Agenda item - Brighton & Sussex University Hospitals Trust (BSUH) and Western Sussex Hospitals NHS Foundation Trust (WSHT) Merger Proposals

21.1    This item was introduced by Carolyn Morrice, Chief Nurse; Dr Rob Haigh, Medical Director; and Oliver Phillips, Director of Strategy & Planning; at Brighton & Sussex University Hospitals Trust (BSUH).

21.2    Members were told that a management contract between BSUH and Western Sussex Hospitals NHS Foundation Trust (WSHT) has been in place for the past three and a half years. This was originally agreed after BSUH was placed in special measures following a critical Care Quality Commission (CQC) inspection report. Consequently there has been sustained improvement at BSUH, which is now rated Good by the CQC (and Outstanding for Caring). WSHT was previously a high-performing Trust and has continued on this trajectory, at its last CQC inspection becoming the first hospital Trust in England to be rated Outstanding across all quality domains.

However, the management contract will shortly expire and BSUH and WSHT have been considering future options: e.g. whether to end the partnership, extend current arrangements, or enter into a formal merger. The option chosen by the Boards of both Trusts is to formally merge.

Merging the Trusts will deliver significant benefits which include:

·         Strengthening existing clinical networks

·         Simplifying Trust governance

·         Offering better career development opportunities for staff

·         Making it easier for the merged Trust to recruit and retain staff

·         Increasing opportunities for external research funding

·         Offering opportunities to reduce duplication and waste

·         Offering opportunities for innovative use of emerging technologies

·         Enabling BSUH to adopt WSHT’s successful ‘Patient First/ model of care

·         An increased focus on environmental sustainability to achieve the goal of Trust carbon neutrality by 2040.

There has already been considerable staff and stakeholder engagement on the merger plans, with an overwhelming majority of positive responses.

There are no immediate plans to make significant changes to clinical services as part of the merger: hence there are no ‘Substantial Variation in Services’ plans requiring formal consultation with local HOSCs.

It is recognised that some people are concerned that a merger may mean that they will have to travel further to access hospital services. However, the intention is to actually reduce travel via strengthened Sussex clinical networks. In particular, the aim will be to provide a range of tertiary services in Sussex rather than in out of area hospitals in London, Southampton etc. where they are currently accessed.

The Trusts also acknowledge that some people will worry that the merger may lead to the eventual downgrading of key local acute services. This will not be the case and the Trusts have committed ‘Strategic Boundaries’: i.e. maintaining key clinical services at all hospital sites. These services include A&E, consultant-led maternity, teaching, tertiary services, paediatrics, stroke services, renal services, cancer services etc.

WSHT is currently an NHS Foundation Trust; BSUH is not, but when merged the entire new Trust will be a Foundation Trust. Foundation Trusts have a very different governance system to standard NHS Trusts and there will be a need to recruit both members and governors to the merged Trust to represent people and organisations within the BSUH catchment.

21.3    Cllr Deane asked a question about stroke services. Dr Haigh responded that the Trust is very happy with stroke services following their recent reconfiguration – with the Brighton Hyper-Acute Stroke Unit (HASU) graded A. No significant changes are planned at Brighton.

21.4    Cllr McNair asked a question about travel times. Dr Haigh responded that, under merger plans the individual hospitals will essentially continue to provide secondary care services for their local populations. Tertiary services will change, but the focus here will be on developing specialities that will enable West Sussex residents to receive treatment in Sussex rather than travelling to London hospitals. Mr Phillips gave an example of the cardiac surgical unit at the Royal Sussex County Hospital (RSCH). This is currently quite a small surgical centre and many Sussex patients are treated at major cardiac centres in London or Southampton instead. The hope is to treat more Sussex residents at the RSCH in the future  (once the 3Ts RSCH improvement programme has been completed).

21.5    Cllr McNair asked a question about communication with the public. Ms Morrice responded that this is key and that the Trust would like to involve the HOSC as a critical friend in this work.

