Embargoed until hours Wednesday July E Trust confirms additional savings by richman6


									Embargoed until 00.01 hours, Wednesday, 26 July 2006

Trust confirms additional savings plan

Stevenage, 24 July 2006 – At its meeting on Wednesday, 26 July the Trust Board
will be asked to approve a detailed plan of savings that the Trust must make if it is to
meet the additional £9.6 million funding gap caused by recent changing
circumstances within the local NHS. In particular this is in reaction to primary care
trusts seeking fewer patients to be referred to hospital for their care. The plan covers
reductions in the number of posts and inpatient beds by 435 and 48 respectively
across the Trust, as well as changes proposed to the working arrangements for
consultants and new staff joining Hertford County and the Queen Elizabeth II (QEII)
hospitals. The plan also confirms that the Trust is working with other local NHS
trusts in pursuing shared arrangements for some common support services, including
non-urgent routine pathology testing.

Commenting on the plan being put to the Board, the Trust’s chief executive, Nick
Carver, said: “The amended financial savings plan reflects the new, additional
external cost pressures that the Trust has to meet if it is to move closer to achieving
its year-end control total set by the East of England strategic health authority (SHA).
While this is something that the Trust must do, wherever possible we are using the
opportunities available to us to maintain services to our patients. I recognise that in
making such highly challenging changes, the pressures on our staff to ensure that
patients get the right level of treatment and care will be increased. It is the job of the
Trust’s management to make sure that these changes are communicated well and
introduced through involving our staff in their implementation, with redundancies kept
to an absolute minimum.”

Mr Carver went on to say: “This is a difficult time for everyone, from nursing, medical
and other healthcare staff caring for patients in all clinical areas, through to those
who are responsible for keeping our hospitals running smoothly all day, every day.
While reducing the number of posts and beds across the Trust will be unsettling, if
we don’t make these difficult decisions now then the Trust’s future financial challenge
will be even greater.”
2/Trust confirms additional savings plan

Post reductions
The Trust’s post reduction proposals comprise two elements. The first relates to
those that had been identified already through existing schemes, such as the new
medical transcription service and the merger of the Trust’s health records
department. The second group refers to posts that will no longer be required as new
initiatives are introduced, including the reduction in the number of beds. It is the
Trust’s aim that while clinical posts will be included in this process, no frontline
healthcare staff – including doctors or nurses – will face being made redundant. The
Trust believes that this can be achieved through targeting suitable vacant posts into
which affected staff can be redeployed. These changes will be carried out this year
and during 2007/08; together they will have a combined full year savings effect of
approximately £9.5 million, although the actual savings in the remainder of 2006/07
will be around £2.5 million.

The existing post reduction programme accounts for 220 of the 435 posts to be
removed by the Trust between now and January 2008. Of these 220 posts, 156 are
non-clinical and 64 are clinical – the majority of which relate to the planned closure of
beds in 2006/07 following improvements in clinical efficiency. Of the 215 remaining
posts that have been identified, 117 are clinical and 98 non-clinical. Again the clinical
posts mainly relate to changes in bed numbers across the Trust, with all non-clinical
areas being targeted for further reductions in staffing levels.

Commenting on the job reduction programme, the Trust’s director of human
resources, Danny Mortimer, said: “When it comes to making changes to the number
of posts that the Trust employs, we have a very successful track record of making the
best use of opportunities to redeploy staff into new jobs within our hospitals. Last
year we closed two wards – 6A south at the Lister and Bayford ward at the QEII –
and all affected staff were found jobs that suited them, either within the Trust or the
NHS locally. Even with the changes being introduced to the work carried out by our
medical secretaries, we expect to manage this through a combination of removing
vacant posts and around 20 redundancies. The Trust is confident, therefore, that the
actual number of staff that will be made redundant will be kept to a minimum. In
achieving this outcome, the aim is that no frontline healthcare staff are lost.”

3/Trust confirms additional savings plan

Bed numbers
With regard to bed closures, the Trust’s plan is to reduce its total number of inpatient
beds by 48 by November 2006 – currently the Trust has around 900 beds across its
four sites. Based on analysis of data provided by independent healthcare experts, Dr
Foster, the Trust has shown that through reducing patients’ length of stay closer to
what is best practice nationally, the following changes can be made:
 •   A new 23-hour surgical 14-bed ward to be opened on 7B north at the Lister in
     August 2006, which will improve the rate at which patients are admitted and
     discharged on the day of their planned surgery, where clinically this is the right
     thing to do;
 •   By the end of July 2006, the six inpatient beds on the QEII’s Essendon ward will
     close, with these patients being cared for on the hospital’s main inpatient
     surgical wards – Codicote and Cuffley.            Essendon’s specialist operating
     theatres and day case beds will be retained;
 •   In September 2006, a new elective admissions unit (EAU) will be created on the
     vacated part of Essendon ward.
 •   The QEII’s current clinical assessment and decision-making unit (CADMU) on
     Ayot ward will be relocated in September 2006 to the area occupied currently
     by the surgical assessment unit, which is close by A&E. Clinically this is an
     important change since CADMU and A&E should be co-located as emergency
     patients often require a period of close observation by doctors and nurses
     before diagnosis and treatment decisions are made. GPs also have the ability
     to refer patients directly to CADMU;
 •   Also in September, the Trust will create its first full-sized dedicated stroke unit
     on Knebworth ward at the QEII, which will be built around the very good but
     size-limited service provided on 7B south at the Lister. As a result, the beds on
     7B south will be closed. Currently no such dedicated inpatient service exists at
     the QEII, with the Lister service – although excellent in what it does – only able
     to treat relatively few of those patients who have a stroke. The new combined
     service on Knebworth will allow the Trust to develop a full inpatient stroke
     service for the first time, which brings it in to line with national guidance;

