Queen Elizabeth Hospital King’s Lynn Foundation Trust is planning a radical restructure after an independent review said it faced a £39m funding deficit by 2018-19.

  • Queen Elizabeth Hospital King’s Lynn faces £39m deficit by 2018-19 if it does not take radical steps, review concludes
  • Chief executive says FT is “up for” restructure
  • Dorothy Hosein says closing A&E not viable due to distance to alternatives

Chief executive Dorothy Hosein told HSJ last week the trust was “up for” radical change. However, she said closing its accident and emergency department, an option proposed in the contingency planning team review, was not viable.

Ms Hosein said the review, which said the hospital was unviable and suggested it could cut beds from “464 to around 350”, set out a “vision” for a “clinically and financially sustainable” future.

She said the review “identified the opportunity [to change the model of care]. We have obviously got to realise it. A lot of that bed reduction is about having a different model in place in the community.

Dorothy Hosein

The FT is open minded about integrating with other partners, Dorothy Hosein said

“The challenge is to get [West Norfolk Clinical Commissioning Group] and our community and primary care partners to gear up, because the patients will have to be seen, just in a different place.”

She said the trust was open minded about integrating with other partners. “Could a GP practice be here? By all means. Could we have more community services on site? By all means.” 

However, she said closing its A&E was not viable because of the distance to alternative A&Es. The nearest alternatives, in Norwich and Peterborough, are both nearly 40 miles away.

Many of the trust’s problems stem from the fact it serves a large area with a small population of around 200,000, and the nearest other hospitals are an hour from King’s Lynn by road.

Ms Hosein said the trust has begun drafting an options appraisal with local partners to be published in late next year. The move follows the trust signing off its response to the contingency planning team report at its September board meeting.

The team’s report, made public in August, said securing the trust’s clinical sustainability would require the trust to reconfigure services, consider sending patients elsewhere, and potentially ration some services.

Cutting bed numbers would allow the trust to consider a range of options such as “co-locating a GP practice onsite – physical space has been made available as 4-5 wards (118 beds) are no longer required”, the report said.

The team was brought in after the trust was placed in special measures in October 2013. It estimated the trust and its health economy faced deficits of £39m and £80m respectively by 2018-19 under a “do nothing” scenario.

Even if all the savings proposals outlined by the team were initiated, the report said the trust would still be left with a £12m residual deficit in 2018-19.

The trust’s response, a joint document with West Norfolk CCG, agreed with this forecast. It said “improved integration/networking of services clearly has to be part of the solution”. The three Norfolk acute trusts are also developing an acute care strategy to try and address the residual deficit.

The trust exited special measures in August after making significant improvements. However, Monitor said it remains concerned about the trust’s finances. It is now rated “good” for being caring, well led and effective.

Ms Hosein, who joined the trust last September and oversaw the changes, said it had been underpinned by changing the “climate” in the organisation, improving communications with staff and ensuring that “expectations are very clear”.

“People talk about culture, but climate is something that encompasses the whole environment. It’s more measureable. It’s holding people to account,” she added.