Got a question? Hopefully you’ll find all the answers you need below but if you have a question that isn’t addressed here, please get in touch.
BACKGROUND AND RATIONALE
Why are you merging?
The trusts that run Colchester and Ipswich hospitals are planning to merge to create a new organisation that will be the biggest in East Anglia.
Merging means we will spend less money on overheads and duplication, releasing more money for our services, leading to improved care for our patients.
The merger provides the opportunity to successfully integrate clinical services, strengthening them in the short term to give a solid foundation for securing additional services and transformation in the years ahead.
Each trust could have continued pursuing their own strategies and plans. They would also have continued facing demand, recruitment and financial pressures as individual organisations. The merger is not a silver bullet for these problems but provides opportunities to address them more successfully by working together as a single organisation.
When will the merger happen?
We expect the merger to be completed in summer 2018.
We are due to submit our full business case for approval by national NHS bodies in April, after approval by both trusts' boards and scrutiny by Essex and Suffolk councils.
What challenges specifically does the local NHS face?
The health system in east Suffolk and north east Essex faces a number of challenges, many of which are not exclusive to our geography.
- Our local population has greater than ever health and social care needs and we need to adapt to meet this demand within limited resources
- Quality of care varies across our region. It is increasingly difficult to retain and attract doctors, nurses, and other specialist healthcare professionals and unless we find new ways of working we will not have the staff to deliver care for our patients
- There is a significant financial overspend at both trusts which cannot be resolved by the trusts working alone
- National standards being set in a number of services mean higher patient volumes are needed to remain viable
Taken together, these challenges mean that neither trust is likely to be clinically and financially sustainable on its own. This is why we are addressing them through the merger.
What are the benefits of merger?
Merging will help us secure high quality healthcare for local people into the future.
It will enable both trusts to improve the quality of services for patients, for example by providing expert services more widely and creating the potential to bring innovative services back.
It will also ensure we’re better equipped to meet national standards and improve our ability to do things such as deliver 7-day working and more round the clock care. Investment could also be shared across two sites which will allow money to be spent more efficiently, helping us to meet the financial challenges both trusts currently face.
Why won’t this merger fail - bigger isn’t always better?
We have put a huge amount of detailed planning into the entire process and shared our plans with local authorities and other stakeholders.
The merger builds on significant levels of cooperation already happening across the two organisations; we already have shared leadership across the two trusts, which has seen standards improve.
Which services will be moved from Ipswich to Colchester, or vice-versa?
No decisions have been made about moving any services at this stage. Both hospitals will retain their accident and emergency service, obstetric-led maternity units and the ability to deal with an acutely unwell patients.
What decisions have already been made?
On 24 August 2017, the boards of Colchester and Ipswich Hospitals approved an outline business case. It recommended that the two trusts work to form a single organisation with full integration of clinical services. Detailed plans are currently now being developed setting out how a new organisation could be created and how it would work. The full business case will be taken to both boards for approval in March 2018.
The outline business case explored the pros and cons of different ways of developing the partnership. It explored what the benefits to patients might be if clinical services come together. However it has not made any specific recommendation to change any services currently provided by the two hospitals. If the new trust wanted to move a service from one hospital to the other and it meant that significant numbers of patients would have further to travel then staff, patients and the public would be consulted in advance of any decisions being made.
Have you not already agreed a number of design principles for the merger?
There are some design principles which our clinicians believe are essential to the success of the Partnership and are informed by its ambition and objectives. This includes the need for two A&E departments and obstetric-led maternity units.
The trusts are developing the Partnership using the following design principles:
- We will focus on providing hospital-based services well, that are appropriate to the needs of the local population
- We will develop specialist services where there will be a demonstrable improvement in care for patients from improved access and/or outcomes
- We will continue to provide A&E services on both acute hospital sites
- We will continue to have obstetric-led maternity services on both sites
- We will have a 24/7 emergency provision at both sites
- We will make best use of our resources and be mindful of the links between services
- We will enhance teaching and training to develop our future clinical workforce
What is the Strategic Outline Case and what did it say?
The Strategic Outline Case was published in February 2017 and examines many different scenarios for a partnership of the two organisations. Groups of clinicians and managers at the trusts and in the local health systems considered the potential benefits of each scenario, leading to a recommendation to the trust boards. This was to continue to evaluate three of these scenarios in the next stage of planning. These scenarios are:
- A merger of the two trusts with full integration of clinical services
- A merger of the two trusts with some integration of clinical services
- An acquisition of one trust by another
As a comparison, the scenario of ‘no change’ is also being considered.
