• High cost supplement based on incorrect assumptions on cost of living in different parts of the capital, CEO says
  • CQC ratings improvement followed ‘relentless’ focus on staff
  • But trust will struggle to meet control total of £6m deficit this year

The chief executive of a suburban trust has called for changes to the pay system in which inner London staff get a larger supplement to their pay than those in outer boroughs.

Ann Radmore, of Kingston Hospital Foundation Trust in south London, says there should be a flat rate “weighting system” across Greater London.

This is “predicated on the assumption that living in Richmond is cheaper than it is to live in Islington. It really isn’t,” she told HSJ.

She is talking with other London trusts, commissioners, and NHS Employers about the arrangement. The weighting, known as the high cost area supplement, is set by the Department of Health and Social Care with input from the NHS Pay Review Body.

Currently staff in inner London are entitled to 20 per cent on top of their basic salary, with a minimum increase of £4,200 and maximum of £6,469. In outer London the uplift is 15 per cent with an upper limit of £4,528.

A review of the supplement in 2014 found there was no strong evidence that recruitment or retention would be improved by changing the current system.

Ms Radmore sees cost of living as a leading contributor to staff turnover. It spurred her to start the “conversation” with her neighbours when her staff raised it as an issue.

She spoke to HSJ after the Care Quality Commission rated the trust as “outstanding”, up from “requires improvement” in 2016. It is the first acute trust in London to be rated “outstanding” for leadership.

The trust has focussed on its staff “relentlessly”, which has been a large part of that success, Ms Radmore said. She has invested in improving staff welfare, training and development to reduce staff turnover and improve quality.

Kingston has “very well-established values” including putting the patients and safety first, she said. Improvements have come by encouraging staff to “think through what that meant at every level of the organisation” and then to take the initiative for decision making, based on those values.

While quality has improved significantly, the trust remains in deficit. “I think we’re in a very interesting place financially,” Ms Radmore said. “We’re one of the most efficient trusts in the country.” However, last year it had a £6.9m deficit, missing its control total of a surplus of £900,000.

“We’ve got a deficit control total this year, just about £6m, and we and the regulator think that will be challenging to deliver.” And it will mean “we stay at the same level of deficit, where we have been for the last three years,” she added.

She said running the hospital estate “is not as cheap and not as effective as it might be because it’s old”, and the trust could invest in the infrastructure to make it more efficient, “if there was more capital available”.

There has been some new estate development at the trust, but it has not been paid for out of its own coffers. Three wards for elderly patients are in varying stages of redevelopment to make them more dementia-friendly, another element of the trust’s work that drew praise from the CQC. However, this remodelling was paid for through fundraising by the hospital’s charity.