Agenda item

King’s College Hospital (KCH) Foundation Trust will attend and provide papers on the below issues: 

i)  Trust plans to improve KCH’s financial position - with CCG in attendance (tabled)

ii)  Staffing retention and recruitment plans (see enclosed)

iii)  A & E Denmark Hill update, including Emergency Recovery Plan

(see enclosed)

The following will present:

•  Dawn Brodrick, Executive Director of Workforce Development

•  Peter Absalom, Associate Director of Workforce Operations

•  Alan Goldsman, Director of Financial Improvement

The following King’s College Hospital (KCH) Foundation Trust and CCG representatives attended:

·  Dawn Brodrick, Executive Director of Workforce Development, KCH

·  Peter Absalom, Associate Director of Workforce Operations, KCH

·  Alan Goldsman, Director of Financial Improvement, KCH

·  Caroline Gilmartin, Director of Integrated Commissioning, NHS Southwark CCG

Trust plans to improve KCH’s financial position

The Director of Financial Improvement presented the finance report. The following questions and comments were made:

·  Can a Foundation Trust run a deficit?  The Director explained that the Trust receive distress funding in the form of Treasury borrowing.

·  Could assets be sold to fund the gap? No, there is a lock on assets.

·  How are KCH going to live within their means? There is Trust plans to make savings and increase productivity. KCH is also part of a health system where solutions also lie. The CCG Director of Integrated Commissioning also agreed that solutions lie here and the STP will enable some of these issues to be better addressed. The KCH Director said KCH funding is over a billion pounds a year and raising each year by a small amount, however KCH costs are rising at a greater amount. The deficit is a relatively small fraction of KCH overall spend.

·  How does the Trust fund deficit compare to other Trusts? It is substantial and high; however the KCH financial envelope is also big to compare to other Trusts.

·  Can you raise more by increasing private patents? There are limited opportunities here as there is  not much physical capacity; there are some opportunities in research.

·  A member noted that the deficit reduction had gone better in previous years, however now it is on an upward trend; why is this? In part because early savings are easier to make. There are other issues such as higher drug costs. There are many challenges. The main aim is to become more productive (efficient).

·  What about winter planning? KCH have tried to think about as this as much as possible - but they will have to see. It will be very demanding, KCH know this.

·  How does this impact on the CCG?  The Director of Integrated Commissioning said they are anxious, the CCG are working with the Trust to enable a good and robust relationship; it's not good if Southwark have a Trust which struggles to get nurses and doctors. The CCG try and set a contract which fully covers Southwark patients. Is there is a direct cost impact? The CCG might have to react if there was a big demand - for example a very difficult winter. We cannot allow hospitals to fail - that was learning from Mid Staffordshire [when care plummeted partly as a result of budget pressures]. 

·  How many users of KCH are local patients? One 1/3 are from Southwark / Lambeth/ Bromley, with Southwark about 10%. There is block contract with local CCGs and dialogue is ongoing and positive with local CCGs..

Staffing and recruitment

Dawn Brodrick, Executive Director of Workforce Development, KCH and Peter Absalom, Associate Director of Workforce Operations, KCH presented and then the following questions and comments were made:

·  How is Brexit impacting on recruitment? Europe dose provide staff with scores from Spain and Romania but international recruitment yields people in the hundreds.

·  Do the exit questionnaires identify housing? We are looking at prioritising housing for key groups. People will more say they want promotion or career development. It's more about not joining because of housing costs.

·  Has Brexit has impacted on KCH  medical workforce ? There is an article in the New York Times on KCH and the impact of Brexit, particularly around research.

·  How many are agency staff? About 200. We are aiming to reduce it and this is going down. Some will be an odd day; KCH do need to retain some flexibility. There is a constant month on months focus on this issue as there is a 27% on-cost for agency workers.

·  Are you looking at research? Yes, we also look at career development and rotation across the STP.

·  How does the international recruitment go? They are less likely to go. We provide assistance on relocation and also support here. KCH  have got 16 years of experience and  are able to add the human touch, offering  bespoke support as some nationalities may stay for different periods.

·  What about mental health recruitment? This is more led by SLaM. It's fair to say the issues in ED mental health issues are increasing as we have an increase in need as a society.

·  Should we feel guilty about recruiting from Philippines? Yes and no. It is a chief form of economic income in Philippines and KCH  work closely with the overseas development agency. Should we be recruiting from local communities? KCH are looking for a diverse staff community to reflect the local community and making  are making recruitment films about KCH. Do you have specific targets for the local community? That would need to be linked to an apprenticeship programme.

·  What about using the Denmark Hill site and possibilities for offering housing to doctors and students? There could be possibilities for attracting and retaining staff with the emerging  master plan; this is linked to realising capital to invest and anyway would not come online for ten years or so. KCH are presently focused more on immediate things they can do.

Members congratulated the team on the significant improvements to staff recruitment and retention.