A merger or acquisition would not necessarily require clinical services to move, but may mean that services would work together more closely, for example, sharing best practice in delivering high quality care.
Will the merger have any impact on mental health services?
Mental health is currently managed within the two local areas and is not within the scope of this programme at present. However mental health advocates will form part of our series of advisory groups, and the trusts are working closely with the commissioners of mental health services.
Who makes the decision about the final form of the merger?
The shape of the new organisation is being designed with patients, staff, other stakeholders and the wider public. Final plans will be laid out in the Full Business Case which will be put to the boards of Colchester Hospital University NHS Foundation Trust and The Ipswich Hospital NHS Trust for agreement on 29 March 2018.
Any proposals for change must satisfy a number of bodies including NHS Improvement and Clinical Commissioning Groups. The merger also fits in the wider context of the local STP which itself is signed off at a national level by NHS England.
Will I have to travel further to my appointment or to get care?
That is unlikely, as there are no major service changes included in the merger
There will be no changes to A&E or maternity services at either Colchester or Ipswich hospitals, and both will continue to provide 24/7 emergency admissions.
The vast majority of outpatient appointments will continue to take place as they do now.
Any changes in the future would be subject to national guidance on public engagement and consultation and there would be a robust assessment of impact on travel.
When will I know if I have to travel further and what about the cost?
The merger doesn’t include any plans to change services.
Any future changes would be subject to national guidance on public engagement and consultation and there would be a robust assessment of impact on travel.
We would make sure any travel concerns were properly addressed.
There is no point improving services if it is too difficult, expensive or impossible for patients to use them.
What is the timeframe for the merger and when will we see changes?
Following a continued programme of engagement with stakeholders, the Full Business Case will go for agreement to both trust's boards on 29 March 2018.
If the Full Business Case is agreed, it will be submitted to NHS Improvement, NHS England and the Department of Health for approval. We hope to be given the go-ahead to merge in summer.
We could begin to make some changes immediately, while others will take longer to be implemented. Depending on the extent of the changes, we anticipate that it could take three to five years.
The timescale for this seems tight. Will you be able to meet it?
The timescale is ambitious, but the current ways of working are not sustainable in the medium-to-long term and we need to embrace change in order to meet changing patient needs, improve outcomes for patients and tackle the issues facing the local health system.
What form with the merged organisation take?
The new organisation will be a foundation trust.
The NHS is struggling nationally – is the merger just a cost-cutting exercise?
It is about meeting multiple challenges currently facing NHS services, (such as the availability of trained staff and the rising cost of diagnostics) only some of which are financial.
When we look at the forecasts for demand - for example, the ageing population and an increase in house-building in the area - and the ability of the government to fund this growth, it is clear that our only option is to change the way we provide care if we want to maintain the current level of provision for our communities.
How much transformation funding is available?
The merger between Colchester Hospital University NHS Foundation Trust and The Ipswich Hospital Trust is a key part of the Suffolk and North East Essex Sustainability and Transformation Partnership (STP). Funding is available through the STP for credible clinically-led solutions.
Isn’t this merger just a way to save money and cut services?
No. There will be some financial savings, but these will mostly come from spending less on overheads and duplication across two organisations.
Our aim is to save, strengthen and grow the services we offer.
Spending less on overheads will make more money available for the services you use and rely on.
The new organisation will have an annual budget of around £700m.
If you are not moving services, and not saving much money, why bother merging?
Three reasons - scale, time and integration
A. Scale - as the largest NHS trust in the region, we will have the scale to save, strengthen and even grow some services - we can’t do this if we carry on as two medium sized separate organisation.
B. Time - our focus is that time matters, so we want to remove the causes of unnecessary stress and frustration for our patients and staff
C. Integration - the new trust will be designed to work in partnership with local NHS, local authorities and other partners to provide care quicker and easier for local residents.
These are explained in more detail below:
A. Save services
- We can’t currently meet national guidance for the number of specialist staff needed to treat less common cancers
- consolidating specialist staff into single teams means we can meet national best practice in more specialties
- this will mean patients being treated locally, rather than travelling to London or Cambridge
- Strengthen services
- We often have to cancel appointments at short notice because of staff absence
- with our clinicians working together in single teams across our hospitals, they will be able to cover for colleagues
- this will help us see patients at the right time.
