Merger with larger trust is 'off the table', says DGH chief

Richard Mitchell, chief executive of the East Midlands trust, told HSJ that the two organisations had extracted elements from the business case for the scrapped merger with their services working together “in a way that doesn’t require the organisations to merge”.

“Merging can be very disruptive and culturally problematic,” Mr Mitchell said. “I get the sense from NUH they are keen on working with us in a way where we have a relationship based as equals.”

Mr Mitchell also addressed the large public finance initiative debt the trust is responsible for paying off, which costs around £20m a year.

“We are trying to reduce the second 50 percent [of debt] to the lowest possible value and it gives us the opportunity to have conversations about what is the solution for PFI payments,” Mr Mitchell said.

“We get money to service the PFI,” he said. “Depending on what is changing nationally around provider funding, that may change and give me some concern.”

Mr Mitchell stressed that although the trust has already reduced its agency spend by 50 per cent in 18 months it still uses a large proportion of agency staff.

“One of the reasons why we had such high agency spend was because the organisation was in special measures and the uncertainty of joining an organisation that is going to be merged,” he said.

Mr Mitchell said the trust has seen an increased number of staff recruited and said it is looking at improving retention by offering opportunities for staff, such as to retire and return on reduced hours and also by offering flexible hours.

The trust was recently awarded an outstanding rating for caring and good overall by the Care Quality Commission after spending 27 months in special measures. Mr Mitchell said this success boils down to two things: a primary focus on providing safe care and making sure staff feel engaged and a leadership team who are visible and listen to them.

“Everyone has my personal phone number,” Mr Mitchell said. “I try to be visible and listen to how things are going. I put a lot of emphasis on emergency flow and go to our 8am site meeting.

“We are very far down the road from a special measures organisation,” Mr Mitchell added, “We have outstanding for caring, and there are other areas where we are looking to be outstanding in the near future.”

In terms of what the 10 year plan for the NHS should include, Mr Mitchell said the NHS needs to work more around prevention and public health.

“Hospitals are really important but a plan on wild growth in the acute sector won’t work,” he added. “We need to work with social care and community care to provide patients with safe care at home.”

Andy Haynes, executive medical director, told HSJ that Sherwood Forest is “a living, breathing example of engagement and culture shift”.

“We are working really hard at putting more senior clinicians in governance,” Dr Haynes said. “The clinicians were a bit bruised and battered because of the financial constraints. We had to listen to their concerns.”

In terms of the relationship with NUH, Dr Haynes said it has now been “formalised and extended” through the clinical services reconfiguration.

“Our neurology service was a real struggle and we were paying a lot of agency fees – from 1 August our service was provided by Nottingham,” he added. “We have a shared service and that has developed better quality pathways.”