Examination of Witnesses (Question Numbers
Dr Chris Gordon, Julie Lowe and Clare Panniker
19 October 2011
Our paperwork is not in the best of order this afternoon. Although
I know who you are, usually we have a biography of each of you
before we proceed with the questions. I wonder whether you would
start, Julie Lowe, by telling us who you are and what your job
is so that people have an awareness.
Julie Lowe: My name is Julie Lowe,
and I am chief executive of Ealing Hospital NHS Trust, which also
incorporates the community services of the boroughs of Brent,
Harrow and Ealing.
Dr Gordon: I am Dr Chris Gordon,
and I am acting chief executive of Winchester and Eastleigh NHS
Clare Panniker: I am Clare Panniker,
and I am chief executive of North Middlesex University Hospital.
Ian Swales: Can I be clear whether these
witnesses are from foundation trusts?
No, they are all in the group of 20 that have declared that they
cannot be, in their current formI chose them for that reasonbut
they are all doing slightly different things. I chose them because
they are in the self-declared group of 20, but it is self-declared
not assessed. This part of the afternoon will be a shortish part
and we want to get as much information as we can out of you, but
equally if you can be direct and succinct in your answers that
would help the Committee enormously in our work.
Can I ask, first of all, were you all briefed
by the Department of Health before you came to us this afternoon?
All witnesses: Yes.
Why was that?
Dr Gordon: Why was there a briefing?
I think to understand the functions of the Committee.
Or was it to ensure that you all spoke with one voice?
Dr Gordon: I can only speak with
my own voice
Mr Bacon: You can try to speak in everyone's
voices; it might be quite interesting.
Clare Panniker: It was clear that
we must give our own opinion, but that we should understand what
the Committee is about.
Okay, but it was not in the context of sticking to Department
of Health or Government policy.
All witnesses: No.
You have some independence from that. Yes? Good. You are all doing
rather different things, so the reason I chose to have evidence
from the three of you is that you are all in the group of 20 that
have declared that they do not think they can achieve foundation
trust status, but you are approaching it in very different ways.
Can you briefly, starting with Julie Lowe, tell us how you are
Austin Mitchell: Chair, why are they
self-relegated? What is the problem in each case?
Chair: We can ask that. Let us find out
who they are.
Austin Mitchell: We need to start with
Chair: I was going to give them the opportunity
to speak, because they are all going in slightly different directions,
and then you can come in on that. Just let them explain who they
Julie Lowe: It will probably come
out when we explain where we are. Ealing hospital, as some of
you may know, is a small district general hospital in west London.
It was built about 30 years ago and serves a population of some
300,000, but a lot of that population look to our neighbours because
it is quite a crowded pitch in north-west London. There are lots
As health care moves forward and becomes increasingly
sub-specialised, and as we move into a world in which more care
is delivered directly by consultants and very senior staff, rather
than by junior doctors, we are struggling cost-effectively to
provide such cover and such a level of specialism 24/7. We originally
applied to be a foundation trust, but in discussion with our neighbours
and NHS London
Julie Lowe: No, we didn't fail.
We applied to be a foundation trust. We discussed what the long-term
future, beyond four or five years, would look like, and we felt
that on our own we would not be able to provide a high level,
modern standard of health care as health care becomes increasingly
sub-specialised, so we decided that we needed to do something
different. The first thing we did that was different was to take
on the management of the three community wings of the three boroughs,
as I explained, because we believe that the future of health care
is increasingly in providing care closer to people's homes and
in community settings.
You are going to stop being a hospitalI am hurrying you
upthat is my understanding.
Julie Lowe: Okay, so we have got
the community services. We need, then, to look at what we do around
our acute services, especially
You are going to stop being a hospital.
Julie Lowe: No, we're not; we
are going to work with North West London Hospitals to see whether
a merger between us is viable so that we can continue to provide
hospital services where appropriate for us to do so.
