˇThe make-up of the West Midlands Region
ˇThe Partnership Board
ˇThe Organisational Structure
ˇOpportunities Facing the New Trust
ˇPost Merger Key Objectives and Priorities
The Chief Executive noted the challenges facing the new Trust, which included:
ˇNearly half of all 999 calls do not require Accident and Emergency treatment
ˇThe need to extend Paramedic training to ensure greater treatment at home
When detailing the regional make-up of the Midlands Ambulance Trust, the Chief Executive noted that Staffordshire still operated a separate Ambulance Service due to concerns that the merger would lead to a dilution of their services. The Chief Executive explained that Staffordshire were still due to enter into the merger at a date yet to be determined.
The Chief Executive detailed the make-up of the West Midlands Ambulance Board, explaining how five Corporate Directors were held to account by their local teams, to ensure an understanding of their specific locations and also ensure the whole Trust followed a common strategic direction.
The Chief Executive highlighted the previous poor performance of the West Midlands Ambulance Trust and explained that in August and September the Trust had met all its targets, which demonstrated a willingness to transform. He also detailed the Trust's performance relative to its key objectives and priorities, which included improving the quality and consistency of care and improving efficiency and effectiveness and explained the Trust was now in financial balance. The Chief Executive emphasised that the Trust's priorities should not just be about responding to 999 calls, but rather providing a good standard of care across a broad range of indicators.
The Chief Executive detailed the savings and economies of scale that could be achieved through the merger of the previous Ambulance Services in the Midlands. This included reducing unnecessary administration and bureaucracy as well as avoiding duplication of work - e.g. employing one administration unit to take on responsibility for payroll for the whole Trust. He explained how these savings could be re-invested in front-line services. The Chief Executive also noted the volume of Control Rooms the Trust used was unsustainable - they currently employed five units, few of which had the necessary I.T systems to communicate with each other. He explained that a service review should be undertaken to determine the volume of Control Rooms that were required, allowing greater cost savings.
Following the presentations, the Chief Executive responded to questions. Members noted that the Chief Executive had been in the post since June and welcomed the progress made during this time, especially financial. They queried whether some of the former ambulance services were in credit, whilst others were in debt, and that through the merger this had created a balance overall.
Members also highlighted the I.T. systems being used and questioned whether any measures were being taken to ensure the Strategic Health Authority (SHA) and Primary Care Trust (PCT) had access to the same systems.
The Chief Executive acknowledged the importance of I.T. systems and noted that the five former ambulance providers currently used 3 different systems - he emphasised that it was a priority to correct this. The Chief Executive explained a number of benefits gained from the SHA and PCT using the same I.T. systems and noted that the greatest advantage would be patient record sharing. Through this the hospital staff, GPs and Paramedics would be enabled to access key patient data in emergencies and allow record sharing across the NHS, whilst ensuring patient confidentiality.
In terms of finance, the Chief Executive emphasised that the Trust had achieved financial balance not by merging the different ambulance providers, but instead by identifying what was not essential, such as certain administration functions, as well as not filling unnecessary vacancies. He also emphasised that the Trust was still protecting front line services and guaranteed that no savings would be top-sliced.
The Group questioned the procurement of services and queried whether officers could act for the Ambulance Providers, the SHA and the PCT to achieve common procurement-savings.
The Chief Executive explained that the common procurement of services currently happened to an extent, through purchasing drugs and equipment: however he acknowledged this could be undertaken more efficiently. He emphasised there was too greater variety in purchasing of equipment and services amongst the different agencies and he stressed there were economies of scale that could be achieved to ensure future savings.
Members expressed concern at the Ambulance Trust and other health agencies using one service provider for drugs and medication. The Chief Executive agreed with this point, noting that if all providers used one common fleet for drugs and medication and there was a fault it would all be rendered unusable. He emphasised that it was a balance between economies of scale and maintaining services. The Chief Executive explained that for drugs and medication, the different health agencies used a range of services, but benefited from using one purchaser. |
| 4 | The Chief Executive of the Heart of England Foundation Trust and Director of Corporate Affairs attended the meeting to respond to members' questions regarding reports that had indicated closing hospital departments for areas with less than 300,000 residents.
The Chief Executive responded by noting there were two main issues - the first being concern over the potential closure of Accident and Emergency (A & E) services for areas of under 300,000 residents and the proposed merger of Good Hope Hospital and Heart of England Foundation Trust (HoEFT). On the first issue, the Chief Executive stressed there was no thought of closing the Accident and Emergency department at Solihull Hospital, nor any intention of reducing the provision of services. He emphasised that if the proposed merger went ahead he hoped there would be scope to expand services. The Chief Executive emphasised the Trust wished there to be no concern or distress amongst residents regarding closing the A and E services provided at Solihull.
With regard to the proposed merger of Good Hope Hospital and the HoEFT the Chief Executive explained that the HoEFT was in a financially sound position and was recruiting staff. He noted that Good Hope was currently in a stable financial position also. It was explained that through the merger this would give Good Hope the stability that Solihull Hospital had. The Chief Executive also noted the merger of Good Hope Hospital would not affect the provision of services at Solihull.
Members questioned the current position regarding the merger of Good Hope Hospital and the HoEFT. The Chief Executive explained he was tracking the merger proposals and noted that key decisions were being made that week. He emphasised that he wished for the merger to go ahead as soon as possible in order to address residents' and patients' concerns and he aimed for the merger to take place during early spring.
The Board queried the views of the staff at Good Hope Hospital. The Director of Corporate Affairs explained that the staff wished to have stability and through the negotiation process they had gone from concern about the future to greater confidence and greater financial stability. She also noted that the negotiation conducted thus far had acted as a good initial integration process.
Members also queried what the impact of a merger would be on the provision of after care for out-patients. They expressed concern that out-patients could potentially be sent long distances for treatment, noting that this would cause particular issues if the patient was reliant upon public transport. The Chief Executive agreed that sending out-patients long distances for treatment would be undesirable and emphasised that the Trust would leave any re-configuration of services to the service providers. He did note that the provision of services would be affected by the introduction of new working time directives for doctors. However, the Chief Executive stressed he could see no reason for sending out-patients on long distances for treatment and, for the vast majority, there would be no change to existing services, except where specialist equipment was available.
The Board made reference to a letter they received from the Chief Executive in September which stated ‘It is important that you should know that there is no intention that any of the services at Solihull Hospital will change as a consequence of the work we are undertaking at Good Hope Hospital.' The members questioned whether the Trust would be able to fulfil this intention.
The Chief Executive acknowledged that if he was instructed by the Department of Health to change services at Solihull Hospital, the Trust would be obliged to follow this. He explained he had not intended this paragraph as a disclaimer rather it reflected that nothing stood still. The Chief Executive re-emphasised there was no thought amongst the Trust of changing A & E services at Solihull Hospital. He explained that through the negotiations with Good Hope Hospital the Trust hoped to identify areas where they could improve the provision of services overall due to the greater resources available from Good Hope. |