Susan Acott: Delivering safe care in small hospitals

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Susan Acott: Delivering safe care in small hospitals

  1. 1. Responding to the challenge of delivering high quality, safe patient care in a small hospital Susan Acott Chief Executive Dartford & Gravesham NHS Trust
  2. 2. Dartford & Gravesham NHS Trust  Whole site PFI  High % of fixed costs  Greater % of activity from NELIP  Emergency tariff  Difficulty in recruiting & retaining skilled staff (no London weighting)  Low appetite for risk  Tiny surpluses  Difficulty maintaining rotas  Few trainees
  3. 3. Why is my small Trust valuable?  Fantastic culture  Very efficient by any metric  Patient focussed  Committed clinicians  Innovative and agile  Can do  Team – we know each other - grip!  It is here when needed  Local  Value for money  ACCESS…………….under estimated value
  4. 4. How have we survived so far?  Unrelenting cost control  QIPP  Decommissioned or offloaded specialties we could not make work (Rheumatology)  Jumped into network solutions where we might retain a stake (pPCI, CA)  Gave up clinical ownership & converted to landlord (ENT)  Transferred services to community (GUM)  Repatriate work from London (EBUS, Renal)
  5. 5. Survive rather than thrive
  6. 6. The Strategy
  7. 7. The Department Store Model  We provide the core services and infrastructure  Enter into franchise or network arrangements with tertiary providers  Act as Landlord for other secondary providers  Enable local provision  Plan to provide out of hospital ‘local’ services  Better Care Fund
  8. 8. Why?  Patients who are ill, frail, rural, don’t drive, have children, other dependants……….LOCAL has real value  Health Inequalities  My Trust is a PFI – has to be paid for!  Cost of reprovision
  9. 9. Let’s be more creative!  We may or may not make it as an independent Trust  But we are determined that our hospital can show that it has a valuable role which can meet most of the needs of the local population  Whole system planning is needed to make the best use of local facilities, commitment and culture  Chains may have some value but lets stop the talk of failing Trusts
  10. 10. Waving not drowning

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