But the reason I have chosen you is that my understanding is that
you are going to stop being a hospital and you are going to focus
on community-based health services.
Julie Lowe: It would be wrong
for us to stop being a hospital, because there is still a need
for hospital-based services.
What are you going to provide that I and we would understand as
Julie Lowe: We are working through
what that will look like at the moment.
Give us some idea. What sort of things? If I were a resident in
your area, in Ealing, what would I use you, as a hospital, for?
Julie Lowe: We are keen that there
is a front door that
Will you deliver babies?
Julie Lowe: At the moment, we
deliver 3,000 babies a year
What will you do?
Julie Lowe: and we need
to work through whether it is appropriate for us to continue to
deliver babies in the long term.
Will you deliver babies? It sounds to me as though you won't.
Julie Lowe: We don't know that
yet. We cannot categorically say whether we will or won't.
I understand that you are going to cease hospital services, and
that is why you are here. Actually, you have taken a decision,
more or less, just to do community-based services.
Julie Lowe: No. That is not the
decision we have reached, because if it were, we would stop, at
the point we are at, running three boroughs of community services
and a hospital
Are you going to have an A and E there?
Julie Lowe: We have an A and E
at the moment, and North West London has two A and E departments.
We are committed to providing 24/7 access to services on the site.
Chair: But what? As a walk-in centre, not as an A and E.
Julie Lowe: No, we have an A and
E department that provides a full range of services.
I hope you are being honest with us
Julie Lowe: I am being honest
because that was not my understanding of where you were
Julie Lowe: I am sorry about that,
but we do have a 24/7 A and E department that provides a full
range of services.
Q21 Ian Swales:
But what will you have? That is the question the Chair is asking.
It is not about what you have now; it is about what you will have.
Julie Lowe: Yes, and as I have
said, I do not know that yet, because we have entered the next
phase of our discussions, which are with North West London Hospitals,
about whether, by coming together, we can provide a viable range
of clinical services. The local population, particularly in Ealing,
is a big user of hospital services and always has been, so we
are keen to make sure that there is accessibility in that locality
for them, because it would be difficult for them to travel to
any of the immediate neighbours for the full range of services.
What we cannot do is continue to provide everything. For example,
we closed our stroke unit, because we were not
I think this is getting too long; we have lots to get over.
Dr Gordon: Winchester and Eastleigh
Trust, after a long period of consideration and a number of discussions
with the SHA around achieving foundation trust status, has recognised
that we were unable to get there on the ability to generate a
five-year plan that produced a long-term recurrent surplus. So
there was an ongoing financial issue.
Plus, because of the size of our organization,
we need to start getting together with other organisations on
a more consolidated basis so that we can account for future clinical
development, sub-specialisations, junior doctors' rotas and various
other things that we think will make it more difficult for hospitals
of our size to provide a service in future. With the SHA and the
PCT supporting us, we went to develop a clinical strategy, to
look at our options, and to choose the sort of partners that we
wanted. We have chosen Basingstoke and North Hampshire Foundation
Trust as our future partner, and we are going to become a foundation
trust by acquisition.
Okay. I understand that you are the most advanced in that development.
Dr Gordon: That is correct.
Does that mean that we will end up with three A and Es and three
maternity units, or are you going to reduce that?
Dr Gordon: There will be two emergency
departments and two maternity units.
From three to two.
Dr Gordon: No, there are only
two at the moment. We have two district hospitals and a community
Why does the merger make you viable?
Dr Gordon: The merger makes us
viable for a number of reasons. There are financial efficiencies
from absorbing back-office costs from two organisations into one,
which is really important, and estate rationalisations. We will
be able to get procurement functions and greater critical mass;
there is a simple financial efficiency. There are clinical efficiencies,
because instead of there being seven radiologists on one site
and six on the other, we now have 13 radiologists with which to
provide a 24/7 sub-specialised rota. That goes through all the
We are on two distinctive sites, so it is not
quite as easy as it might seem, but we are also at increased clinical
viability. We now subtend a population of around 500,000 to 600,000,
which allows us to develop those ranges of services.
