GWH’s new chairman looks ahead as the NHS changes – and to Savernake Hospital’s role

Written by Tony Millett.

Trust Chairman Roger HillTrust Chairman Roger HillRoger Hill has been chairman of the Great Western Hospital Foundation Trust (GWH) for just two months. But he has been a non-executive director there since 2008 so he knows the hospital and its staff well.

He could not have taken up his important new post at a more testing time for major NHS hospitals.  As he told MNO:  “The era we are moving into is the most complex, most difficult and most high risk.  If we get it wrong…what’s next?”

The challenges increase by the week. GWH has had a pretty fraught winter with staff stretched and target watchers circling.  This year sees the start of the government’s Better Care Plan which will scoop money from hospital budgets.  And there are vital contracts to be tendered for.

Roger Hill retired some years ago after an international and successful career in the computer business – he was chairman and managing director of the UK subsidiary of the American computer giant Intergraph.  And he has also set up companies himself.

He lives in Aldbourne and has been chairman of Marlborough Golf club for four years.

GWH seen from the southGWH seen from the southMany people see GWH as Swindon’s hospital – even Swindon’s ‘community hospital’. But one third of its patients for acute treatment and of its income comes from Wiltshire.  It also attracts patients from Gloucestershire, West Berkshire and Oxfordshire.

One of its problems is Swindon’s ever growing population.  Another is the ageing of the population: “There is a material increase in the older population and a growing need for us to provide care for the frail elderly.”

GWH has just recruited three more consultants to their geriatrics team.  Their successful drive to recruit more nurses continues and they have already increased nursing staff in the last year by 130 - over and above nurses retiring and leaving the area.

This has been a very tough winter for the GWH.  Having put into action a whole list of ways to cope with extra pressures – those pressures kept on coming.  They did not meet the target for 95 per cent of A&E patients to be seen with four hours – and for one week were in the bottom ten of hospitals in England.

Having analysed the statistics for the whole hospital rather than just their emergency department, Roger Hill knows that their ambulatory care unit (for walk in rather than ambulance delivered patients) and their surgical assessment unit certainly helped filter patients through the system.

Now with winter over some of the extra beds are being mothballed again and planning has already started for next winter.  

However, GWH is facing a year-round and steep rise in the number of patients it sees. In January and February this year they saw a ten per cent increase in patients who have not chosen to have operations – the majority following referrals by GPs.

Recently GWH, with about 500 beds, has been accepting 350 admissions every week. To handle that level of demand needs some very astute planning and a tight control over ‘blocked beds’ so people can leave hospital quickly when they are ready to.

How will a hospital under such pressures cope when the Better Care Fund not only takes away some of its budget, but with the integration of health and social care for the frail elderly also tries to keep them away from hospital?

Hospitals will have to change their ways.  Roger Hill tells MNO that GWH has saved £500,000 in the last year by holding thousands of ‘virtual clinics’: if a patient needs no further treatment, they can be signed off over the ‘phone by their consultant rather than having to make time to travel to GWH.

As it costs £1 million a year to run a ward, that £500,000 is a very worthwhile saving.

Roger Hill believes the NHS in Wiltshire is “ahead of the game” when it comes to integration of health and social care services.  He is full of praise for the Council’s Health and Wellbeing Board and the way the Wiltshire Clinical Commissioning Group is working.  And GWH is fully on board: “All the time we are actively involved in the integration of care – we want to participate in the way care is delivered.”

They have employed the new Care Coordinators that are the advance guard of the Better Care Fund’s aim to treat people at home for as long as possible. Some are clinically trained, but in the Marlborough Area they are trained in social care.

As Roger Hill sees these developments, it helps both provider and patient when instead of sending three services to look after a frail and elderly person, you can send just one.

As someone who has first-hand experience of computers, he wants to get GWH staff in the field fully set up with appropriate IT systems.  That is a challenge when Wiltshire’s open spaces have gaps in mobile ‘phone coverage.

A distinct change in the life of a hospital administrator is the constant round of tendering.  The bid to continue GWH’s contract for community maternity services was not successful – the service went to the Royal United Hospital in Bath.

Now they are starting their bid for children’s community health services in Wiltshire.  This is complex because while at present GWH runs the main part of the service, there are several other providers, some of them working across county borders.

Wiltshire CCG wants either to give the whole service to one provider, or to find an organisation that would have overall responsibility for a group of providers.  

GWH has found, Roger Hill tells MNO, it needs a small team looking after all the Trust’s bids for service contracts: “We have to be able to manage bids professionally.”  

Not exactly a boost to the front line of the NHS and another unintended consequence of the Health and Social Care Act’s policy to favour non-NHS providers.

Roger Hill is bullish about the role for Savernake Hospital – which GWH now owns.  He says the hospital’s space is full at the moment and he is pleased consultant clinics are being held there, extra beds are in place and the mobile chemo truck visits.

GWH is now looking to see how they and the Prospect Hospice (which serves the Marlborough area) can accommodate an end of life ward at Savernake.  This would support the work Prospect does with its home care service.

As always there is an element of uncertainty about Savernake’s future – something GWH’s new chairman is very aware of.  Next year GWH will be tendering for the contract to provide adult community health care across Wiltshire.

The results of that competition could mean Savernake Hospital – and its hefty annual PFI payments – might be sold.

How does Roger Hill sum up the coming years? “Significant strides have been made as to how we are going to achieve integrated care – it’s got to be done as a system – and there is no evidence that the acute [hospital] element of the NHS is under threat.  I am fairly confident we will make it happen.”