Hoping to win the trust of patients

New primary care trusts to run health services across the region come into effect from Sunday . Health Correspondent MARK NICHOLLS spoke to chief executives to look at how they hope to make a difference to patients.

New primary care trusts to run health services across the region come into effect from Sunday . Health Correspondent MARK NICHOLLS spoke to chief executives to look at how they hope to make a difference to patients.

Any new organisation would wish to come into being with a clean slate - free of the baggage, reputation and image of its predecessors.

For the executives who will run the new Norfolk Primary Care Trust, that is a forlorn hope.

It comes into effect with the debts of the PCTs it is replacing; many of their policies and initiatives, which will remain in place with perhaps a minor tweak; and probably a few familiar faces too - though the executive board has still not been finalised.

And the chief executive is an interim appointment.

It is not destined to be the most auspicious of starts. It is hardly surprising that the permanent role of chief executive of the new Norfolk PCT has become known as “the job nobody wants.”

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Effectively, the new senior executive is faced with cutting services to pay off that £31m debt by March 2008, cutting jobs either by redundancy or natural wastage and streamlining the service.

There is a will and a desire to take health care in Norfolk forward, but with a “financial ball and chain” around its ankle, the new trust is going to be slowed in its drive to be innovative.

With no new name on the horizon for the chief executive's berth, and unlikely to be so at least until the New Year, Hilary Daniels is to remain at the helm.

The chief executive of outgoing West Norfolk PCT has been the “transitional lead” charged with moulding five into one, and will be in post possibly unit next June.

She acknowledges that there will be tough decisions to take, that there will have to be a lot of hard work in cutting costs but also jettisoning the reputation some of the poorer performing PCTs in Norfolk attracted.

Norfolk PCT - to be based in Dereham and with a massive £875m budget - has been formed out of West Norfolk, North Norfolk, Broadland, Southern Norfolk and Norwich PCTs.

Yarmouth and Waveney PCTs merge now to form a separate organisation, along the lines of existing natural partnerships and also by public demand after campaigns forced regional health bosses to have a re-think and pair the two together.

For Norfolk PCT, there will be cuts before there are new services.

Ms Daniels explained: “We are trying to create a new organisation but we have to deal with the financial position. We cannot do all the initiatives we would like until we sort that one. And when you have a debt of £30m-plus, you cannot save it by tweaking bits and pieces around the edges. You have got to look robustly at things.

“We will be looking at every single aspect of health care in Norfolk. There are no sacred cows. I cannot give any guarantees on jobs either. We have to be seen to be making significant inroads into that debt and it has to be paid off because while Norfolk is in debt somebody else in another part of the country has to under-spend to fund that.”

There are likely to be redundancies but with vacancies being kept open there may also be redeployment. It is not clear what the redundancy costs of bringing the five PCTs together will be this side of Christmas, though there is an obligation to make at least 15pc management savings - much of it by the loss of senior executives from the former PCTs. This money is eventually destined for cancer and palliative care.

But there are cost-cutting measures already in place - such as moving patients to non-branded cholesterol reducing drugs (statins), which could save up to £24m across the region. In Norfolk around 80pc of patients could move to cheaper statins by the end of March.

Ms Daniels stresses that good health care is not always the most expensive. Once the new trust begins to see its way forward, there will be greater choice for patients, the driving forward and developing of existing initiatives, and shifting care into the community via community hospitals, GP surgeries or in a patient's home.

But she warned there would be no wholesale dismantling of plans laid out by the current PCTs.

“It will be a case of looking what is there. There will be some tweaking but in some cases we may even think that they do not go far enough,” she told the EDP. “The issue will be developing services closer to people but they will have to be cost-effective.”

There are concerns that some of the “bridges” and infrastructure that will help make the transformation from hospital to community-based treatment are not in place. Ms Daniels thinks they generally are but added: “To have more care in the community we have got to make some brave decisions, and that might be just to get on and do it but we have got to be much slicker in doing these changes.”