Even on two sites.
Dr Gordon: Even on the two sites,
but with 250,000 each we would not be able to do that. Because
of the geographies of our two sites, it will be important for
us to continue to provide a wide range of acute services on both
sites. That has been said by the acquiring foundation trust and
by the current commissioners, NHS Hampshire.
Okay. Clare Panniker. Again, the reason I thought it would be
interesting to hear from you is that you are talking to another
hospital that the Secretary of State announced will no longer
deliver either A and E or maternity servicesChase Farm.
Clare Panniker: That is right.
You are merging with a failing hospital, whereas Chris Gordon
is merging with a working foundation trust?
Clare Panniker: Well, there are
two distinct parts to this. One is the clinical strategy that
was agreed and consulted upon publicly in 2007, which saw the
reduction of service at Chase Farm, turning the A and E into an
urgent care centre and removing the consultant-led maternity services
from there. That was agreed back in 2007 and significant amounts
of that activity, because of the way the geography works, would
flow into North Middlesex hospital. We have had some delays in
implementing that strategy but, as the chair said, the Secretary
of State in September agreed that we could go ahead. As a separate
part of that decision, he also asked us to look at the feasibility
of North Middlesex taking management responsibility for the Chase
Farm sitethat is, separating it from Barnet and coming
under the wing of North Middlesex. That piece of work is currently
under way and we will report back to the Secretary of State on
Are you driven by the fact that you have a PFI, so to fund the
PFI and North Middlesex you have had to merge with Chase Farm
and close the services there?
Clare Panniker: At the time we
agreed the contract for the PFI in 2007 we anticipated small amounts
of growth. The economic climate and the care close to home
Is it true? Is that driving the decision?
Clare Panniker: Decisions were
made to invest in the North Middlesex site knowing that the Chase
Farm site would downgrade, so the North Middlesex, with the current
economic climate, needs that additional activity.
But to be fair, both the previous Secretary of State and this
Secretary of State promised that they would not close Chase Farm.
Clare Panniker: Well, that is
not my decision.
So you mean the decision was taken to put a PFI in
Clare Panniker: In 2007.
on the basis that you closed some services at Chase Farm.
I know that you said that it will still be there, but it won't
be in five years. But let us take that as given. Then both political
partiesthe previous Government and this Governmentagreed
to keep Chase Farm, knowing that the investment in North Middlesex
was predicated on the closure of Chase Farm.
Clare Panniker: No. The decision
to invest in the PFI in 2007 was made independently. There was
no inference that Chase Farm needed to close to fund the PFI.
But things have moved on since then and the care closer to home
agenda has moved on. The economic climate has moved on. The overprovision
of hospital services is a key factor in north London.
It is not the overprovision of services. What you have is the
financial pressure emerging from a £137 million PFI.
Clare Panniker: There is a PFI
on the site. That was a decision that was made some years ago.
It provides state of the art health care provision. Neither Chase
Farm nor the North Middlesex had sites that were fit for the future.
They were both serving the population in crumbling buildings.
What is going to be different with two failing trusts to make
them, when merged, a successful foundation trust?
Clare Panniker: Well, I would
challenge the label "failing". North Middlesex has delivered
surpluses for the last five years and has continued to improve
clinical quality, so I don't regard North Middlesex as a failing
organisation. There may be some merit in creating a hospital for
Enfield people that is situated at North Middlesex and at Chase
Farm that works closely with the Enfield commissioning group and
with the Enfield local authority. There may be merit in that and
that is what we are testing at the moment.
Okay. I just have to say that looking at the NHS's own publication
under the quality of services your performance is "under
review". Under maternity services, late 2010 showed that
"trust rated worse than other trusts in nearly all categories."
In March, "trust was warned that its neonatal unit was dangerously
understaffed" and under user experience, you are "underperforming".
