Merger an "option" as financially challenged trusts consider future

Northern Devon Healthcare Trust and Royal Devon and Exeter Foundation Trust, which have increasingly shared executive directors on their boards since 2018, have made the commitment in a bid to combat challenges such as staffing, performance and the use of technology.

NDHT is believed to be the most remote acute NHS trust on the English mainland. Both trusts are located in the health economy, which was formerly one of England’s three “success regimes” (NHS England’s system-wide intervention for areas with multiple performance problems).

In a joint statement to HSJ, the two trusts said the precise nature of the joining together needs to be “worked through” by both organisations.

But the “trigger” was the view taken by NDHT’s board that joining together with RD&E “offered the best way of securing the long term sustainability of services”, according to the trusts’ statement.

“At this stage, all options are on the table on what joining together will mean practically”, the trusts said.

Since July 2018, NDHT has increasingly filled their board with current RD&E leaders. Joint posts include chief executive (Suzanne Tracey), medical director (Adrian Harris), chief operating officer (Pete Adey), director of people (Hannah Foster) and chair (James Brent). Ms Foster was a joint appointment between the trusts in August 2019. There are also five non-executive directors on NDHT’s board.

According to the trusts, the NDHT has carried out a review of its hospital services to consider how its “core acute services” could be best supported, given that the organisation is among the most remote in England and has persistent staffing issues.

This review prompted NDHT’s board to conclude that joining with another provider offered the best chance of sustaining those acute services, the trusts said. However, the trusts said they could not publish the review because it is “commercial in confidence”. 

The trusts’ commitment is “on the premise that any new arrangement benefits all communities served by both trusts and is supported by NHS regulators”, the trusts said.

Asked what has been achieved since the trusts began to share leaders in 2018, the trusts pointed to:

• Improvements in NDHT’s Care Quality Commission rating (though the overall rating has remained at “requires improvement”);
• The creation of joint posts across both trusts – particularly in maternity; and
• Improved performance in NDHT’s diagnostics (performance against the 99 per cent target rose from 68.3 per cent to 89.8 per cent between June 2018 and November 2019).

Between November 2018 and November 2019, the trust’s performance against the four-hour emergency care target (95 per cent) has dipped from 85.4 per cent to 82.8 per cent, while performance against the 18-week referral to treatment target (92 per cent) also dropped from 80.3 per cent to 75.6 per cent. In the same period, 62-day cancer performance reduced from 89.6 per cent to 79.2 per cent (the target is 85 per cent). 

The trusts also believe there are likely to be “some efficiencies” that will arise from working more closely together on clinical services.

• Story updated at 9.46am on 9 January to include the trusts’ comment about publishing the review of hospital services.