The chair of the new trust, Sheila Childerhouse, who has been involved in tackling the £11m debt at the Queen Elizabeth Hospital at King's Lynn in her previous role, stresses the importance of involving patients as well as GPs, clinicians and partner agencies in taking the county's healthcare forward.

She said: “There are some really positive forward-looking innovations in the PCTs and they are things we can build on. But with a lot of sparsely populated rural areas one of things we have to do is bring a consistency to the quality of health care across Norfolk and the need for local responsiveness is really important.”

Fears of a lack of local focus have been raised but the new trust plans to maintain a presence across the county with satellite teams and this is an issue Ms Daniels will report on to the first board meeting on October 19.

Mrs Childerhouse added: “We need to have a long-term view of where we want Norfolk healthcare to be. We have got to deal with the particular financial position and deal with it here and now but we have also got to have a clear view of where we want to go.”

As the old PCTs disappear, they have attempted to highlight achievements rather than deficits. But the harsh fact remains, most ended their lives in debt.

While West Norfolk and Norwich are looking at a break-even figure, North Norfolk has a debt that could hit £15m, Broadland of £6.6m and Southern Norfolk of £9m.

The reorganisation will also see a new Suffolk PCT created and a countywide authority for Cambridgeshire but with a separate PCT for Peterborough.

The new Great Yarmouth and Waveney PCT - which will be based in Beccles - starts against a different backdrop to its larger Norfolk neighbour. There is a deficit - about £6m - but one that its chief executive Mike Stonard considers “manageable.”

Mr Stonard will be in charge of a £300m budget but will still have to take tough decisions with job cuts inevitable as two organisations merge and a need to make 20pc cut in management costs.

But he believes it is a merger of two well-performing PCTs.

He said: “It is a new organisation and people need to see it that way. But it is one the people of Great Yarmouth and Waveney fought a long and hard campaign to get it. We are well aware of the high expectations of that and of the expectation to invest in and improve local health services. We have got to deliver against people's expectations.

“I will have to address some tough financial issues. Like all the PCTs in Norfolk, Suffolk and Cambridgeshire, it will start with a financial deficit, but I believe it is manageable and relatively small as a percentage of PCTs overall budget.”

He said there will be a “root and branch” examination of expenditure, benchmarked against similar sized PCTs across the UK and also a look at how robust the trust's financial recovery plan is.

“It will be also a case of looking where are we spending too little, where are we spending too much. It is about getting the best for the local population.”

But Mr Stonard believes there can be improvement without significant impact on patient services, a result he achieved as Suffolk West PCT chief executive with figures reported to its final board meeting yesterday showing a deficit from £22.6m deficit to £10.2m.

Mr Stonard said: “The new PCT is very much about the health needs of the local population of Great Yarmouth and Waveney. We have deprivation of a type and depth in parts of the PCT which is unknown elsewhere in Norfolk and Suffolk.”

It shows some of the highest rates of heart disease and cancer, coupled with lower life expectancy than many other parts of the region.

“Because of that we need to create a PCT that will focus on those health needs,” he added. “We need to make sure that the new PCT is very well engaged with the local population, clinicians and partner agencies such as social care.

“We need good public health to make sure that our services are the best for people to address those needs and get the best value for money for local people.”

He warns there will be no overnight transformation - more like over the next three years - but believes patients will see waiting times for treatment reduced, services provided more locally to help them stay at home and not go to hospital, and more diagnostic and day treatment provided locally to where the live.

“I also hope they will notice more choice of services as part of the PCT reforms and that the PCT will act as a vehicle to make choices available to patients and not just where they are treated but the type of treatment they get and the choice of hospital.”

Over the coming months, the progress of the new organisations will be closely watched: how they perform on managing finances; whether they can extend services; deliver on promises and targets; and most significantly, how they best serve the interests of the patient.