interviews

Change without controversy

Chief executive of East and North Hertfordshire NHS Trust Nick Carver spoke to NHE about the organisation’s overarching programme of hospital change, and the efficiencies this was generating.

A mid looming financial pressures and a constant need for improvements in patient outcomes, many trusts are looking to centralise services, creating much-needed efficiency savings, whilst boosting care provision. But how can trusts manage this process and avoid the public backlash to inevitable closures?

East and North Hertfordshire NHS Trust is in the middle of a programme that will see acute services concentrated in one hospital, the Lister, whilst the QE2 hospital is redeveloped as an outpatient diagnostic non-bedded hospital.

NHE talked to Nick Carver, chief executive of the trust, to unlock the secrets of effecting change without the controversy.

The trust is halfway through a four-phase, £150m process to concentrate acute services on the Lister site. The Lister will gain a new A&E department, as well as new theatre and ward blocks, subject to Treasury approval.

Clinical leadership

Carver acknowledged that such configurations are often controversial, and much vocal protest by media and campaigners can be made over hospital closures, or reductions in services. But he said the move to a non-bedded hospital at QE2 had been “less controversial than many”, due to extensive consultation and a change process championed by clinical staff.

“Of course the public aren’t delighted,” he said. “[They] aren’t jumping with joy when you close a hospital that’s closer to them, but I think they have seen considerable investments here and they’ve also seen much better outcomes in services that we’ve already centralised.”

Additionally, local politicians were “extremely responsible”, he said, with the county council assessing whether the changes would bring improvements to patient care, as well as the more obvious cost savings. This approach helped convince the public of the clinical benefits of reconfiguration, although Carver was keen to stress the importance of going back to people with evidence of improvements.

He said: “I’ve a strong view about us needing to be accountable to local communities. We need to be available to go wherever we have to attend to talk about the way we’re achieving improvements having spent the money.

“We made a pledge to the public that we’d improve care by spending this money and by centralising services. We have a very strong ethical obligation to demonstrate to the public, on an ongoing basis, that their trust in us changing much-loved facilities was well-placed.”

Better outcomes, lower costs

The improvements will see the number of critical care beds at the Lister site increase to 20, which will provide greater access to facilities in an environment Carver described as “wonderful”. There will be less movement of patients from ward to ward, and instead care will be moved around them.

The overall reconfiguration programme is expected to deliver better clinical outcomes, including lower HSMR rates. Patients are already giving higher satisfaction ratings and there has been a 5% efficiency saving in maternity since the development of a new unit.

Carver said: “Overall, reconfiguring the single site will enable us to have better outcomes, better responses from patients and users, and improve our ability to recruit staff.

“It will also lower our costs. After the cost of capital and the costs of essentially the mortgages for these new facilities, we still make savings of about £10-12m – quite substantial.”

The right approach

Updating an existing hospital such as the Lister rather than starting from scratch was “the right thing to do” for the trust, Carver said, as it meant far less was spent to create state-of-the-art facilities in a building around 40 years old.

He explained: “In a financially constrained environment, refurbishment linked with some new buildings has been the right approach.”

Commenting on the current debate around the number of hospitals and the spread of care available, Carver said there was a responsibility to engage with political leaders and the public to discuss how to improve care provision.

It was very important that solutions fit the individual challenges, rather than a one-sizefits- all approach, he highlighted.

Looking ahead, growing demands will require more and more from the NHS. Carver said the trust is fully aligned with commissioners’ plans, and recognises that more patients will be treated in community settings. This joined-up approach could make the facility fit for use for “the next 20 years”, he said.

“We have a shared view on how much activity we should be doing this year, next year, and over the next three or four years. We have a shared sense of destiny. We want to make sure our commissioners are financially healthy.

“It’s in our interest that they are and so we have to work with them in bringing services together, providing better quality care but also lowering the unit costs of what we do.”