The report makess seven main proposals:
1. The operational efficiency of the hospitals that make up SLHT needs to improve so that the Trust’s costs are in line with strong performing NHS organisations. This will mean that, over the next three years, the sites that make up SLHT need to make the full £74.9m of efficiency opportunities identified through analysis. This will require a transformation both in clinical and managerial leadership and in fundamental organisational culture.
2. Queen Mary’s Hospital Sidcup should be developed into a ‘hub’ for the provision of health and social care in Bexley, facilitated by the transfer of the required portion of the land and estate to Oxleas NHS Foundation Trust. Implementing this recommendation will deliver annual savings of £4.5m by the end of financial year 2015/16.
3. Vacant and poorly utilised premises should be exited (in the case of leases) or sold (in the case of freeholds). The NHS should engage with the local authorities in Bromley and Bexley in the process of selling surplus estate to ensure its future use maximises regeneration opportunities.
4. On an annual basis until the relevant contracts end, the Department of Health should provide additional funds to the local NHS to cover the excess costs of the PFI buildings at Queen Elizabeth Hospital and Princess Royal University Hospital.
5. In line with commissioner intentions to improve the quality of care for the local population and agreement amongst clinical leaders to aim to meet the acute clinical standards set for London, there should be a transformation in the way services are provided in south east London. Specifically, changes are recommended in relation to community-based care and emergency, maternity and elective services:
- Community Based Care – The Community Based Care strategy for south east London should be fully implemented, at pace, to deliver improved primary care and community services in line with the aspirations in the strategy. This will enable patients to receive care in the most appropriate location, much of which will be closer to, or in, their home.
- Emergency care – Emergency care for the most critically unwell patients should be provided from four sites – King’s College Hospital, St Thomas’ Hospital, Queen Elizabeth Hospital and Princess Royal University Hospital. Alongside this, services at University Hospital Lewisham, Guy’s Hospital and Queen Mary’s Hospital Sidcup will provide urgent care for those that do not need to be admitted to hospital. Emergency care for those patients suffering from a major trauma (provided at King’s College Hospital), stroke (provided at King’s College Hospital and Princess Royal University Hospital), heart attack (provided at St Thomas’ Hospital and King’s College Hospital) and vascular problems (provided at St Thomas’ Hospital) will not change from the current arrangements.
- Obstetrician led maternity care – Four obstetric led delivery units should be provided at King’s College Hospital, Princess Royal University Hospital, Queen Elizabeth Hospital and St Thomas’ Hospital. In addition, five midwifery-led birthing units should be provided: one at each of those four hospitals and one at University Hospital Lewisham. All other maternity care will continue to be provided in a range of locations across south east London.
- Paediatric emergency services and inpatient units should be co-located with all acute admitting units and paediatric urgent care should be provided at University Hospital Lewisham, Guy’s Hospital and Queen Mary’s Hospital.
- Elective care – An elective centre for non-complex inpatient procedures (such as hip and knee replacements) should be developed at University Hospital Lewisham to serve the whole population of south east London, managed by a partnership board of representatives of all provider organisations. Alongside this elective day cases procedures should continue to be provided at all seven main hospitals in south east London; complex procedures should continue to be delivered at King’s College Hospital, Princess Royal University Hospital, Queen Elizabeth Hospital and St Thomas’ Hospital, and specialist procedures at Guy’s Hospital, King’s College Hospital and St Thomas’ Hospital. Outpatient services should be delivered from a range of local locations.
6. In order to deliver this transformation programme, South London Healthcare NHS Trust should be dissolved and other organisations should take over the management and delivery of the NHS services it currently provides. In addition to the proposals for Queen Mary’s Hospital Sidcup outlined above:
- The Queen Elizabeth Hospital site should come together with Lewisham Healthcare NHS Trust to create a new organisation focused on the provision of care for the communities of Greenwich and Lewisham.
- Princess Royal University Hospital should be acquired by King’s College Hospital NHS Foundation Trust, which would enable the delivery of service change, enhance the services offered at the site and strengthen the capacity of the site to deliver the necessary operational improvements.
- It is important that these new organisations are not saddled with the issues of the past. To facilitate this, it is recommended that the new organisations are not faced with any repayment requirements relating to historic debts, and that the Department of Health should write off accumulated debt.
7. Transitional funding will be required for Oxleas NHS Foundation Trust, King’s College Hospital NHS Foundation Trust and the new organisation combining Lewisham Healthcare NHS Trust and Queen Elizabeth Hospital, to cover the in-year finances while the recommendations are being implemented. It is estimated that the level of support required will be in the region of £55.3m in the three-year transition period. If the recommendations are accepted, further work between the Department of Health and the Trusts to agree these figures will be a crucial element ahead of implementation. There should also be a Programme Board under an independent chair appointed by and reporting to Sir David Nicholson, Chief Executive of the NHS Commissioning Board, and David Flory, Chief Executive of the NHS Trust Development Authority. The programme board will work with all south east London organisations to ensure change is delivered.
You can read the full report on the NHS website.