To scrutinise services provided by Great Ormond Street Hospital for Children NHS Foundation Trust.
Minutes:
The Director of Planning and Information at Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH) explained that GOSH was a specialist children’s hospital, founded in 1885. The hospital had a small number of beds (350) but high staff number (approximately 4,000) and turnover. Nearly half of the hospital’s beds dealt with complex care and there had been an 80% increase in the number of patients seen over the last 8 years. The hospital also ran the second largest private hospital service in the UK.
GOSH offered all children’s services except burns treatment. GOSH dealt with 25% of children’s heart surgery in the UK as well as 33% of bone marrow transplants and 75% of children’s epilepsy surgery. 1There were a total of 19 specialist children’s services offered by the hospital and these were not commissioned by CCGs but by NHS England in most cases. Forty-eight per cent of GOSH patients were from London with a further 24% from Hertfordshire, Essex and Bedfordshire. 11.5% of admissions were from Essex with the ONEL boroughs each accounting for 1.6 – 3.2%. Redbridge for example had seen 1,210 admissions in the last year. One per cent were overseas patients funded by the NHS under reciprocal agreements.
There was no A & E department at GOSH and the hospital did not generally take referrals from GPs. Referrals were usually made by consultants in other hospitals. The Trust’s vision was for GOSH to be the leading children’s hospital in the world for patient experience, outcomes and research.
A major Challenge for GOSH was the planned in NHS commissioning arrangements for specialist services which could have an impact of £20 million on the Trust’s finances, The ability to recruit and retain key staff was also a challenge. The Trust also wished to make patient records digital and transferrable.
Opportunities for the Trust included the hospital’s strong brand name which allowed it to diversify its income base. The hospital’s new clinical building was due to open in 2017. GOSH was also at the forefront of genomic medicine such as the development of a non-invasive pregnancy testing service.
The greatest clinical pressures at GOSH related to end of life care. GOSH was often the hospital of last resort and families were often reluctant to agree to the ceasing of intervention. Some patients incurred extremely high treatment costs with the 125 most complex cases seeing £12.5 million more being spent on treatment than GOSH had received from commissioners for these patients.
The private patient wing at GOSH was operated separately from the rest of the hospital and funds from this were being used to support NHS services and research.
The Liverpool Care Pathway had never been used at GOSH and the UK’s only dedicated paediatric palliative care team was based at GOSH. Digital records were in the process of being rolled out to different departments at GOSH. It was hoped to also develop a portal system to be used by other hospitals around the UK.
GOSH did make use of premiums for groups of staff that were difficult to recruit to although the Trust had not moved outside of national pay scales. Staff recruitment and retention at GOSH had improved in the last year and a lot of nurses had been recruited from countries including Ireland, Portugal and Spain.
A service level agreement was in place to allow the GOSH palliative care scheme to visit hospices. This team also administered care in people’s homes.
Lobbying and risk assessment work was in progress in relation to the impact of specialised commissioning changes. GOSH was also seeking to increase efficiencies and derive more income from private patients. The GOSH officer accepted however that the planned changes in commissioning arrangements were likely to lead to fewer NHS beds and theatre sessions at GOSH.
The Committee NOTED the update and thanked the GOSH officer for his attendance and input to the meeting.
The Committee AGREED that GOSH should not be penalised by any forthcoming changes in the arrangements for specialised NHS commissioning and that a letter communicating the Committee’s view should be sent to NHS England.