Minutes:
6.1 The chair welcomed King’s Medical Director, Mike Marrinan and Director of Strategy, Jacob West. They opened their presentation by commenting that the TSA made the recommendation for King’s College Hospital Trust to acquire the PRUH. The Medical Director explained that there are no major plans to change the delivery of services at King’s College Hospital as a result of this, although they are hoping to decompress some activity. He emphasised that there are not any plans to bus patients around.
6.2 The Medical Director said that this is predicated on the restructure of South East London healthcare services, which was initiated by the bankruptcy of South London Healthcare Trust (SLHT) and subsequent appointment of the TSA, however restructuring is going on throughout the country of health care. He explained the new model emerging is for larger Acute Hospitals with Accident and Emergency wards, District General Hospitals and Local Hospitals. He said this will lead to a dramatic increase in consultant delivered care, and said that there is clear evidence that the earlier you see a consultant the better the outcome. He commented that the notion that everything can be done in a local hospital is just not true: however Southwark residents are lucky as they are close to two large Acute Hospitals He added that there may be some travelled involved for elective care, and reported this is still under negotiation with the Department of Health.
6.3 A member asked if the Department of Health had supplied enough money for the proposed changes. The Directors reported that this has not been agreed yet, which they said is frustrating and problematic. They added everything planned is based on the assumption that King’s receive enough money. The Medical Director commented that King’s have made proposals, however the Department of Health think it should be much less.
6.4 The chair asked what King’s would do if there is not enough money. The Directors said they can give the committee an assurance that the plans will not be taken forward without adequate funds. They explained that the financial risk rating for King’s College Hospital Trust is three, and they do not want to be downgraded. The Medical director explained that they have given the Department of Health a detailed appraisal of what is needed, which is not greedy, but what King’s need. He ended by saying they will not do it unless it is doable, however King’s think the gap is bridgeable.
6.5 A member commented on the quality of consultants and the extent of their treatment of private patients. The Medical Director explained that consultants have set contracts of time with the NHS. He added that King’s have the highest productivity of consultants, while South London Healthcare Trust had the lowest. He said this is predicated by the assumption of giving good care and high aspirations.
6.6 A member asked about the board and the Medical Director commented that there were many good people at SLHT, but an impossible structure. He added that he is sure medical care can be brought up to a high standard in a short space of time. He said that King’s have great human capital in the consultants, which gives strengths and depth. A member asked who would be lost and the Directors explained that because King’s senior managers will be in charge this means some senior managers will go at the PRUH, however some may be integrated. He emphasised that most clinicians will remain, but some senior nurses and many senior administrators will be lost. The Medical Director said that staff reassurance is an important part of the process, as this has been a difficult time.
6.7 A member asked about the decompression of King’s College Hospital and the Medical Director said that Neurology will be decompressed - so King’s can increase neurosurgery.
6.8 A member noted that the Medical Director reported that there would be no travel for acute care out of the borough, however what about Elective Care? He responded that the model of elective care is not fully worked out. He said that King’s do have anxieties about profitably, as Guy’s and St Thomas’ do too. He explained that Elective Care is the part that makes money and subsidises other care. A member commented a very cynical interpretation would be that this is an attempt to bankrupt other parts of the health service.
6.9 A member asked about patient records at PRUH and the Medical Director said that this is a key issue, because delivering on these could cost around 20 million: PRUH have no WiFi, or existing electronic records. A member asked if all records would be converted and he responded that the emphasis will be on new records being digitalised.
6.10 The Medial Director said that King’s have a vision of two sites but the same Trust. He said that there will need to be an investment and it will take time. He commented that Kings’ have good systems that will help; however these are also subject to improvement. He explained that it is never easy for a District General Hospital to compete with an Acute Hospital and he said that the bringing together of an Acute Hospital with a General Hospital in one Trust will be helpful.
6.11 A member asked what King’s is doing to reassure staff and the community. The Strategy Director emphasised strong communication, and noted that PRUH and King’s College Hospital are both jammed from the long and unprecedented winter.
6.12 The chair then asked the Medical Director about the liver transplant service and how people were able to access NHS livers as private patients. He explained that this is mostly because the livers are marginal and of poor quality, but very occasionally of good quality but there is no NHS match.
6.13 The chair said he had concerns about the tariff not being released under FOI. The Medical Director explained that the only fee is to the surgeon, anaesthetist, and a payment to use the hospital. The Medical Director commented that this is a highly regulated service and indicated that he would like to come back to the next meeting with a fuller report.
RESOLVED
The committee requested that King’s College Hospital keep the committee apprised of its negotiations with the Department of Health.