It was reported in September that more than half of the patients
seen at North Middlesex university hospital trust in June had
waited more than 18 weeks for treatment.
Clare Panniker: In September,
that position on waiting times fully recovered.
But that is not a very good record from the stuff that I have
Clare Panniker: The issues that
you identified are all related to patient experience. We know
that we have some challenges in ensuring that we score well on
patient surveys for our very ethnically diverse and mixed population.
That is an agenda that the trust board is prioritising and taking
It is not patient experience; it is quality issues.
Clare Panniker: Most of the drivers
around that were related to patient experience.
What you are there for is to offer a service to patients. Whether
it is maternity services, neonatal or seeing people within 18
weeks of treatment, you are not doing very well. That is a fact.
You can call it patient experience, but you are there for patients
to experience a good service.
Mitchell: You are all in a state of uncertaintyDr Gordon
least of allbut in this state of uncertainty, while the
future aims are decided, what is the effect on recruitment and
staff morale? It must be disastrous to be in a hospital that has
declared itself failing and which is going to merge or lose services.
What is the effect?
Julie Lowe: Again, it is important
to differentiate the words "failing" and "unviable
in its current form". All three of us have said that our
current form is not the right form to take our services forward
for the future. In the case of Ealing, one of the main drivers
for us to explore a merger with North West London Hospitals is
the fact that our clinical staff have told us that they would
feel happier in a bigger department in many cases where there
is sufficient expertise to sub-specialise.
Mitchell: Yes, but if the staff want to get out, you must
find it difficult to attract new staff.
Julie Lowe: Staff that are with
us already are very keen to work with us to develop the opportunity
to work in what will be a very big local organisation caring for
our local population. Recruiting staff is always difficult when
there is any uncertainty. One of the things that we are keen to
do is to get through thisnot as quickly as possible, but
with due processin good time so that we are not prolonging
the period of time when there is uncertainty. You are correct
in terms of recruiting new staff; it can be very difficult, particularly
to attract senior staff, at a time of uncertainty.
Mitchell: If I were employed there, I should be rushing to
leave the sinking ship. Dr Gordon, what is your advice?
Dr Gordon: I think you would be
making a mistake, Mr Mitchell. People are very loyal to their
organisation. They hate uncertainty; they want to know what is
going on. Once they know, they can start working to that model.
As soon as my people understand that they are going to be working
for a new foundation trust with a new geographical area and a
new clinical model, they start working in their own heads to understand
how that will work for them and for the patients they currently
serve, so naturally our clinicians will look for opportunities.
We have concentrated really hard on looking
at the opportunities that will come out of this, of which there
are many, and people can see those opportunities. We have had
fantastic support from our staff looking to the future. It has
been a very brave thing that people have doneto be able
to look above the parapet to see what the future is for a stand-alone
organisation over the next five years and go for something that
feels initially at risk, but actually will turn out to be something
Mitchell: Clare Panniker, any panickers on your staff?
Clare Panniker: Very good. No,
they are not panicking at all because they see that the North
Middlesex is a fixed point in terms of providing acute services
to a very needy local population.
Q45 Ian Swales:
I want to return to the PFI question. Have you all got PFI hospitals?
Clare Panniker: Yes.
Dr Gordon: No
Julie Lowe: No
Q46 Ian Swales:
One of you has. In your area, you are self-declared as not being
viable in your current form. What proportion of your income goes
in servicing the PFI debt?
Clare Panniker: Eight per cent.
Q47 Ian Swales:
Okay. To what extent are your services tied into the PFI contract?
Clare Panniker: Only the hard
estate management is tied into the PFI contract. We have separate
contracts for all the other facilities management, such as cleaning
Q48 Ian Swales:
You only have management of whatmaintenance of the building?
Clare Panniker: Just maintenance
of the building.
Q49 Ian Swales:
On the estate. You do not have expensive contracts for other services?
Clare Panniker: No, we have separate
contracts for the other services.
