Agenda item

The Chief Executives from York Teaching Hospital NHS Foundation Trust and NHS North Yorkshire and York will be in attendance at today’s meeting along with the Chief Finance Officer from the Vale of York Clinical Commissioning Group. They will be discussing the Financial Status of NHS North Yorkshire and York and the handover process to the Vale of York Clinical Commissioning Group and some of the challenges that this will bring.

 

 

 

Members received a verbal report from the following people; Chris Long, the Chief Executive of NHS North Yorkshire and York, Patrick Crowley, the Chief Executive of York Teaching Hospital NHS Foundation Trust, Adrian Snarr, the Chief Financial Officer from the Vale of York Clinical Commissioning Group and Alan Maynard, the Chair of Vale of York Clinical Commissioning Group.

 

In his report to the Committee regarding the financial status of the NHS in North Yorkshire and York, Chris Long informed Members that;

 

·        NHS North Yorkshire and York had agreed (with the Department of Health) a £19 million deficit in the current year’s budget.

 

·        That a further £24,000 still needed to be achieved through efficiency savings in order to cover the deficit, and that KPMG had been brought in to look at how this figure could be achieved and whether it was viable.

 

·        That KPMG and Chief Executives from providers to the NHS would present a set of proposals in mid November.

 

·        That following the release of the proposals a consultation with the Health & Social Care and Voluntary Sector would take place.

 

·        That the main focus of reforms should concentrate on how robust services could be provided in the community, rather than an over-reliance on using hospitals.

 

Adrian Snarr, the Chief Financial Officer from the Vale of York Clinical Commissioning Group (VOYCCG) gave an update to Members on the financial position of the VOYCCG. He gave a background to Members on the transfer of functions from the Primary Care Trust (PCT) to VOYCCG. In relation to the financial situation he told Members that;

 

·        Neighbourhood Care Teams were in development to reduce the reliance of patients and doctors using hospitals in the first instance.

 

·        That the VOYCCG was looking into starting a referral review to make sure that patients would be seen by the correct person.

 

·        It was noted that the decision on referral would be made by a clinician in the particular speciality to which the case was related.

 

·        That a process of “Shared Decision Making” would be implemented which would include a greater involvement by the patient and the clinician in deciding what treatment they wished to have, and in what way and where they wished to be treated.

 

·        That the VOYCCG were advising GP’s on which drugs to prescribe, as these varied in price and accounted for a large amount of the budget for GP’s.

 

·        That areas still existed where potential financial savings could be made, but the identification of savings was heavily influenced by the level of patient education.

 

 

Questions from Members related to the following issues;

 

·        How would “Shared Decision Making” provide a cost saving?

 

·        How would GP practices be monitored to discourage automatic referrals to hospitals for treatment which could be done elsewhere?

 

·        Would the reduction of hours of service for minor injury units in Malton and Selby have a knock on effect on to district hospitals?

 

In response to the question about Shared Decision Making, it was reported that it could potentially produce savings as it would be highlighted to the patient, who would make the choice for treatment, that a hospital operation would be more expensive.

 

In relation to surveying patients about the quality of their treatment whether carried out in hospital or not, some Members felt that the results would be heavily influenced by the level of experience that the patient had in the NHS.

 

It was reported that in some GP surgeries, GPs did not immediately refer a patient on to hospital, but that this tended to be in cases where the surgery had an expert in that particular area. It was highlighted that the success of the scheme was particularly significant given that both York and Scarborough hospitals had particularly high referral rates over the last few summer months. The rates it was said were comparable to winter levels, and it was suggested the scheme could be used as an alternative to manage these levels to avoid the deterioration of hospital services. Additionally, it was noted that community health services had not been funded as highly as clinical services, but the Shared Decision scheme hoped to remedy this through redistribution of funds.

 

In response to a Member’s question about the reduction of operating hours of minor injury units, it was noted that this was a part time measure for the current year. Members were also informed that the cost of treatment in a minor injury unit was comparable to that in Accident and Emergency (A & E) departments. It was suggested that people who lived closest to minor injury units and A & E departments were the ones who used them more often than other patients. Therefore, by restricting their opening hours, it was hoped that these residents would visit their GP surgery instead.

 

The Chair of the Vale of York Clinical Commissioning Group, Alan Maynard, attended the meeting. He raised a number of points which followed on from previous discussions including;

 

·        That the status of community care within the health system needed to be clarified, i.e. would it be used as complementary or as a substitute to clinical care?

 

·        That evidence needed to be provided as to whether Neighbourhood Care Teams would reduce admissions to hospitals and therefore provide savings.

 

·        That if there was not clear evidence from the start that the teams would reduce admissions then an evaluation should be put in place as a moral responsibility.

 

·        That it was important for patients to be asked where they wished to die, whether this was in a hospital,  in a hospice or at home.

·        That a large challenge existed to get large GP practices operating 24 hours a day and seven days a week, in order to decrease hospital admissions.

 

Chris Long informed Members that he felt that four main issues existed which would force change in healthcare in general. These were;

 

·        The UK economy would not grow at a fast rate, and that there would be a flat economic period for a number of years.

 

·        There would be large implications for Local Authorities and Social Care following the release of the Comprehensive Spending Review by the Treasury.

 

·        The conclusions of a second report by Robert Francis QC into the quality assurance of care delivered by the NHS.

 

·        The advent of seven day working, in particular given that five day working at a primary care level is not realistic.

 

He finally felt that debates around these areas would continue to be dominated by the level of access to care, the quality of the care offered and its affordability. He underlined that if high quality services could not be provided locally, they would remain at a central location.

 

Some Members asked how the transfer of funding from the PCT to the VOYCCG would remain secure, they questioned whether it would lead to unexpected closures of services. They also asked whether the current deficit in the PCT’s budget was exceeded, if a plan had been formulated by the VOYCCG to overcome this.

 

It was reported that the VOYCCG would not know if the budget had been exceeded until April 2013.

It was also suggested that the financial reforms could be seen as being controversial, but that they would hopefully be carried out soon in order to bring down the deficit.

 

The Chair thanked the Chief Executives from York Teaching Hospital NHS Foundation Trust and NHS North Yorkshire and York along with the Chief Finance Officer and Chair of the Vale of York Clinical Commissioning Group for attending the meeting.

 

RESOLVED:       That the verbal updates provided by NHS North Yorkshire, York Teaching Hospital NHS Foundation Trust and Vale of York Clinical Commissioning Group be noted.

 

REASON:           In order to keep the Committee updated on the financial situation of these bodies.