- Grow services
- We don't provide cardiac MRIs because we see too few cases each year to develop the right skills
- we will cover a larger population, so our specialists will see more people with complex or rare conditions
- this means our staff can gain the skills they need to provide specialist services locally.
B. Time matters so:
- For the new organisation, the approach to achieving our full potential will be to think about how much time matters to our patients, their families and staff
- too often, we add unnecessary stress and frustration to patient care through poor communication, duplication, late-running appointments and staff battling with multiple systems
- we will concentrate our efforts on removing those aspects of our system that don’t work for our patients and staff.
C. Integration will improve care for patients so:
- We are committed to working as part of a joined-up system which brings together health, mental health and social care services and resources in the best interests of local residents
- our new Trust will focus on seeing patients at the right time in the right place, with our staff working in Colchester and Ipswich hospitals, in community services and six community hospitals
- we will work closely with local NHS, local authorities and other partners to provide care more quickly and easily for local residents, in a location that is best for the patient, not for us.
TRAVEL & TRANSPORT
How will the merger address any impact on travel times for patients?
There are no plans to move any services at this stage and all services will remain on their respective sites.
We continue to work closely with local authorities to make sure everyone can access care when they need it.
How will the ambulance service manage any additional pressures?
As we develop our clinical strategy we will work closely with partner NHS organisations including the East of England Ambulance Service NHS Trust (EEAST). They are part of our Clinical Reference Group and other stakeholder groups.
What will this mean for staff working at the two hospitals?
Some staff will see changes to their role, whilst for the majority their day-to-day role will be unaffected. Where there are changes we will support wherever possible, and through training if necessary, to adjust to new ways of working. We will involve staff in the decisions that affect them and continue to consult formally with trade union representatives wherever appropriate.
Will staff still belong to the same trust or be based at the same hospital?
Once merger has taken place, there will be only one trust, of which all staff will be members. Our aim is that we will have one team working across the whole area previously covered by two trusts' staff, but both hospitals will retain their identity.
For a small number, their base hospital may change, but staff will be informed and supported if this is the case.
Some departments are facing a reduction in workforce due to retirement – will the merger address these issues?
One of the main aims of merger is to attract and retain the best staff. Merger aims to make the single trust more attractive by operating at the scale to provide a greater number of services and offering improved development and research opportunities that we are currently unable to provide as two smaller trusts.
Working with patients and others
How will you involve patients, staff and other stakeholders in the development of the merged organisation?
We have established a number of reference and advisory groups including a stakeholder advisory group and patient advisory groups. These groups include representatives from the local CCGs, borough and district councils, the third and voluntary sector and other organisations involved in the delivery of health and social care services. We hope that through discussion with these groups we can understand more clearly, and sooner, any issues which they may have concerns about and seek guidance on how we best engage with the wider community.
We have also established a staff reference group for each hospital and a Clinical Reference Group to ensure staff are able to influence and shape the direction of the merger. We have held a number of clinical workshops with staff to help shape our clinical services and regularly meet with trade union representatives at both hospital sites. Staff will also be informed throughout the process via our intranet and staff newsletter, as well as through updates in our leadership briefings and all-staff sessions.
As our strategy develops we will be doing more work with patients and the public who may be specifically impacted by any proposed changes.
How will advice from the reference and advisory groups influence the merger?
Any advice, views, suggestions or opinions expressed by our reference and advisory groups will be presented to the senior team working on the merger.
How will you work with colleagues in General Practice?
We have established a Clinical Reference Group which has members from the local Clinical Commissioning Groups including GP representatives. We understand that we are facing a system-wide transformation and that GPs want to be involved with that change.
The merger also represents a major strand of the local Sustainability and Transformation Plan for Suffolk and north east Essex, which was developed through a partnership of local health and social care organisations. Other plans are being developed across the region, outside of the merger process, to better integrate services with local GPs.
Why haven’t you carried out a public consultation on the merger?
We have engaged widely over the past 18 months, and continue to do so, but a full public consultation is not required as there are no significant service changes propose.
Any future changes would be subject to national guidance on public engagement and consultation and there would be a robust assessment of impact on travel.