4/Trust confirms additional savings plan

  •   In October 2006, the Trust will close the 28-beds on ward 7A at the Lister,
      which to date has been used for urology patients. This change has been made
      possible through reducing average length of stay through initiatives such as the
      new 23-hour surgery ward on 7B north, which will be suitable for many urology
      patients. The remaining patients will be accommodated in the hospital’s main
      inpatient surgical wards on level 8.
  •   Also in October 2006, Lemsford ward at the QEII will become a medical ward
      with trauma patients being cared for in the hospital’s existing dedicated surgical

Reflecting on the bed reductions envisaged, the Trust’s director of operations, Julie
Lowe, said: “The changes in bed numbers and their use addresses many of the
long-standing clinical issues that have existed for some time. It will only be possible
to make these changes if we gain the understanding, co-operation and involvement
of our staff. While beds will be lost, this is possible through a combination of more
innovative clinical practice – for example the new 23-hour surgery ward at the Lister
– and creating important new services – such as the new surgical assessment and
full stroke units at the QEII.”

Other planned changes
While the planned post and bed reductions go a long way to making the savings
needed to meet the gap in the Trust’s financial recovery plan for 2005/06, during
which it has to make additional in-year savings of £9.6 million, more still needs to be
done if the year-end forecast position set by the SHA is to be met. From September
2006, the Trust proposes to cease to pay the additional London weighting payment –
worth £846 to £1,466 per year – to new staff. Staff based at the Lister do not receive
such a payment and the position for those new staff joining the specialist teams at
the Mount Vernon Cancer Centre will be unchanged. Based on historical recruitment
patterns, this change is expected to reduce the Trust’s wages bill by around
£250,000 in the first 12 months – the total cost of the London weighting payment
across the QEII and Hertford County hospitals is £2.5 million.

5/Trust confirms additional savings plan

The Trust is also planning to introduce changes for the 165 of the Trust’s 190
consultants who are on the new national contracts introduced across the NHS in
2003/04. The new contract divides the work that consultants undertake within the
NHS into blocks of time – usually four hours each – called programmed activities (or
PAs for short). Every consultant on the new contract must work a minimum of 10
PAs on NHS duties every month, covering everything from outpatient clinics through
to caring for patients on wards and operating theatres. On average within the Trust,
most consultants work a weekly minimum of 11 to 12 PAs; they are paid a minimum
of £8,000 per annum for each additional PA.

Within their overall earnings, consultants are also paid to carry out a range of
activities that involve much less direct contact with patients – for example auditing
their clinical practice, keeping abreast of developments within their specialism and
teaching and research activities. These are called supporting professional activities
(SPAs), which underpin clinical activities undertaken by consultants. With effect from
October 2006, the Trust will be reducing the maximum number of additional SPAs for
which most of its consultants is paid from 2.5 to 2. The Trust will seek to reallocate
20% of these sessions back to identified consultants who undertake extensive
commitments. 80% of our consultants, however, will find their pay reduced by a
minimum of £4,000 per annum, saving the Trust a full-year effect of approx £550k.”

Talking about these employment changes, the Trust’s chief executive, Nick Carver,
said: “When it comes to paying our consultants for the work that they do when not
caring directly for patients, we have to live within our means. Our consultants will
continue to be paid for carrying out such work, but at a time when jobs and posts are
being removed the Trust cannot be as generous as it has been in the past.”

Mr Carver went to say that: “The payment of London weighting on two of three of our
principal sites was always an anomaly.        We believe that we can withdraw the
payment from new employees without affecting our ability to recruit new staff.”

6/Trust confirms additional savings plan

Other changes being pursued during 2006/07 to release efficiency savings include a
new combined pathology service that will support the work of the Trust, as well as
Bedford Hospital NHS Trust and the West Hertfordshire Hospitals NHS Trust. While
still in the planning phase, this new combined service will provide essential pathology
services to each NHS trust, from routine microbiology tests through to biochemistry
and haematology testing. Blood samples would continue to be taken locally at each
hospital, which would also retain the ability to carry out urgent tests itself. All routine
pathology requests would be handled by the new combined service, which may or
may not have private sector involvement. Similar plans are also being developed for
a new sterile services facility, which would provide a service to a group of hospitals in
areas of north London, Hertfordshire, Bedfordshire and parts of Essex.

The Trust’s chief executive, Nick Carver, said: “Although yet to be quantified, the
potential savings offered through these pathology and sterile services initiatives is
considerable. While significant efficiency savings can be made, getting these service
changes right represents a substantial challenge for the Trust, as well as the NHS

Mr Carver went on to say: “While all of these additional cost saving activities – posts
and bed reductions, removal of London weighting payments from new staff joining
the QEII and Hertford County, reducing the number of SPAs paid to consultant staff
and centralising pathology services – allow us to make considerable inroads into the
£9.6 million that we need to achieve this year, on their own they will not be enough.
Further proposals will be developed by the Trust, which again will be shared in an
open way with both our staff and the public.”


For more information on this press statement, please call Jo Arthur, public relations officer on:
01438 781736 (direct line) or Peter Gibson, head of public affairs on: 01438 781522 (direct line);
for out-of-hours, please page the duty press officer on 07659 103839.


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