Why are you introducing a single executive and management structure?
When the South Tyneside and Sunderland Healthcare Group was formed in February, we indicated then that we would be managing the transition towards one common management team and, indeed, this is cited within the Memorandum of Understanding signed by both organisations in May and available to view on the public websites of both Trusts.
What will be the benefits of this change?
For staff: a single management team will significantly improve the focus and leadership capacity to both Trusts.
The new management structure will help us deliver improvements required in some clinical services identified by CQC, which will improve the quality, experience and safety for our patients.
It is anticipated that creating a single executive and management structure across the two NHS Foundation Trusts will generate initial savings in excess of £500,000 per annum, with additional savings being achieved as a result of the way in which services (both clinical and non-clinical) are delivered across both organisations.
As well as significant financial savings there will be greater efficiencies in the way health services are managed, other advantages include:
- More focused leadership which will ensure a consistently high quality and safe service for patients
- Shared experience and learning across the two organisations
- Greater flexibility in managing pressures across the system, with improved resilience services for local residents by sharing clinical expertise
- Support for the transformation of local services and empowering local people to stay well and be looked after outside of hospital
Will this mean closure of some hospital services?
Both hospital and community healthcare services will be transformed across South Tyneside and Sunderland through the South Tyneside and Sunderland Healthcare Group approach. We know concern has been expressed about South Tyneside District Hospital and we can say with great confidence that its future is assured, however, as is the case throughout the NHS, we cannot guarantee that in every case services will be run exactly as they are currently. With regard to the Accident and Emergency Department, this will form part of a service review in 2017 but we wish to make it absolutely clear that our vision is for patients and residents of South Tyneside to continue to receive urgent and emergency care at South Tyneside District Hospital. Currently, many emergency and elective hospital services are duplicated at both Sunderland Royal Hospital and South Tyneside District Hospital. However, in a number of these hospital services recruitment of key staff is challenging and it is becoming increasingly difficult to ensure the delivery of high quality 24/7 services across both hospital sites in some of these services. There are many quality standards being developed nationally and an increasing pressure to further establish 7-day services in all areas. Addressing these challenges as two completely independent Foundation Trusts is increasingly difficult so, subject to the outcome of service reviews, some hospital services may need to change and aspects of them may be delivered at only one hospital – either in South Tyneside or Sunderland.
Will Sunderland/South Tyneside residents have to travel to South Tyneside/ Sunderland to receive their care?
We understand transport and travel is a concern and whilst it is possible that the outcome of a service review may result in some patients from South Tyneside travelling to Sunderland (and likewise patients in Sunderland travelling to South Tyneside), we envisage that residents will continue to receive their general, straightforward care at their local hospital or clinic. However, where there are complexities or a specialist team is required, it may be necessary, as is often the case now, for patients to travel. Whilst the distance between the two areas is relatively short, with good public transport links, we are working closely with partners in the local authorities and transport providers to address ways of meeting the needs of patients. Where such a situation is deemed appropriate, it will only be after clinicians have been involved in service transformation discussions and agree that to travel to another community is in the best interests of patient safety and patient experience.
Is this a takeover or a merger by stealth?
No. Both South Tyneside NHS Foundation Trust and City Hospitals Sunderland NHS Foundation Trust had already agreed to work together as part of a group structure. Both Foundation Trusts are, and will continue to be, separate statutory bodies with respective Councils of Governors and Boards of Directors.
However, both Trusts have also recognised that, in light of the huge financial challenges in the NHS and social care and in light of projected demographic and demand changes, the current model of healthcare delivery is not sustainable.
Both Trusts believe that a single executive management team supporting both Foundation Trust Boards is required now to better manage that challenge and improve efficiency.
Does the regulator / NHS Improvement support this?
Yes, we have fully engaged with NHS Improvement, as well as NHS England, and they are aware of the background to our intention to form a joint management team and strongly support this move, which they believe is essential.
Do the CCGs support this?
Yes. We have been working closely with our CCG partners from both South Tyneside and Sunderland and they are supportive of this single management team.
Why hasn’t there been consultation / engagement about this?
This move represents only changes to the management structure and not a change to the provision of clinical services for which consultation would normally be required. There is therefore no requirement to undertake public consultation. This is an agreement to work in a different way which does not alter the statutory responsibilities or the FT licence arrangements of both organisations. We will, however, be consulting, where appropriate, regarding any changes to clinical services and more information will be available in the autumn regarding this. Any individual service changes will be considered on a case-by-case basis and, in discussion with our CCG colleagues, we will examine if those changes are such that public consultation is required. It is our intention, however, to communicate regularly and openly with our patients, staff and the general public to ensure they are all kept up-to-date with our plans and progress.
Why does it have to happen so quickly?
Our Trusts have been working well together as part of a Group structure since February. We feel it is now essential, as does our regulator NHS Improvement, that if we are to protect the future sustainability of health services for both our populations, we now move to a joint executive and management team as quickly as possible to secure efficiencies and to use the combined strength of that team.
