Impact of the Spending Review on health and social care Contents
Annex 1: Note of visit to Salford Royal NHS Foundation Trust, 21 March 2016
Presentation by Sir David Dalton, Chief Executive of Salford Royal NHS Foundation Trust
Sir David Dalton provided the Committee with a presentation about Salford Royal NHS Foundation Trust (see slides published on the Committee’s website). He also expressed the following views in response to questions from the Committee:
- Sir David agreed that the health services should provide 7 day services with the focus being on the reliable delivery of the 10 NHS Clinical Standards associated with urgent/emergency care and timely clinical assessment. He noted that reliable delivery would take several years to achieve.
- Sir David emphasised that technology is a key enabler of successful transformation. Salford Royal NHS Foundation Trust’s electronic health record (HER) system is integrated with primary care and has improved the effectiveness and coordination of its care. He is convinced that standardising care pathways, to the evidence of best practice, through digital HER approaches allows the best means of reducing variation in care standards and achieving economies of scale.
- However, he said that too often the NHS procures IT in the wrong way and continues to implement systems that do not deliver the expected results. He believes that improvement could be achieved by designating Trusts, who have a track record of successful implementation and delivery, as the project managers of implementation in other Trusts. He favoured a hub and spoke approach rather than every Trust retaining its independent approach to digital improvement.
- For devolution to deliver better care at a lower cost, Sir David suggested Greater Manchester needed to ensure that its hospitals collectively served larger population bases so that they can deliver single-shared services across multiple hospitals and consolidate inpatient services which are currently provided by more than one provider. This would enable standardisation of care to be delivered at scale.
- He believed that a significant proportion of NHS expense is consumed by asset renewal ambitions of Trusts and that as more care is provided out of hospital, then the estate will need to be reduced by prioritising the removal of NHS estate which was considered to be in the worst condition.
- The NHS has too many provider organisations, which often act in the interest of their own organisation instead of in the interest of the wider population that they should serve. He believes that there are significant patient and population health benefits to be achieved by creating Groups of Trusts where the Group HQ would undertake strategic and capital planning on behalf of Trusts who collectively would serve a population of between 1 and 2 million. The Group HQ would create the standardised operating models and care pathways which the Trusts would be required to implement. He believes that this would ensure that Trusts were focussed on delivering operational excellence and improving local services.
- Sir David also believes that 240 independent Trusts is an unsustainable overhead which the NHS can no longer afford and which mitigates against better care being provided across a wider geographic base. He believes Providers should share back office functions and high-performing trusts should take over those that are underperforming.
Tour of Emergency Village
The Committee was shown around the ‘Emergency Village’ which brings together the Trusts A&E department together with the adjacent emergency assessment unit (EAU). The ward is designed to accommodate early assessment and diagnostic, with a multidisciplinary approach to planning patient discharge from hospital. The Committee was shown the following features:
- The emergency department walk-in entrance and triage system.
- An electronic display of A&E attendance for clinicians to understand and prioritise patients on the basis of their needs.
The Committee spoke to an Advanced Practitioner – a trained nurse with a master’s qualification that allows them to assess patients in a specialised field in a similar way to a qualified doctor.
Tour of Neurosciences Centre
The Committee visited Salford Royal’s Neurosciences Centre, which is already the recognised tertiary centre covering patients within Greater Manchester for Neurosurgery, Neurology, hyper acute and acute Neurorehabilitation, Neuropsychiatry, Neuropsychology and Complex Spinal Surgery. The Unit also provides Hyper acute stroke services 24/7 on behalf of Greater Manchester, supported by two other trusts which provide hyper acute access between 7am and 11pm only.
The Trust expects that the Greater Manchester Combined Authority will continue to recognise SRFT’s unit as the established Neurosciences centre for Greater Manchester (and a catchment beyond Greater Manchester for many specialist neuroscience sub-specialties). The unit has an excellent reputation for high performance, excellent quality outcomes and innovation, and the Trust expects full support from GMCA in continuing to develop these services in the years ahead.
The GMCA has not affected the planning of Neurosciences up to this point. However, going forward the Trust will be looking towards GMCA to support further service reconfiguration for service areas such as Neurorehabilitation and stroke services, with the aim of ensuring that it can continue to improve equity of access and the standardisation of high quality care for the population of Greater Manchester.
Tour of hospital wards
The Committee were divided into three groups and shown the following three wards by the ward matron:
- Trauma and Orthopaedic.
- Ageing and Complex Medicine.
- Urology and Short Stay Surgery Ward.