Agenda item

*Clerks Note – Cllr Kober took over as Chair for the remainder of the meeting*

A cover report was included in the agenda pack (pages 317-318), which  updated the board on proposals being developed around the NMUH joining the Royal free London NHS Foundation Trust “Group”.  A presentation was also given jointly to the Board by the Richard Gourlay, Director of Strategic Development, North Middlesex University Hospital and Ron Agble, Director of Partnership & Transactions, Royal Free London Hospital.

The Board were advised that Royal Free London proposed developing as a Group in order to develop the capability and infrastructure to reduce unwarranted variation – which was intended to result in improved clinical outcomes, patient safety and patient satisfaction. The Group intended to consolidate a range of clinical support services and non-clinical activity, which should also deliver financial benefits. NMUH had experienced significant operational challenges, in terms of both quality and delivery of access standards that may have been mitigated with access to a wider workforce resource.

North Middlesex University Hospital took a decision in March 2016 to explore how joining the group would help secure the future sustainability of services – both financially and clinically.  A Partnership Board was established in June 2016 to maintain an overview of the progress towards the decision and the integration of NMUH into the new group structure.  This Partnership Board incorporated senior leaders from the Trusts as well as representatives from Haringey CCG, Enfield CCG, NHS England and NHS Improvement. Both trusts boards would make ultimate decisions regarding progress of the Partnership Programme, with the Partnership Board acting as the collective forum to oversee the work on behalf of both organisations. The Director of Partnership & Transactions, Royal Free London Hospital assured the Board that any decision to join the Royal Free London Group would not result in NMUH being centrally managed from RFL and that local management arrangements would be maintained.

In response to a request for clarification on the risks involved in the proposal, the Board was advised that during a leadership away day for senior managers at NMUH’ one of the key areas of concern was around the need to protect the identity of NMUH. The Director of Partnership & Transactions, Royal Free London Hospital advised that the biggest risk in his opinion was around staff retention and staff recruitment.

The Director of Strategic Development, NMUH emphasised the need for any investment to deliver a return given the financial pressures facing the NHS and that getting this wrong would carry significant risks around public perception and wasting public money. The Board were also advised that there were risks to wasting the time and commitment of clinical staff and the wider impact this could have on staff morale. The Director of Strategic Development advised that whilst the group was aware of the risks involved, there was a much greater risk around not doing anything at all.

In reference to a possible Accountable Care Organisation model, the Deputy Chief Executive stressed the need to have community based services closely connected to acute services in order to build resilience and keep people out of hospitals. The Deputy Chief Executive asked whether community care providers & GP’s were being considered as part of the process, alongside acute care providers. In response, the Board was advised that primary care, social care, mental health provision and community health services were all being considered as part of the process but cautioned that the extent of that consideration varied across the different sectors. The Director of Partnership & Transactions, Royal Free advised that they would be working closely with partners in each of those sectors.

The Board was also cautioned that no decisions had been taken on the model of population health care and that an Accountable Care Organisation was just one of the potential options being considered.

The Deputy Chief Executive sought clarification from the CCG as to whether it was felt that GP’s were being engaged with in that conversation. The Deputy Chief Executive also urged the Director of Partnership & Transactions, Royal Free  to engage with the partners around a social care perspective sooner rather than later.

The Leader enquired how the Royal Free London Group would ensure that recent improvements to the standard of care delivered at NMUH were sustained. In response the Board was advised that discussions were taking place through the NMUH Executive Board, around improvement plans and what investments needed to be made in the next 12 months. The Director of Strategic Partnership acknowledged that there was a risk around capacity within the system but advocated that by doing this at scale, there were greater opportunities available, such as being able to share consultant resources across the network.

In response to a question around the structure of clinical leadership, the Board was advised that there was a clear understanding from the group of the need to operate as a homogenous group across all of the sites. The Board noted that clinical practice groups would meet periodically, consisting of clinicians from across each of the sites, to review data on outcomes and the practices that are leading those outcomes. There would be structural resources available across the sites that would be supported at group level, in addition to the conventional structures of clinical management usually seen at hospitals.

In response to concerns raised around the complications involved in setting up an Accountable Care Organisation across such a large footprint, the Board was advised that the ACO was just one example of an approach to population health based system and it was reiterated that the group was a long way off establishing such a system. The paper set out an ambition for population health in broad terms but the details of this required significant further consideration. The Lay Member Haringey CCG urged the group to initiate conversations with the CCG at a very early stage in the process. In response to a question as to whether, in terms of commissioning, the proposals would be cost neutral; the Director of Partnership & Transactions, Royal Free commented that he would hope to see a positive return on investment to any population based system that was introduced.

In response to a request for clarification around the level of financial modelling that had been undertaken, the Board was advised that this was still very much at an embryonic stage and that further work would be undertaken with clinical and leadership teams in the coming weeks and months to try and identify what could be possible in terms of the financial modelling.