You’re just selling South Tyneside out, aren’t you?
No, this is certainly not the case. We do appreciate the concerns that some South Tyneside patients and staff may have about the pace of these necessary changes. The work that is being undertaken is an essential process to secure the future delivery of health services in both Sunderland and South Tyneside. To do nothing would certainly put our services at risk. The programme of clinical service reviews will be looking to ensure sustainable and improved services fit for the future.
Will jobs be under threat as a result of this / will people be made redundant?
It is not possible to guarantee that there will be no job losses in these challenging times but it will be the strong preference of both Trusts to achieve such economies through natural wastage wherever possible. We cannot rule out, however, the possibility of redundancy as a last resort, if absolutely necessary.
What jobs will go?
It is not possible to say at this time.
Will this lead to outsourcing or job losses?
It is not possible to say at this time.
How will you select the management team?
A thorough appointment process based on selection by skills and experience, together with emphasis on a succession planning will be adopted by the two Foundation Trusts and will be independently scrutinised by the Non Executive Directors of both Boards.
Is this just a cost-cutting measure?
Whilst financial benefits will be realised, the main driver for change is that a single executive team will mean it is easier to lead on the transformational change required quickly to protect the future of services to the communities served by both organisations.
Is it just the executive team structure that will be affected or will other levels of the organisations be affected?
It is probable that other levels of the organisations will be affected but further change will only be undertaken where absolutely necessary. Directors will be asked to review their structures in the autumn.
How does this latest change affect the recent management restructure in South Tyneside?
When the earlier restructure was planned it was not anticipated that we would be moving to a single management structure so quickly, however, a significant number of the changes resulting from the restructure will support the single executive team and any further change will only be undertaken where absolutely necessary and in full consultation with staff.
Which services will be affected?
As part of the programme of transformation, all services will be looked at over time. However, in the first instance the services to be looked at will be stroke, trauma, emergency surgery and maternity.
Will radiology services be looked at as part of the Clinical Services Review programme?
We can confirm that a specific review of diagnostics (including radiology) will be taking place twice during the review programme due to the critical nature that diagnostics play in both emergency and elective services. It is anticipated these
reviews will be undertaken between September and December 2016 and again between September and December 2017. How the two radiology teams can work more collaboratively and efficiently across the two organisations will be explored during this process.
Will staff have to move off site/rotate?
This could be an option in some services but it is too early to say what the implications may be for staff working arrangements.
How are you going to ensure you communicate effectively with staff?
We are committed to openness and to doing everything we possibly can to get the communication and engagement right. We aim to do this in a timely manner, and whenever and wherever possible, over the coming weeks and months through a variety of methods e.g. face-to-face briefings, email messaging, intranet information. If you have a preference for a particular form of communication then please let us know by emailing email@example.com or firstname.lastname@example.org
Will there be consultation regarding any back office and support staff changes?
The Trust is committed to ensuring the impact of change and reconfiguration on staff is handled fairly, effectively and in line with agreed processes. We are committed to supporting staff throughout the process of organisational change by consulting
and communicating appropriately with staff involved and listening carefully to the views of staff affected. We will seek to manage all change programmes in a planned, open and honest way in order to maximise the potential benefits and minimise any adverse implications for staff.
What is the vision for Maternity and Paediatric services?
These service reviews are currently underway and the vision for the future is not yet known however they will be included in the first phase of listening and engagement activities where you will be able to learn more about the potential solutions being proposed and have the opportunity to give your views. In addition they will also be subject to formal consultation early next year.
There’s a Clinical Services review but what about a Primary Care Community Services review?
We don’t have a timetable yet for the out-of-hospital services review. This has to be decided with our colleagues in the CCGs and the Local Authorities but we are conscious of the need to ensure that current service reviews are not looked at in isolation and do take account of community services We hope by doing this we are able to provide more joined up services which will benefit our patients.
What is the implication for community services in Gateshead?
South Tyneside NHS Foundation Trust’s community staff, including those in Gateshead, are exceptional and the Trust was incredibly disappointed not to get the new Gateshead tender for many services. However, we will continue to run some community services in Gateshead after October 1st. These are: Health Visitors, School Nurses, Equipment Service, Talking Therapies, Emotional Wellbeing Team, Sexual Health, Dental and Safeguarding.
What is the plan for palliative medicine?
This is a very important service and there will be opportunities to influence our commissioners and to develop and expand. The best way to do this is for the clinicians to come together and be instrumental in developing a model for the future.
If NHS Improvement was to intervene due to our financial position, what would this involve?
If we can’t demonstrate that we’re taking urgent action now to secure the future sustainability of our services in the best interests of patients, NHS Improvement (or even the CQC) would most likely take regulatory action. This could range from a formal investigation through to senior leadership change or further significant intervention. We believe to do nothing risks losing our ability to shape services using our existing knowledge and understanding of local needs.