Agenda item

Proposal on creating a single healthcare organisation.

5.1  The chair invited Professor John Moxham, Director of Clinical Strategy, to speak about the development of a Strategic Outline Case. The Director of Clinical Strategy explained that the four organisations that make up King’s Health Partners KHP (South London and the Maudsley, Guy’s and St Thomas’, King’s College Hospital NHS Foundation Trusts and King’s College London) have decided to look at the case for creating a single academic healthcare organisation.

5.2   He stressed that King’s Health Partners have been collaborating as an Academic Health Sciences Centre (AHSC) since 2009. He went on to state that all the partners already have good services, and this is important to note. However, he explained , all could do better and need to do much better, and believe the integration is the way to make a step change

5.3  The Director highlighted the potential to work with SlaM to better integrate mental health and physical health. He reported that clinicians know that the physical health of mental health service users is poor and vice versa.

5.4  He reported that to achieve brilliant specialist services you need scale, and that presently some are sub scale. He went on to note that since the advent of KHP AHSC the hospitals have seen the quality of people coming to work with them improve . he added that the consultant staff are supportive of this move. He said that patients also support this move and understand the rational when the case it put forward.

5.5   The Director reminded the committee of the huge challenge to improve outcomes while reducing costs. He went on to say that collectively services need to shift the emphasis from treatment to prevention and welcomed tonight’s agenda item on Public Health. He said that recent research shows we need to do much better at driving improvements and drew members’ attention to the ‘heat map’, which he said demonstrates the level of inequality experienced in Southwark. He reported that while Southwark has a high level of red in Bromley most conditions are showing as green.

5.6  The Director commented that all the hospitals are doing well, and that all have achieved Foundation status. He emphasised that this is not driven by an outside imperative, and rather a local choice by all the hospitals to further improve quality.

5.7  He went on to explain that as part of the AHSC the whole of KHP is wrapped into 21 Clinical Academic Groups (CAG) and these comprise the building blocks for further integration. The vision is to substantially improve care through better integration and an emphasis on prevention and reduced health inequalities. He reported that KHP believe this presents a unique opportunity for KHP to be a UK top ten global provider of health services.

5.8   The Director finished his presentation by explaining that the Strategic Outline Case will be considered by partners, Trusts and Kings College London over June and July and once complete this document will be sent to the committee. The chair thanked Professor Moxham for his presentation and moved to taking questions. He started by asking how long would a full business case would take to prepare and the Director responded that this does depend on who you talk to , but somewhere in the region of 18 months to two years. The chair then asked if the business case would consider the lessons of mergers that have failed. He assured the chair that KHP would, and went on to comment that often failing organisations seek merger as a remedy for failure, but then continue to fail, or it can be a top down process; however all the trusts and partners involved are successful organisations and this is a bottom up approach.

5.9  A member then asked why a merger would make KHP more successful; and if it would not be better for the organisations to continue to work as partners utilising the CAG model and questioned the reasoning that big is always better. The Director of Clinical Strategy answered if you have specialised services for treating pancreatic cancer; brain surgery; strokes etc it turns out if the doctors repeat the procedures through practice the services improve. He gave the example of strokes service, and explained that now KHP have one service, when before there were two, and went on to explain that similarly there is now one Bone Marrow transplant service. He went on to emphasise that you get better outcomes the more you do , and said that , for example , there are surgeons who only to do aorta surgery. A member asked if this improvement is marginal or significant and the Director said that it was significant and reported that there had been dramatic improvements in the thrombosis process following the introduction of one specialist stroke service.

5.10  The Director said that being one organisation will make it much easier to integrate services and money flows. A member asked if this will enable a shift of money to primary care and the Director agreed that it would; as fewer people will receive care in hospitals and there will be a move to integrated care in the community. A member noted that those polyclinics that remain seem to be located in hospitals.

5.11   A member asked what is going to be different and commented that people have been talking about the shift from treatment to illness prevention for some time. The Director responded that formally hospitals have tended to only concentrate on the treatment part of an illness cycle; however, KHP are interested in integration and the whole pathway. He explained that the approach would be to then invest and disinvest, nearer the start of the pathway. So for example if you put investment in smoking cessation.

5.12  A member asked about clinical self-interest and the Director mentioned that Dr Cosgrave in America has a philosophy of putting patients first and doctors last. Decisions will are also be driven by data on outcomes.

5.13  A member said that a patient reported that they were first treated in Kings and then at St Thomas hospital, however the consultant could not read the scans or look at test results. The Director responded that all the Trusts IT systems are not fully integrated yet; because this would mean all the hospitals adopting the same system. Progressing this level of integration would be easier if we had one overall boss. The member asked if that means you are intending to procure one IT system and he responded that the technicians are now talking about linking devices.

5.14  A member asked how integration would make a difference to tackling health inequalities. She noted that we have been working on this for years and by now there should been marked improvement. The Director responded that are many causes that would benefit from an integrated approach including the underlying determinates such as this as housing; jobs; economy. He noted the single greatest cause of lung cancer is smoking which very associated with socio economic status. He noted that the poorest of the poor are single women with children. He went on to comment that over the last 40 years there have been little change in the 5 year survival rate for lung cancer despite medical advances; it remains around 7%. However, there has been a large fall in its incidence due to smoking rates falling from 45% to 22%.

5.15  A member commented that one of the problems has been expensive drugs not being available to all. He went on to speculate that the health service will develop so there will be a private service that can supplement the  more ordinary health service. He asked if people on the NHS plus pathway might well in future be able to access a subsidised market and get drugs and devices at a price they can afford. The Director of Clinical Strategy answered that there is nothing that you cannot get at a public hospital that you get at a private hospital.

5.16  A member asked how the consultation would involve patients and the response was that there are many patient groups, the governors and around a thousand volunteers. He assured the committee that patient involvement is very important to the partners.

5.17  The Director was then asked if there will be a reduction in hospital provision and if the merger poses a risk to patient care. He assured members that the merger would not be a distraction from patient care.

5.18  A member asked if a big trust could pose a conflict of interest with the commissioning of services by doctors on the new clinical commissioning committees. The director responded that the Health and Wellbeing Board may a find a route through some of those conflicts of interest. The member commented that a merger is one way of  mitigating against the dangers of any qualified provider destabilising the system. However, he questioned the likelihood of Monitor considering that the merger could be a monopoly provider. The Director responded that Monitor would take a view on the competition angle.

5.1  The chair asked if the committee can expect an answer on if this is likely to proceed by the end of the month and the Director confirmed that the three Trust boards and Kings College would be given information by end of the month, which they will then consider. The chair thanked the Director of Clinical Strategy for his presentation and said that the committee intend to keep the merger under review.

RESOLVED

The chair asked KHP to keep the committee updated on progress and provide the Strategic Outline Case when, and if, this is produced.