Ian Swales: Okay. That is shorter than
I expected. Thank you.
Johnson: I want to ask each of the chief executives what their
understanding of the failure regime is. If you do not make it
by 2014 to foundation trust status, Ms Lowe, what will happen
Julie Lowe: If we try to stay
alone and we don't make it, we would get into a situation where
we needed to be acquired by an NHS organisation that had achieved
foundation trust status. We are trying to get into a merger and
then through an FT process so that we are able to achieve FT in
a new organisational form. That would be our preference.
Johnson: In other words, a shotgun marriage with any institution
that will take you, come 2014.
Julie Lowe: That is one potential
solution. The other thing that could happen us to locally is
that we lose more and more services off the site.
Johnson: So you die on the vine. Dr Gordon?
Dr Gordon: As an organisation,
we looked at the consequences of not moving a couple of years
ago, and none of them looked particularly attractive. A gradual,
progressive loss of services, worsening and worsening financial
instability, with clinical crises that would followthat
is what has led us to this decision. We are not going to be seeing
a failure regime, because very early in the new year we will be
part of a foundation trust.
Clare Panniker: Our TFA process
takes us through the various steps that we need to go through
to determine the best future for us. We do not have one fixed
point. We are exploring the "Enfield hospitals" possibility,
and if that is not feasible, there are other options that we will
look ata range of other partners.
Johnson: Ultimately, if your plan does not work, you will
be in the same position, potentially, as Ms Lowe: you will either
have to find a foundation trust to take you on, or you will simply
Clare Panniker: It will be difficult
to close, given that we have a long-term commitment around a PFI.
It will be in everyone's interests for the local trust, with
the support of the Department, to find a solution in advance of
Johnson: Very quickly, can you each say what your operating
deficits are on an annual basis at the moment?
Julie Lowe: I do not think
that any of us have operating deficits.
Clare Panniker: An operating surplus
of £3 million last year.
Q55 Joseph Johnson:
You do not have a deficit?
Clare Panniker: None of us has
Julie Lowe, I could not get hold of yourwhat is this wonderful
document called?tripartite formal agreement. What words!
Why have you not published yours?
Julie Lowe: Ours was signed with
the SHA and the Department only very recently because of the discussions
about the merger. It will be going to our trust board next Thursday
and will appear on our website with our public trust board papers
Yours was also signed recently, but you got it out.
Clare Panniker: It is published,
Q58 Mr Bacon:
I want to ask Dr Gordon one question arising out of what you said
earlier. You made what sounded like a very persuasive case for
the course of action that you are taking; you mentioned, just
as an example, 13 radiologists being a lot better than six in
one place and seven in another, and said that that went across
all disciplines. It prompts the question: what is not to like?
If you can do that and get so much more bang for your buck, why
was this not done many years ago?
Dr Gordon: I think 21 miles of
Hampshire is probably the main cause of not having done it many
Q59 Mr Bacon:
Twenty-one miles? Is that all?
Dr Gordon: It is 21 miles of the
M3. People are very proud of their organisations. We celebrated
our 275th anniversary as a hospital yesterday, so I think that
people like to retain their integrity. It takes a very brave organisation
to look at its organisational future, and for a board to look
at the possibility of voluntarily
It is 21 miles between Winchester and Basingstoke?
Dr Gordon: Yes.
And Winchester and Andover?
Dr Gordon: 16 miles.
Q62 Mr Bacon:
I represent a constituency in Norfolk, so these seem very small
distances to me.
Dr Gordon: I think it depends
on your world view to some extent, doesn't it? It leads to a
big decision from any organisations, whether you are 20 miles,
five miles or 100 miles apart, to say, "We are viable now,
and we provide a really good quality of service now but, in a
few years' time, that will be really difficult; what is best for
our patients?", and for the board to take the decision to
go through a process that will dissolve itself.
