Annual members' meeting

Review the full presentation.

Eric Martlew, Public Governor Carlisle queried the total number of patients on the North Cumbria Integrated Care (NCIC) waiting list.

Answer: Dean Oliver, Executive Director of Performance and Planning reported the total number of patients on the waiting list currently sat at 38,000. The waiting list had stood at just over 30,000 as of April 2022. Planning for industrial action had resulted in a reduction in elective care in order to support and cover staff within Emergency Care; this had contributed to an 8000 increase in the waiting list.

Eric Martlew, Public Governor Carlisle queried the impact to NCIC on patients opting for Private Healthcare

Answer: Lyn Simpson, Chief Executive Officer reported the Trust currently did not capture data on patients choosing to opt for Private Healthcare. This was normally a decision made at General Practitioner (GP) level.

Lyn Simpson detailed the introduction of a new patient choice system. The system enabled patients to register electronically on a patient choice system that would identify waiting times for treatment/operation they required with other NHS providers nationally. NCIC would be expected to support and facilitate the transfer of care to another Trust.

Mahesh Dhebar queried the regional variation of access to emergency care.

Answer: Adrian Clements, Executive Medical Director discussed the importance of delivering high quality and safe patient care to the whole population of Cumbria. The Trust was aware of challenges faced in Cumbria due to the rurality and deprivation of certain parts of the county. In particular poor transport links often resulted in patients presenting late in their treatment for their emergency care.

Mahesh Dhebar queried the current financial challenges faced by the Trust and impact on services, in particular at West Cumberland Hospital.

Answer: Lyn Simpson, Chief Executive Officer emphasised that finances were not more important than the delivery of patient care. The Trust had a responsibility to manage the current deficit position ensuring that money was spent wisely. There would continue to be investment across all sites where the Trust delivered patient care including Cumberland Infirmary Carlisle, Community hospitals and West Cumberland Hospital. The Trust would continue to apply for national funding to help support continued investment in services.

David Hughes, Public Governor Copeland queried the current Private Financial Initiative (PFI) arrangements at Cumberland Infirmary Carlisle.

Answer: James Drury, Executive Director of Finance and Estates detailed the Trust are currently in a 30-year contract that was due to end in 2030. Due to the commercial and confidential nature of the contract, it was not possible to provide further detail.

David Hughes, Public Governor Copeland queried the how the Trust was able to have £48million capital investment plan in the face of a £50.7million deficit.

Answer: James Drury, Executive Director of Finance and Estates explained the £50.7million deficit is from the Trust’s income and expenditure account. The Capital investment plan was supported by funding from the national team called Public Dividend Capital. While there was an element of Trust funding, projects such as West Cumberland Phase 2, Community Development Centre and the Electronic Patient Record were primarily funded by Public Divided Capital.

Sheila Gregory, Appointed Governor for Community & Voluntary queried if the Trust’s deficit positon affected the delivery of services.

Answer: Steven Morgan, Trust Chair explained the Trust would continue deliver services despite the deficit position. At times, the deficit position limited the Trusts ability to make the investment and changes to services as much as would be liked. However, despite the deficit position the Trust would continue to drive improvement and deliver high quality patient care.

Martin Harris, Appointed Governor Cumberland Council queried the number of patients within the Trust who were awaiting treatment within another NHS Trust.

Answer: Johanna Reilly, Director of Operations (programmes) explained the Trust captured this data four times a day. At the current time, there was no patients in hospital awaiting treatment at another hospital. For any patient currently on a ward at NCIC awaiting treatment with another NHS Trust would not be transferred from NCIC until they were clinically stable to do so.

Brian Eaton, Public Governor Allerdale queried steps the Trust were taking to manage the high demand of patients going through Accident & Emergency (A&E) Departments.

Answer: Adrian Clements, Executive Medical Director reported on steps to expand pathways into the hospital to help alleviate pressures on Accident & Emergency. The Trust had increased provision of Same Day Emergency Care (SDEC). This service was now available 7 days a week at both CIC and WCH sites. The SDEC at CIC service also now had a direct pathway from patients coming to the hospital by ambulance; this ensured they bypassed the Accident and Emergency department if necessary. The Trust also operated two Urgent Treatment Centres (UTC) at Penrith and Keswick that would help to manage the demand and pressures on A & E.  

Lyn Simpson, Chief Executive Officer discussed a Listening into Action (LIA) project called ‘Do you come here often’. This project aimed to understand and support frequent attenders to the accident and emergency department. This also included education on more appropriate avenues to attend to when requiring access to healthcare.

