Unrest over changes at health trust

Employing around 3,000 NHS staff and serving a population of 870,000 people in and around the county, Norfolk Community Health and Care NHS Trust (NCH&C) provides more than 70 different NHS services.

It manages 12 inpatient community hospitals, including St Michael's, in Aylsham; Swaffham Community Hospital; Norwich Community Hospital; and Benjamin Court, in Cromer.

Other services it provides include stop smoking services, specialist and general children's services, including health visiting and school nursing, community nursing, and highly specialist services for cardiac and neurological rehabilitation, stroke rehabilitation and palliative care.

But NCH&C has existed for less than a year. It was officially created in November 2010, after the government said primary care trusts in charge of buying health care, like NHS Norfolk, were no longer allowed provide their own in-house community health services.

Since then it has been making a whole host of changes, including a long-running review of its administration and clerical staff, as well as a consultation on children's community services. This includes services such as health visiting, school nurses, and speech therapy.

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Anna Morgan, NCH&C's director of service pathways, said the proposed changes to children's community services were also an opportunity to ensure patients across Norfolk were receiving an equal service. While NCH&C has been an independent NHS Trust for less than a year, it previously existed as part of five separate Norfolk-based Primary Care Trusts which later came together to form the current local commissioner, NHS Norfolk.

Each of these historical trusts had commissioned services to be delivered in slightly different ways for different areas of Norfolk, which had resulted in some variation in the structures and approaches taken by services across the county.

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Ms Morgan said: 'Having previously existed as part of a number of separate organisations, which each delivered services in different parts of Norfolk in different ways, NCH&C is now looking to ensure that we provide an equitable service to people across the county and that there is consistency in how we deliver services locally, while still taking into account local needs.

'The purpose of this consultation is to gather staff feedback on our plans, which will be thoroughly assessed before we implement any changes.'

But the plan which could see some front line staff take a hit in their pay packages has been exacerbated by news that the trust has spent more than �800,000 on 'exit packages' for staff in 2010-11.

One member of staff, who did not wish to be named, said: 'It's just heartbreaking seeing such tight knit teams being torn apart, morale is at an all-time low and ultimately the patients and their families who we should be there to serve are going to suffer and have less of the service they deserve due to management failures and blunders.'

Paul Cracknell, NCH&C's acting chief executive after former boss Sheila Adams-O'Shea stepped down to join another health trust, said: 'NCH&C has a long history of delivering care locally as it has formerly been a part of a number of other local NHS trusts, however the organisation has only existed as an independent NHS Trust since November of last year.

'It has taken the opportunity during its first year to initiate a number of changes to its management and service delivery structures in order to further improve the level of care offered to patients in Norfolk. This has been a significant task but the improvements in quality and efficiency will really benefit local people.'

Children's Community Services Consultation

The trust is currently consulting more than 60 clinical staff over a redesign of its children's community services, and if proposals go ahead then many staff could see their pay bands downgraded in the reshuffle.

A member of staff, who did not wish to be named, said: 'At a recent meeting staff expressed their anger and displeasure at having their wages cuts, feeling unvalued for the work that they do for children with complex health needs and disabilities in Norfolk. Concern was raised over the overall effect this will have on those most vulnerable.'

They added: 'A redesign with complex needs pathway is also being undertaken, which will have an impact on the special schools in Norfolk and the service currently offered. Headteachers are as yet unaware, I believe, of the proposals in the core offer, which will affect care plans, training and so on.'

Anna Morgan, NCH&C's director of service pathways, said: 'We are now consulting with staff about our plans to implement new structures, which we believe will bring our services more in line with the needs of our patients and make them even more effective. The proposed new structures will achieve a more efficient use of our workforce by re-aligning the skills mix and delegating tasks to the most appropriate levels of staff.

'This process is not about downgrading our staff – it is about ensuring that we have the right number of staff at the various clinical levels in order to fulfil necessary roles and continue to safely and efficiently deliver each of our services. By getting this balance right, we can ensure our ability to deliver the best possible service to local people, both now and in the future.'

Administration and Clerical Review

NCH&C employed an external consultant to undertake a review of its administration and clerical support, although it has not revealed how much this has cost.

Re-bandings, role changes and relocations are expected, but the lengthy process means these staff have been under a cloud for over a year', according to one employee.

Anna Morgan, NCH&C's director of service pathways, said: 'An independent assessment of our existing administration and clerical structures was carried out over the last year by an external consultant, which has formed the basis for our work to redevelop these structures to make them more efficient.

'This review is still under way and we continue to work with staff to discuss how we can avoid unnecessary duplication of roles in the future, while potentially providing additional administration support in areas where it is needed.

'Admin and clerical staff play a key function in enabling our trust to deliver our high-quality services, so it is essential that we ensure that necessary levels of back room staff are in place to support our frontline clinicians. However, we also have a responsibility to ensure that we are being as efficient as possible and are committed to ensuring that the structures we have in place are necessary to the running of our Trust and the delivery of services to local people. The review is still under way and we will continue to work with staff to ensure we get this balance right.'

Exit packages and redundancies

NCH&C spent more than �800,000 on 'exit packages' for staff in 2010-11.

This includes seven compulsory redundancies, one of which cost between �100,000 to �150,000, and another which cost more than �200,000. There was also a �327,000 settlement of a legal claim in relation to a member of staff.

A spokesman for NCH&C, said: 'As stated in our 2010-11 annual account, a relatively small number of former staff members received compulsory redundancy packages during the last financial year.

'This was chiefly incurred as a result of significant changes which were made within the trust during the implementation of a new management structure, which resulted in some positions being deemed unnecessary to the future running of the trust. All staff affected by the restructuring received support to find suitable, alternative positions within the trust, but in a small number of cases this was not possible. While this has meant we have incurred a cost in the short-term, the changes implemented have helped to make us even more efficient. This means that in the long-term we will recoup this money and make further savings due to the reduced unnecessary expenditure.'

Fledglings Nursery closed

Despite a Facebook campaign by families to try to keep it open, NCH&C closed the Fledglings Day Nursery at Norwich Community Hospital.

The nursery was used by NCH&C staff, as well as other NHS staff and families nearby, but the health trust said it was making a loss and had to be subsidised. Families argued that more could have been done to keep it open, by marketing it more effectively to the wider community, but the nursery closed at the end of August.

Foundation trust status

The government expects the majority of NHS trusts to achieve foundation status by April 2014.

NCH&C is in the process of working towards becoming a community foundation trust, which would give it more independence over its own finances and governance.

This is a long process, and the trust has to recruit public 'members' – the cost of this is another reason why staff feel aggrieved at some of the other cost-cutting measures.

Earlier this month a National Audit Office study said that of those trusts in England yet to achieve foundation trust status, 80pc face financial issues, 65pc have quality and performance problems and 39pc are tackling issues over governance and leadership.

It did not identify or name any of the trusts in its report, but it added that 20 of the trusts 'face such substantial problems that they have recognised they are not financially or clinically viable in their current form'.

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