Securing sustainable NHS services: the Trust Special Administrator’s report on South London Healthcare NHS Trust and the NHS in south east London Final report Volume 1 of 3 7 January 2013 The Trust Special Administrator Appointed to the South London Healthcare NHS Trust Securing sustainable NHS services: the Trust Special Administrator’s report on South London Healthcare NHS Trust and the NHS in south east London Volume 1 of 3 Presented to Parliament pursuant to section 65I of the National Health Service Act 2006 3 OFFICE OF THE TruST SpECIAL AdmINISTrATOr Contents � 1. Introduction 13 � 2. Context 15 � 3. Approach 20 � 4. Assessment of and recommendations relating � to South London Healthcare NHS Trust 36 � 5. Commissioning context and recommendations � relating to south east London health economy 63 � 6. Recommendations relating to organisational � solutions 98 � 7. Recommendations relating to transition and implementatation 107 � 8. Conclusion 114 � 9. References 116 � 10. Glossary 119 � 11. List of appendices 122 � FINAL rEpOrT 4 Foreword By matthew Kershaw Trust Special Administrator I was very proud to be appointed, in July 2012, by the previous Secretary of State for Health, Andrew Lansley, to be the first Trust Special Administrator. At the same time, I recognised that it would be foolish to under-estimate the task ahead, which is to work up recommendations to address the long-standing challenges faced by South London Healthcare NHS Trust in a way that secures the clinical and financial sustainability of services for the population of south east London, and to do so to the very tight timescale required by the regime for unsustainable NHS providers. It has been a privilege to be working alongside so many professional and committed people in South London Healthcare NHS Trust and elsewhere in the NHS in south east London. In addition to developing recommendations on long-term solutions, since July I have also been accountable for the day-to-day running of the Trust. I have been heartened by the way in which staff have continued, throughout this difficult period, to show significant commitment and dedication in providing the best possible care to patients. This is not the first time that the health system in London has come under scrutiny or been reviewed. recently it was brought to my attention that as far back as 1890, a review by a Select Committee of the House of Lords looked at the distribution of hospitals. A series of reviews in the intervening hundred years or so have had variable success in terms of improvements. more recently, there have been turnaround, strategic change and organisational restructuring programmes in south east London, notably A Picture of Health and the merger of three hospital Trusts to create South London Healthcare NHS Trust in April 2009. These previous changes did not go far enough, in terms of both the decisions made and the implementation of the changes that were agreed – they have failed to deliver clinically sustainable and financially viable hospitals. I have been pleased to engage with so many patients, patients’ organisations, the public and their representatives who have developed and shared ideas, especially over the last few weeks when I have been consulting on the recommendations in my draft report. This consultation – not just with patients, but with doctors, nurses, other health professionals and staff – has generated a public debate that has involved thousands of local people. One thing is most evident from engaging people in this way: the NHS (and its future) is dear to people’s hearts. Everyone relies on the NHS being there when they need it most. However, what is less evident is that people do also recognise and understand that the NHS needs to change, if it is to thrive going forward – that standing still will not generate improvements in the quality of health outcomes, nor will it deliver value for money for the taxpayer in a public finance environment where this is more important than ever. 5 OFFICE OF THE TruST SpECIAL AdmINISTrATOr I am confident that the recommendations in my report, if implemented, will succeed in delivering the scale of change that is needed in a way that previous attempts have failed. In developing them I have received significant input from a range of doctors and other professionals working in commissioning and provider organisations across south east London and beyond. At the same time, I acknowledge that contrary views have emerged, unsurprising given the size of the challenge – and therefore the scale of change proposed – and the natural inclination of some people to want to maintain the status quo. many with those contrary views will argue that the recommendations should have been confined to changes at South London Healthcare NHS Trust and its hospitals. However, it has been clear from the beginning of this work – and indeed before this, given the Secretary of State’s guidance when I was appointed – that, given the size of the challenge, I would have to look at solutions beyond the Trust itself and across the NHS in south east London. The many reviews of south east London and of South London Healthcare NHS Trust have consistently concluded that internal efficiency improvements, even if fully realised, would be insufficient to bridge the financial sustainability gap. There are bound to be some who will remain deeply uncomfortable with what I am recommending to the Secretary of State. Change is often unsettling for people. proposed changes to much loved institutions, such as local hospitals, unite people who are concerned about what those changes would mean for them. This is why I understand what I have seen and heard in Lewisham in particular. There is a powerful strength of feeling among local people, who are anxious about the implications of the proposals for the future of university Hospital Lewisham despite, for example, the fact that around one half of the number of patients currently attending the A&E department would continue to receive high quality urgent care there if the proposed changes are implemented. The challenge for all of us in leadership positions in the NHS is the need to communicate the benefits of changes effectively – such as those to cardiovascular, trauma and stroke services, where changes already made in south east London have saved lives – otherwise those responsible for delivering change will not be trusted. prompted by an increasing body of evidence that highlights the potential for improving clinical services, the recommendations for service change in the report have been generated by a clinical advisory group, made up of doctors, nurses and other health professionals from south east London. These recommendations have also been endorsed by a clinical panel from outside south east London – experts who have been able to view the proposals as they have emerged through a different lens – and the principles underpinning the recommendations, for example the agreed London-wide clinical standards, have been supported by a number of royal Colleges and professional bodies in their responses to consultation, such as the royal College of physicians and royal College of Obstetricians and Gynaecologists. If the recommendations are implemented, it will be vital for engagement to continue with the professional bodies, especially given the reservations aired by some of them – such as the royal College of midwives – about the system’s capacity to deliver the changes. In developing the final recommendations we have reflected on all the contributions made during the consultation. Whilst they are not fundamentally different from those set out in my draft report, they have, however, been refined and improved in response to what stakeholders told us during the consultation. And, where the draft report signalled particular areas that needed more work on them during the consultation period, the final recommendations also reflect the additional analysis, assessment and engagement with experts that has been undertaken and a clear recommendation provided to the Secretary of State. FINAL rEpOrT 6 In conclusion and as we have said consistently, no change is not an option. That is why I was appointed under the regime for unsustainable NHS providers. Only by meeting the challenge of implementing significant change over the next three years will we have an NHS that can continue to deliver services to meet the needs of people across south east London. I should like to thank everyone who has supported me over the last six months. It has been very much a joint effort. Without the significant input of others, I would not have been able to produce this report. In particular, I am grateful to Hannah Farrar who has overseen the development of the draft and final reports and the core team that has supported us – John Bailey, Shaun danielli, Amy darlington, patrice donnelly, dominic Harris, Stephanie Hood, Katie Horrell, Emily Hough, Steve russell and philip Tydeman. We are both grateful to the leadership shown by dr Jane Fryer and dr Chris Welsh – chairs of the clinical advisory group and external clinical panel respectively – and to peter Gluckman, chair of the patient and public advisory group and the health equalities impact assessment steering group. These last two groups have played a major role in ensuring that the work has been properly informed by the users of services. I am grateful too for the support of the various advisory and working groups – chaired by some of the core team plus Sheree Axon, Sarah Blow, Annabel Burn, Tim Higginson and Jacob West. Finally, I am grateful for the support of all those from across the system, including provider organisations and clinical commissioning groups, who have given so much of their time to attend working and advisory group meetings and workshops. Matthew Kershaw Trust Special Administrator 7 OFFICE OF THE TruST SpECIAL AdmINISTrATOr FINAL rEpOrT 8 Foreword By dr.