Agenda item

This report provides a post-acquisition review of the Chelsea and Westminster Hospital NHS Foundation Trust acquisition of West Middlesex University NHS Trust, one year after the formal integration of the two trusts.

Councillor Vaughan welcomed Lesley Watts, Chief Executive, and, Iain Beveridge, Consultant Physician & Gastroenterologist / Associate Medical Director from Chelsea and Westminster Foundation NHS Trust (CWFT) and West Middlesex University Trust (WMUT).  The presentation provided an update, one year after CWFT acquired WMUT, bringing together two acute hospitals, providing care for between 850,000 and 1 million people, with approximately 1000 beds, combined.  With the aim of delivering specialist care to a wider demographic, Lesley Watts explained that they were engaging closely with CCG colleagues to better understand how care could be better integrated.  Part of this involved building the right culture, embedding shared values across both sites.  Both hospitals retained distinct identities, with healthy competition driving good practice.  Staff were highly committed to the integration and commended strong performance to clear governance and leadership.  Lesley Watts reported that targets in A&E wait times, RTT (referral to treatment) and cancer and access outpatient waiting targets, had all been met, with A&E being the best performing unit in London. Another positive was lower than expected mortality rates in both hospitals, against the “required improvement” CQC assessment on both sites, prior to the merger.  There were continuing challenges, such as the patent experience and staff engagement rates which were expected to decline given the change and integration of the past year, and achieving the £3 million surplus required to release sustainability and transformation plan funding, for which they were on target.

Councillor Brown acknowledged that his perception of the merger had changed, and reflected that he was now convinced that this had been the right course of action, with a rare and successful evolution of the two hospitals, setting a highly positive example to other NHS organisations.  In response to a question as to what could be identified as a failing and what the Council could do to assist, Lesley Watts explained finances remained her biggest concern, together with trying to persuade the organisation that maintaining a surplus was a good strategy to encourage greater investment.  She continued that staffing recruitment and the turnover of staff was another issue.  WMUT was very much a local hospital, staffed and served well by its local community, with the average age of staff at WMUT being approximately 47, by contrast, there was a very young workforce at CWFT, where the average age was 27.  Iain Beveridge confirmed that there was a real crisis in maintaining a medical workforce currently and that because of the changes in the previous year, they were behind the curve on recruitment and retention.

Patrick McVeigh sought assurance that following the EU referendum and the UK’s decision to leave the EU, the views of the Trust would be communicated to NHS England.  Lesley Watts responded that they had been asked to articulate information about current staff skill levels.  As an aside, she reported that CWFT and WMUT had dealt robustly with both staff and patients, who had expressed negative or vitriolic comments about overseas NHS employees following “Brexit”, and who had been, respectively, dismissed or removed from patient lists (without jeopardising treatment or care).  It was intended that a clear message from the trusts signalled that such negative, ill-informed behaviour was not to be tolerated.

In response to a question from Councillor Carlebach, Lesley Watts explained that they had undertaken considerable work on both appraisals and mandatory training, which were both linked to incremental salary increases.  This was built into the induction process and staff were encouraged to think about how appraisals will inform career development.  It was acknowledged that workforce retention was an issue, with the turnover rate at 16.2% in London, with one outcome being increased reliance on bank or agency staff. 

Councillor Carlebach highlighted a recent constituents experience, following treatment and hospitalisation after a stroke and queried the way in which responsibility for patient care during transfer was managed.  Iain Beveridge explained that one of the advantages of the merger was the availability of a wider range of services.  The health service was moving towards increasingly collaborative working, forging links with, for example, Imperial College Healthcare NHS Trust. 

Councillor Carlebach asked if the Trust could expand on how it would work with the mental health trusts in terms of identifying patients.  Iain Beveridge responded that they worked with two acute mental health trusts, in addition, there was an adolescent mental health ward at CWFT.  Patients presenting with mental health concerns could be seen within the A& E unit.

Councillor Perez enquired about cuts to local health services, for long term HIV positive outpatients.   Iain Beveridge explained that the service, which had been transferred from Charing Cross hospital to Hammersmith Broadway, had received good feedback but the decline in this specialist support service was largely due to reduced resources.  Lesley Watts added during the past twenty years, there had been a change in clinical practices, with more effective treatments, a better understanding of HIV and the greater resilience of patients living with this condition long term.

Bryan Naylor expressed concern about end of life care and the transfer of resources from hospital into the community if “bed blocking” was to be avoided.  Lesley Watts responded that community based and GP resources were under pressure and that they were looking at undertaking ward rounds in residential nursing homes.  She recognised the need to design and provide such services effectively.  Iain Beveridge added that the Trust accepted criticism about the end of life care offered in a hospital setting, which presented challenges, and understood the need to improve palliative care.  Referring to the Care Quality Commission recommendations on “Do Not Resuscitate” (DNR), Bryan Naylor highlighted additional concerns about the miscommunication and application of DNR protocols.  Iain Beveridge explained that the Trust had well-rehearsed guidelines, developed by senior clinicians, together with families, recognising the inherent sensitivities and challenging circumstances that arise.  Conversations around end of life were best undertaken at home and not in the sudden and clinical or acute setting of a ward or hospital.

Councillor Vaughan enquired about electronic patient record system and it was noted that Trust was working with Imperial College Healthcare NHS Trust to develop the new system, which was not yet in place.  This was attributable to several factors including patient flow, financial and the introduction of a new system over an existing one.  The joint working with Imperial had been a positive learning experience with lessons being learned.

Summarising the discussion, Councillor Vaughan thanked the presenters, noting that the electronic patient records system was work in progress and looked forward to receiving further updates.  He welcomed the continuing partnership with Imperial and the fact that WMUT had maintained its own, strong identity and relative autonomy within the structure of the merger, whilst sharing best practice and services.  Challenges around staff recruitment, retention and reliance on bank or agency staff were acknowledged, as was the robust approach to staff and patient attitudes, post Brexit.  Councillor Vaughan welcomed the work around end of life care, (an item being considered in December) and the collaborative approach sought on palliative care. 

RESOLVED

That the report be noted.