Mike Taylor, Public Governor Eden queried how the Trust were making savings on staffing vacancies despite recent investment in recruitment.

Answer: James Drury, Executive Director of Finance detailed the budgeted staffing base for the Trust was 7,100 members of staff. The current staffing base was around 6,800 members of staff; earlier in the calendar year the Trusts staffing position was around 6,500. The Trust was steadily moving towards its budgeted staffing position. The vacancies were helping to drive the underlying financial position.

Ajay Bangaragiri, Staff Governor Carlisle and Eden queried if there was plans to improve the current bed base position at CIC and WCH.

Answer: Lyn Simpson, Chief Executive Officer reported the Trust previously operated 693 beds across acute and community sites. The Trust had improved its bed base recently at West Cumberland hospital with 50 beds becoming part of substantial funding. The Trust were always looking at ways to improve its bed base position.   

Rebecca Mullins, Public Governor Carlisle queried if the Trust had in place processes to ensure medical equipment was recycled.

Answer: Mr Park, Director of Communications provided assurance that the Trust did have a process in place to ensure any medical equipment was recycled where it can be appropriately done so.

Chris Findley, Staff Governor Allerdale and Copeland queried differences between how the Trust were paid per patient compared to other NHS Trusts.

Answer: James Drury, Executive Director of Finance and Estates detailed a funding formula used nationally to calculate how Trusts were paid per patient. The formula took into consideration a number of factors including levels of morbidity and deprivation. The funding received to the Trust would be reflective to Cumbria and parts of the rural deprivation experienced within the county.

Pre-submitted questions and responses:

Question from Philip Tuer: Having heard nothing I take it we were unsuccessful in obtaining money for Solar panels to go above the car parking spaces? Are there any other opportunities we can tap into?

Answer: James Drury, Executive Director of Finance and Estates said we will be applying for funding for a range of schemes to help towards our NHS net zero targets via the Public Sector Decarbonisation Scheme (PSDS) Grant funding when the process opens on the 7th November 2023.

----------------------------------------------------------------------------------------------------

Question from Philip Tuer:  I do look forward to receiving the monthly electronic newsletter but on 27 October, the same day I received one, there was a report in the local press about the failings, as highlighted by a coroner, regarding communication, both within and between trusts that resulted in the death of a patient. Has management had a really good look at both this incident as well as looking across all other departments to ensure that there are going to be no other incidents like this one in the future?

Answer:  Jill Foster, Chief Nurse responded in the meeting covering the process that the Trust must follow when we receive a 'regulation 28' from the coroner which includes making sure learning takes place.  She also talked about our new process for learning from incidents that is being implemented called Patient Safety Incident Response Framework.

--------------------------------------------------------------------------------------------------------

Philip Tuer: Unfortunately I've had to visit the A&E department at CIC twice in the last month with a 10 year old girl. Fortunately she is quite mature for her age and is not 'fazed' by having to walk past patients being treated in beds and chairs in the corridor. I do wonder if younger children may be affected by seeing some of the things I saw on my visits. Why are we still so overcrowded in A&E that it requires patients to be treated in the corridors? Has anybody thought about how it might be affecting children on their walk to/from the paediatric treatment area?

Answer: Johanna Reilly, Director of Operations:

With regard to the pressures on our A&E department, these remain are high across the country due to a number of factors.  These include issues which patients sometimes experience in seeking to accessing GP services, and challenges in social care which impact on patients who are waiting to leave hospital who require social care support.

As a Trust, we are working closely with our health and local authority partners to address these issues, which will reduce pressures in our A&E. In the meantime, we will continue to work to ensure that patients are only looked after in this area when extremely high demand impacts on our A&E department.

----------------------------------------------------------------------------------------------------------

Question: Dr Martin White, Medical Director Cumbria Medical Services NHS - I am aware from my role as medical director of Cumbria Medical Services NHS (CMS) of the significant backlogs of work certainly within Dermatology and Ophthalmology at NCIC. We as a CQC rated outstanding organisation have consistently directly and indirectly through the CCG/PCN offered help managing some of this work.   We currently see over 8,000 new patients per annum referred by GPs who would otherwise be referred to the hospital.  CMS delivers  the service at approximately 60% of the cost of NHS tariffs.
 
To date NCIC have continued to use out of area insourcing companies. The costs to use these companies is expensive. Can the board maybe give some justification for these decisions especially in light of the financial constraints the organisation is working with.

Answer: Johanna Reilly, Director of Operations said we are currently reviewing our outsourcing companies to ensure that we get value for money, if there is a more competitive company then obviously we would look at this. Johanna offered to meet with Cumbria Medical Services to discuss this further.