Trusts take ‘uncomfortable’ step to share capital budget

Maria Kane, who earlier this year became joint chief executive of the new hospital group between University Hospitals Bristol and Weston Foundation Trust and North Bristol trusts, said the joint capital pot would happen “in the next planning round”.

In an interview with HSJ, she also called on fellow NHS leaders not to “collude with despair”. She acknowledged the service’s challenges, but said it was important for senior figures to “keep people hopeful and optimistic”.

On the new joint capital allocations Ms Kane said it may feel uncomfortable for both trusts at first but that it was “key for us to be able to determine how we use our capital on a more strategic basis”.

She said: “Capital, at the moment, is an allocation to both trusts. If we’re able to review our capital allocation as one trust, we may decide to make different decisions. And already we’re talking about that.

“I think that’s going to happen in the next planning round. Our system, Bristol, North Somerset and South Gloucestershire, is very progressive. It wants to deal with a single acute provider voice which is able to say, ‘this is how acute services will be delivered in the round, and this is the capital for you to go and do what is most needed’.”

The two trusts announced in December they would form a hospital group, and in March they published a joint clinical strategy.

Ms Kane, who was appointed CEO of North Bristol in 2021, said: “I’m incredibly proud of how people have worked together, but we are going to have to learn to think differently.

“We’re going to have to open our minds, be permeable to new suggestions, and I am quite sure [the joint capital allocation] will feel a little bit uncomfortable at the start. We have to build trust, we have to communicate, get to know one another as people, and be able to justify our decisions.

“If people are signed up to this clinical strategy, then the money, the estate, the resource allocation, will have to follow that. It may feel a little uncomfortable, but I think people who have committed to the joint clinical strategy will understand why.”

The “group” working will also seek to tackle variation, and to join up 44 “completely duplicated services” across the two trusts, which “unsurprisingly was where the biggest variation in outcomes was”, Ms Kane said.

Leaders ‘should not collude with despair’

Ms Kane said it was important for NHS leaders to “keep people hopeful and optimistic”.

Asked what she thought would happen this winter, she said: “I would like to think we will get through it. I don’t think it’s going to be easy, but NHS staff, they rise to these challenges, and I’m sure we’ll keep everybody safe. It will be hard, but we’ll get through it.

“These are really tough jobs that they’ve got [but] I think, let’s not collude with despair. I don’t think that does anyone any good.

“Our patients need us to be positive, confident in the services we’re delivering and what we’re going to do for them, and that they will have good outcomes. I think our role as leaders is to model that as much as we can.”

AI progress held back by ‘clunky’ procurement rules

Ms Kane described the “really exciting” possibilities of artificial intelligence in healthcare – including use in outbreak prediction, diagnostics and electronic health records.

Ms Kane said the NHS “always needs checks and balances”, particularly in using personal data, but acknowledged “we’re not as agile and commercialised as some environments, about how we go about making partnerships with independent sector”.

She added: “Probably some of our commercial partners sometimes would say things do take a very long time in NHS decision making — because of our necessary governance, we’re spending public money. But it probably takes a longer time than they’re used to with other sectors.”