Q63 Mr Bacon:
While I was asking my question a minute ago, a chap behind you
was smiling and nodding sagely in agreement. At least I think
Dr Gordon: That is my chairman.
Q64 Mr Bacon:
That makes me wonder whether you think that it is probably fair
to sayI think this is what you are saying, but perhaps
you can confirm itthat were it not for local chauvinism
with a small "c", there are probably lots of things
that could have been done, especially when a lot of extra money
was going in, that might have improved service quite a lot some
time ago. However, they were not done because we were not in
a financial crisis. They were providing a good service, they
had other pressures, and it was not top of mind, so it did not
get done. It is rather like how very profitable companies do not
necessarily think about how to become even more profitable when,
if they looked at their costs very hard, they probably could be.
Dr Gordon: Sure. I do not think
it is quite fair. I think it's really important to be
Mr Bacon: I am not trying to be unfair.
Dr Gordon: No. I think it is important
to say that the world does not move in explosions too often, hopefully.
It moves gradually, in the way that we change. If you think about
the way that, over the past 10 years, we have come to look after
cancer in networks; the way that, over the past five years, we
have come to look after stroke through networks; and at the vascular
trauma networks, on which we are going through a consultation
process in Hampshire, it is all about networking across different
organisations. It is a huge change in culture for many people.
Organisations that evolved before the NHS, into the NHS and into
the future are now grouping together and working together in networks.
It is only natural that, for some organisations, that can be taken
further, into an organisational union to support those services.
Some of us represent slightly different constituencies. It depends;
if you have a car, you are okay and another 10 miles might not
kill you, but if you are dependent on public transport, you are
Dr Gordon: Public transport links
are good up and down the M3 corridor. It is really important that
local services are provided. You have to find the balance whereby
you can provide local services to a local hospital, but where
critical mass makes it important, for some services, people are
sometimes prepared to travel a little bit further.
So you will reconfigure services in this new trust?
Dr Gordon: I cannot say that.
There are no plans.
Dr Gordon: To take this back to
the consultation around stroke services, for instance, the proposal
in the public domain in the NHS Hampshire stroke consultation
is that the hyper-acute service for north and mid-Hampshire will
be centred for immediate care around Winchester, for the Winchester
and Basingstoke area. For some extremely urgent things where critical
mass is really important, those processes are already happening.
Q68 Mrs McGuire:
I should declare an interest: my husband was carted into the Royal
Hampshire in the back of an ambulanceyou do not look as
though you recognise me, do you?with a compound fracture
in his ankle. I can only say that the treatment he received was
excellent. I also have a niece and a nephew who were born in the
Royal Hampshire. I do not know if that makes me biased. You might
wonder why an MP from Scotland has that connection with Hampshire
Dr Gordon: I was wondering about
that Hampshire accent.
Mrs McGuire: I am happy to explain to
I want to concentrate on the Winchester and
Basingstoke area, partly because I know it, but partly because
it replicates something that happened in my constituency. We had
two district hospitals, which were effectively exporting medical
cases and not attracting some specialisms into the hospitals because
they could not provide the critical mass, training and so on.
In many ways, although there was an issue about staff, the big
issue was how to persuade the local communities that they would
still get a service that met their needs.
Frankly, I think that people understand the
need to travel for specialist services. If you need a brain surgeon
or specialist cancer treatment, the chances are that you will
have to travel, but most people's interaction with a hospital
is like the compound fracture of the ankle at 12 o'clock at night.
What are you doing to ensure that you get the new "clinical
model", as I think you called it, into some sort of balance,
so it is not just about the staff and their personal and professional
development, but also about how the local community sees delivery
of services nearby? Like Richard, I have a large constituency
in which people travel more than 21 miles, but that does not undermine
the rationale of my question.