21.6    Cllr Powell asked a question about how the merged Trust would protect and promote its staff diversity. Ms Morrice responded that it will be important to retain learning from the existing BAME and LGBTQ networks, but that merger will also offer opportunities to benefit from working on a larger scale. Dr Haigh added that there has been good recent work on inclusivity, but there is more to be done. The merger will help spread some of the expertise held in the individual Trusts more widely (for example WSHT’s nationally recognised work in elderly care). Mr Phillips noted that a full Equality Impact Assessment has been conducted as part of the merger process. It has also been pleasing to see that staff engaged on the merger plans have identified inclusiveness as a priority going forward. Cllr Powell said that she would like more information on all protected characteristics and Ms Morrice agreed to share detailed information outside the meeting.

21.7    Cllr Powell asked a question about the impact of Brexit on merger plans. Mr Phillips responded that this is impossible to fully answer at the current time, as details of any trade agreement are not available. However, Brexit is bound to pose challenges, particularly in terms of workforce. The merger will make the Trust a more attractive place to work and should make recruitment and retention easier than it would have been with separate Trusts.

21.8    Cllr Williams noted that the city has problems recruiting and retaining key workers due to high house prices and a lack of key worker homes. This is particularly a problem for people from BAME communities, who tend on average to be in lower paid jobs. It would be good to explore the potential for joint schemes to address this. Ms Morrice responded that the Trust would welcome the opportunity to work jointly with the council on this type of initiative. Recruitment is an issue for the Trust, particularly for nursing.

21.9    Cllr Grimshaw asked a question about plans to rationalise estates. Mr Phillips responded that there are no plans to centralise estates as part of the merger. Dr Haigh added that there are excellent new ophthalmology facilities at Southlands Hospital which could provide a better and more convenient services for local people than current arrangements.

21.10  Cllr West asked a question about patient travel and carbon reduction. Mr Phillips responded that he would not expect the merger to have a negative impact on patient travel, with some potential benefits if fewer Sussex residents are required to travel to London for tertiary services. The Trust has a new strategic theme to be more sustainable in order to meet the NHS 2040 carbon neutral target. This work is still at an early stage, but the commitment is there. Ms Morrice added that there had been some concern from staff that the merger might mean they would have to travel further. However this is not something that will happen: there would be a negative impact on retention if staff were obliged to travel further to work. Dr Haigh added that mutual aid between hospitals had been a really strong feature of the local Covid response and this is something that will be built on in future procurement which could see carbon benefits.

21.11  Fran McCabe asked a question about any further merger plans (e.g. with East Sussex Hospitals NHS Trust: ESHT). Mr Phillips responded that there are no plans to merge with ESHT. There is the possibility of closer working arrangements with Queen Victoria Hospital (QVH) in East Grinstead. The QVH Board is currently considering proposals to link more closely with BSUH. Dr Haigh added that BSUH has a very close relationship with ESHT for tertiary services and there are no changes required to this.

21.12 Fran McCabe asked a question about the progress of the 3Ts development of the RSCH. Dr Haigh responded that Covid has caused delays to the programme.

21.13  Ms McCabe asked a question about how the very different demographics of West Sussex and of Brighton & Hove would be reflected in a merged Trust. Ms Morrice agreed that this was an important point. The merged Trust will benefit from its increased scale but will also need effective place leadership and plans are in place to deliver this, for example by having a  Chief Nurse operating at a place level.

21.14  Cllr McNair asked a question about whether safe discharge was a public rather than a staff priority. Ms Morrice responded that this is a priority objective for the Trust. It is recognised that discharge is not always perfect and there is very active planning to improve the consistency of performance.

21.15  The Chair thanked Ms Morrice. Dr Haigh and Mr Phillips for their full and informative presentation and responses to questioning.

21.16  RESOLVED – that the report be noted.