Sunday, 10 November 2013

How much power does a hospital board really have?

Weston General Hospital
24.10.13 - 10:00hrs

Meeting between:
Chief Executive of Weston Area Health Authority - WAHT
Project Director for Procurement Process
Weston General Hospital Campaign.

The background to the meeting is that the coalition government had, as part of the 2012 Health and Social Care Act, laid out the financial constraints by which hospitals qualify as Foundation Trusts. Weston General (WGH) is too small to qualify and, therefore, has either to be acquired by  an existing NHS Foundation Trust or franchise the running of the hospital to an NHS Trust or a private health company.

There is now an established, formal process to be followed for this, much of which is outside the hospital's control. Project Director reported that lessons have been learnt from Hinchingbrook (now run by Circle and much criticised by the National Audit Office etc - there is also a debate on competition in The Health Service Journal - and the George Eliot Hospital which has been going through the process ahead of WGH. There is no clear timescale for the WGH process and she does not want to release too much information into the public domain until this is clear. This is so that there is no risk of being open to misinterpretation.

Chief Executive described their roles as running the hospital until the procurement solution is delivered. Although he sits on the Project Board he is not responsible for the process. The body responsible for delivering the solution is the national body, the Trust Development Authority (TDA) which answers to the Secretary of State. Bronwen Bishop is the board director directly responsible to the TDA for the project and works to get the best outcome for the hospital. The board makes recommendations to the TDA which makes the final decision.

Project Director reported that, after consulting staff and stakeholders, they had decided that the right way to ensure the best future for the hospital was to test the whole market although they could have opted to pursue an NHS only solution, but there were 3 NHS Trusts interested. George Eliot looked for a joint NHS/Private approach.

WGH Campaign raised the issue of contract weaknesses, citing the Emerson's Green Treatment Centre's underspend as an example and asking why there was not a swingeing 'fit and proper person clause'. They emphasised that some of the private companies which have expressed interest in WGH have particularly obscure accounts, utilise off shore tax havens and are heavily leveraged to their Private Equity owners. Project Director noted these concerns and stated that the contracts were now being standardised nationally.

She reported that the George Eliot procurement process had gone to the stage beyond Expressions of Interest. She also emphasised that whatever solution was agreed for Weston, the hospital would remain as an NHS entity and staff would remain employed as such.

Once the TDA approves the Outline Business Case there will be an evaluation stage of the bidders to see if they are technically able to deliver on their bid promises and then short listing will take place.

WGH Campaign felt that the 'Outline Business Case' for the hospital had been too critical of the current management and that she cannot believe a new management team can come in and do anything about the £5 million deficit. Project Director reiterated that WGH has to find a solution and the process is about achieving this.

WGH Campaign raised the issue of the future of a full A&E service at the hospital. Chief Executive responded that this was an issue for the North Somerset Clinical Commissioning Group (CCG). WAHT has to ensure quality of delivery but it is up to the CCG what they commission. The WAHT board would inform the CCG if they were unable to provide services from within their resources.

WGH Campaign asked about the conflicts of interest involving John Underwood and Kathy Headdon. Project Director explained that Underwood had been brought in to give strategic advice and as the process moved to operational requirements his input would no longer be required as frequently. She explained that there is a requirement for a range of experience in roles such as Kathy Headdon's and that in the event of conflicts of interest due to prior or existing roles, they would be obliged to absent themselves from the process. WGH Campaign pointed out that the public perception of her role with Capita Symonds and position on the Stakeholder committee would be very negative.  Chief Executive disagreed with WGH Campaign’s ethical position on conflicts of interest. Project Director stated that terms of reference for committees would soon be up for review and they would continue to ensure proper governance arrangements were in place.

She wanted to reassure WGH Campaign that if the procurement process goes ahead that there will be a wide range of people evaluating the bids including clinical and nursing staff. The TDA will evaluate the financial information in the bids. She also said she is considering asking the short listed bidders to write a short statement, which will be included in a magazine for the public.

WGH Campaign mentioned that the Social Value Act now allows public sector bodies to look at how the social, economic and environmental well being of an area can be improved through a procurement contract.

WGH Campaign thanked Chief Executive and Project Director for their time and for clarifying so many issues for them

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