Dr Gordon: Absolutely. You are
absolutely right. There is a really important balance to be struck
on where we put services, but also on how the public perceives
what services might be available. If you are going to what is
an acquisition, people might think that things are going to be
moved away from an area. For some services, such as unscheduled
care, a very large proportion of our patients over 80 are acutely
unwell and need to come in through an emergency service in their
local hospital, so it is important that we are very clear that
we provide that. We have gone through this process with our current
commissioners and with our future clinical commissionersthe
GPCCs, as they were called at that stage.
Q69 Mrs McGuire:
That might change in time.
Dr Gordon: They are CCGs now,
or whatever. They have been on board with this model, and they
have been involved in that process. We have also been in consultation
with Hampshire county council's health overview and scrutiny committee.
My foundation trust colleagues and I have been to speak with Andover
borough council, Test Valley borough council, Eastleigh borough
council and Winchester borough council to understand what the
population feel. There will still need to be an incredibly important
engagement process to continue to inform the population as to
what services are available at these hospitals.
Q70 Mrs McGuire:
Can I flip this on its head? So far I have not heard people mentioned;
I have heard about councils and authorities, but I will give you
one word of advice that comes from my experience in the Forth
valley area: if the authorities go out and consult with people
on the groundnot the councils, not any intermediaryand
actually try to have an understanding of what people are expecting
from their hospital services, you get a better model. It would
probably be one that is not that far removed from what you are
proposing. People need to understand it and, frankly, I do not
think that you can always work through intermediaries such as
councils or MPs or whatever. Sometimes you actually need to meet
Dr Gordon: I am sure that you
are absolutely right. We talk to our patients a lot about this.
We talk to the local populations about how we can get through
to them. We are encouraging membership of the new foundation trust,
which will be an important part of helping us to understand what
patients want to experience.
Doyle-Price: I have a few reflections about leadership, because
you, Dr Gordon, have outlined a good example of leadership, where
the board has decided collectively on a course of action and engaged
the public to deal with it. Obviously, going forward, the new
trusts will have to depend much more on good-quality NEDs and
senior management teams to take the institutions forward. It is
interesting to pick out the characteristics of good leadership
in this context. I want to ask each of you: do any of you have
Dr Gordon: Yes.
Clare Panniker: Yes.
Julie Lowe: I do not.
Doyle-Price: You do not; okay. In terms of non-executive directors,
could you, Dr Gordon, say how easy it has been to attract a full
complement of NEDs of sufficient quality? Has that been a challenge?
From my perspective, it is patchy in different areas of the country.
With varying degrees of ease, do you get the right skill sets?
Dr Gordon: I entirely echo your
sentiments about the need for leadership. Leadership at board
level is crucial. I have to say, given the audience, that my chairman
is a fantastic leader of our organisation. We have an excellent
team of NEDs. Under his leadership we went through an awful lot
of board development. It is really important that non-executive
directors from a wide variety of places come together and really
understand the machinations of the NHS, how a hospital works and
the complexity of the organisation. It is important that the executives
and chief executiveif they are clinical it makes it slightly
easierillustrate what the underlying meaning is for clinicians
and what the strategy means for patients, the staff and the service
going forward. We are going to need to ensure that our non-executive
directors are brought in carefully, inducted into the organisation
and given the level of knowledge that they needI should
not say thisto be able to challenge the executives on the
information that they are given, and to have provided the clarity
of information that they need to be able to make a judgment.
Doyle-Price: How long have you been in post?
Dr Gordon: A year and a half.
Doyle-Price: And how long has your chairman been in post?
Dr Gordon: Four years.
Julie Lowe: I have been in post
for four years, and my chairman has been in post for three years,
but he has been a non-exec on the board for much longer than that,
because he was a non-exec before. I have been very fortunate,
in that all of my non-execs have committed to staying with the
process, subject to terms of office, and working with our staff,
our patients and our local community to get us to our sustainable
And Clare Panniker?
