Agenda item

To provide an overview of the ongoing collaboration between the Whittington Health NHS Trust and the University College London Hospitals NHS Foundation Trust.

The Acting CEO of Whittington Health introduced the report to the Committee. Main points summarised below.

-       The vision of the collaboration was to use the collective strengths of the Whittington and UCLH to better serve the community and improve the sustainability of services across the two organisations. The collaboration was not driven by changes to organisational form and/or cost savings.

-       More opportunities were being considered to join multiple clinical teams together and reduce duplication in back office, non-clinical services.

-       There was a long history of collaboration between the two institutions especially within the pandemic, which had resulted in excellent patient outcomes.

-       The Acting CEO emphasised the collaboration meant that the two institutions would still be treated separately, however collaboration had meant successes – for instance when joint appointments had provided back up to services when recruitment for vital specialised areas had been difficult. This approach had worked especially well and put Whittington Health 34^th in the Patient Cancer Experience table. 

-       She explained that the Whittington Health had also set up the Virtual Ward – a service that helped patients who could be looked after at home to remain home under clinical supervision. The equivalent was found in the UCL as the ‘Hospital at Home’ scheme.

-       She stated that due to the collaboration there had been a reduction in waiting and theatre time, patients could be cared for in their own homes with the Virtual Ward and Hospital at Home scheme. The collaboration had improved services where patient care had been impacted. It had also opened research opportunities across the two organisations.

-       The team was considering more NHS partnerships – and a clinical dialogue was occurring across the two organisations.

-       The management also recognised the risks to the increase in collaboration. This included ensuring that there was adequate clinical support across the two organisations, support for charges for patients, alignment with JHOSC, adequately resourcing the merger, and assessment as to whether patients were being best served.

-       She stated that there were active communications going on across the organisations to bring out collaboration ideas.

-       Harmonising corporate functions such as finance, legal, procurement and instating joint people officers were a priority for the collaboration.

The floor was then open to questions.

Cllr White requested clarification on a statement contained within the report that pointed to “the establishment of a more aggressive Hospital at Home scheme”. He pointed out that there were risks to this as patients or their families could not be held responsible for their own care. The Acting CEO emphasised that the service would be for patients well enough to be discharged from hospital and who could be treated in their own home. The patient was monitored for a maximum of two weeks. The Acting CEO took the example of the ‘delirium pathway’ in which patients sometimes experienced confusion as a result of infection. Experiencing this in hospital made the confusion much worse. At home a full risk assessment could be made as to whether the patient could be looked after by carers or family. Cllr White indicated that there was still a substantial risk as doctors would not be able respond quickly to emergencies. The Acting CEO clarified that a Rapid Response Unit also operated alongside the Home at Hospital Scheme. The team had a two-hour response time. In response to questioning as to whether these were hitting their targets the Acting CEO offered to send round data – including rapid responses in the LTN areas which was also requested.  ACTION .

The Acting CEO emphasised that the Home at Hospital scheme was a Home Monitoring Service and not Intensive Care at home. It would allow patients to recover at home whilst being monitored. Discussion then turned to the Delirium Pathway. The Chair emphasised that this was a highly intensive process - as with dementia. Although in cases such as these, it was beneficial for the patient to remain at home, however the family would take over the pressures of 24-hour nursing care. This would then have an impact on Adult Social Services. The Chair questioned whether there had been an honest appraisal of how the families would be coping in these Virtual Wards. The Acting CEO replied that all the pathways had been set up by Multi-Disciplinary Teams who had carefully considered the risks as well as whether the right level of support was present at home. The patient would not be discharged until they had started to improve - and did not need specialist care. Reassurance from the Acting CEO was given that the families were being taken care of and it was stated that there had been very positive feedback from families so far.  Cllr White then pointed out that the burden of care should not be transferred to unpaid families instead of professionals. The Acting CEO then assured the Committee that patients were not expected to be ill for long on the Hospital at Home scheme.

The Committee then requested that the panel return responses and follow ups of the Hospital at Home scheme; also details of the times, response times, staff involved, as well as details of the kind of support families caring for a patient may need. It was then outlined that Virtual Wards such as ran alongside the Step-Down Service rehab provision. The Officer panel offered to include an update of Virtual Wards as part of the update of the Hospital at Home Scheme. ACTION

In response to a further query, it was outlined by the Officer Panel that it was not currently expanding the collaboration principles to other hospitals and trusts. However, this may be considered in the future.

Discussion then turned to Finance, and the risks associated. It was stated that the  Whittington had a £10 million deficit whereas UCLH operated at a surplus of £45 million. The Programme Director at UCLH responded that the collaboration was not considering spending substantial money - but instead aiming to achieve savings and efficiencies. In this way they did not perceive the differences in balance as a risk. A question was raised as to how the efficiencies would impact on staff and patient services. The Programme Director at UCLH stated that he did not anticipate any changes. There were efforts to reduce agency staff however there were no obvious examples of where services or staffing would be impacted. 

Discussion then turned to how recruitment was carried out. It was stated that from a UCLH perspective recruitment was not usually an issue for specialist roles. The organisation took a decision to stop overseas recruitment and instead train up nurses straight from colleges in the UK. The organisation’s policy was to retain nurses they had trained – this approach to recruitment had been extended to specialist roles. It was emphasised that there was no consideration of where applicants lived, and opportunities were still open to candidates from around the world including international medical graduates.

The Chair expressed appreciation for the inclusion of a risk register in the report. She asked for clarification on the mitigations in place against the loss of material income especially around orthopaedic work  which was being treated by the surgeons at UCLH. The Programme Director stated that the model of care was being adjusted to ensure that patients were receiving the right care. The two organisations had a transparent, open book approach on accounting  and the two Finance Directors were working closely together. The approach would be assessed over the year.

It was Remembrance Day. A two-minute silence was observed.