Clare Panniker: I have been in
post for almost eight years, and the chair has been in post for
May I ask, in drawing this session to a close, how you have dealt
with financial cuts in 2010-11? Starting with Clare, for a change,
what did you cut? Were you forced to cut any front-line services
or front-line workersmidwives and other workers whom we
have been hearing about? This is in the context of the King's
Fund publication, which suggested that a lot of front-line services
were involved. Was that the case in your hospital?
Clare Panniker: On the contrary,
actually; we have been recruiting midwives. We have had at least
eight start in the past couple of months. We have also increased
our substantive clinical staffboth doctors and nursesover
the past eight months or so. We have done that through reducing
our vacancy rates, so that we have to depend far less on bank
and agency. We have almost eliminated agency use within the organisation.
We have made our cost savings by reducing the
premium that we spend on temporary staff, but also through implementing
new models of care. Just this week, we have started a new ambulatory
service, which means that patients can be treated as out-patients.
Things that we might have kept people in hospital forIV
antibiotics, for examplefor weeks on end, they can now
come and have done in the hospital on more of an out-patient-type
basis, which has reduced our need for some of our in-patient beds.
We have looked very much at other areas of productivity and efficiency,
such as theatres, out-patients and improving processes within
Thank you. Julie?
Julie Lowe: I do not want to repeat
everything that Clare said, but we spend a lot of money, as many
London trusts do, on agency staff, and we are reducing that right
down. On procurement, we are buying things more efficiently. We
are providing more care at home, and building on our community
links to try to reduce length of stay.
Have you been forced to cut what would be commonly accepted as
front-line services or staff working in front-line jobs?
Julie Lowe: No.
And Dr Gordon?
Dr Gordon: There is no cut in
front-line staff. We have managed to make cost-efficiencies through
back-office savings, a reduction in management costs, using our
staff more efficiently by reducing agency use, and making extra
payments to consultants for extra work. There are also all the
things that make our work better, including joint teams with social
services and community services to shorten length of stay and
to improve patient flow.
So you are all denying, for your individual hospitals, the assertion
from the King's Fund?
Dr Gordon: Absolutely.
Starting with Julie, do you feel more or less secure in the new
world, where you will have to stand on your own feet, rather than
being managed by David Nicholson? Well, you might still be managed
by David Nicholson.
Julie Lowe: I think being a foundation
trust is tremendously exciting for a trust chief executive, and
for a community like the one that I work in. The opportunity to
be part of a local community and to have greater community involvement
will be a tremendous benefit.
Will you get more community involvement? I cannot see that with
foundation trusts. How?
Julie Lowe: By having a council
of governors and by having members, there is a real ability to
Who are you getting in on that? Councillors? I think that was
Julie Lowe: When we started to
go through the foundation process in 2007-08, thousands of local
people signed up to be members and were really keen to be involved,
and they have remained involved, despite the fact that we have
not pursued FT status.
Chair: Do you want to add to that, Jackie?
Doyle-Price: This is where we get into the geographical discrepancies.
Certainly with my local foundation trust, getting governors of
the right quality to give appropriate accountability is a real
challenge. To put all your eggs in that basket to monitor performance
will not be enough; you will need to have better ways of community
engagement. That will not be the panacea. Certainly, one issue
for me is to make sure that Monitor hoists that into the system.
Clare, are you looking forward to the new world? The question
was really whether you feel more or less secure.
Clare Panniker: There is a big
journey ahead, and there is a lot to be done. The prize is worth
having, because the journey around developing the governance and
the financial control is
You think you will get there, do you? You have the toughest challenge.
Clare Panniker: Yes, I think we
will get there.
Clare Panniker: I think during
And Chris Gordon?
Dr Gordon: Yes, I am confident
that the chief executive of foundation trusts in Basingstoke will
have the skills necessary to carry my services forward. I look
forward to handing them over to her in January.
Q90 Mr Bacon:
What are you going to do?
Dr Gordon: That is a story yet
to be told.
Q91 Mr Bacon:
Will you come back and tell us?
Dr Gordon: I would love to.
Chair: Thank you very much, including
for being very concise. We now have to move on.