Frequently asked questions
Couldn’t a merger between the two trusts increase the potential for privatisation?
Both Trusts are NHS organisations and a merger would in fact strengthen, sustain and improve local NHS services.
Couldn’t the merger put further pressure on hospital services?
The whole reason for our merger proposal is to help take the pressures off hospital services and continue to improve the safety and quality of care we deliver.
Both Trusts are facing challenges, such as waiting times for services and achieving high standards of care for all patients, as well as financial challenges and recruitment issues. While these are all significant challenges, we believe that by working more closely together we have a much better chance of addressing and overcoming them, for the benefit of our combined patients. It makes sense for us to explore ways to work together, and differently, to improve the quality of care we offer, whilst also making savings. As part of this, we also want to look at how we can best use our combined buildings and facilities.
Does the merger mean the loss of local services, with specialist services only available at one hospital, rather than two?
The merger is not about losing local services but about saving them. Standards for care, which are set by the Royal Colleges and the NHS nationally, continue to improve as medicine advances. All the evidence tells us that doing more complex work, more often leads to better results for patients and this is being reflected in the standards services must meet. Because of these standards, many highly specialist services may only be available in one hospital in a region. Unless we arrange services locally there is a real risk that we will lose them to areas which have already brought services together.
We will need to review how services are delivered and for some areas it could mean change is needed if we are to improve care for our patients. At this stage we have no agreed plans, other than for Trauma and Orthopaedics. Our doctors, nurses and health professionals will need to decide the best way to deliver care, taking the best from each service and proposing the best way to give care for all patients. In doing so, we would always aim to keep care as local as possible.
For example, they might decide that bringing together all the inpatient care on one site would allow for what is called a ‘critical mass’. This means that the team involved see so many patients that they increase their skill levels (because they’re doing more complex work, more often) and that results in better outcomes for patients. At the same time, outpatient’s clinics, which patients spend most time in, could be run at local hospital sites.
The recent public consultation on changes to Trauma and Orthopaedics care provides an example of exactly this approach. The clinical teams agreed that it would help patients if emergency care and one off surgery were concentrated at one location, while still delivering outpatient clinics at all sites. During the public consultation, we received very positive feedback to this proposal, with patients supportive of the benefits it would bring.
Further details can be found here:- https://www.liverpoolccg.nhs.uk/get-involved/current-ongoing-consultations-engagements/orthopaedics-ent/
Will you close one of the A&E departments?
We have no plans to close either A&E department.
Will the merger result in a decline in quality of services and an increase in waiting times?
Our key aims are to improve the quality of the care we offer patients, and to improve the health of our local populations by dealing effectively with the challenges we face on a daily basis. The merger will help us improve the quality of care we offer all patients who use our services. For example, by combining the highly specialist skills of staff in areas such as emergency general surgery or cancer surgery, into single teams, serving our combined patients, a merged service would have a wider pool of highly skilled staff. This would improve the ability of the service to meet challenges – allowing staff to work where they are most needed to ensure sufficient numbers of specialists to see patients. This will also allow clinical teams to deliver more timely and more consistent specialised services to patients.
Likewise, a shared workforce would help reduce our reliance on agency staff. An agency healthcare professional may never have worked in our hospitals before, and may never do so again. Generally they are less familiar with how we operate and may not be allowed to carry out some procedures that our permanent staff are allowed to do, which can cause delays. We will continue to need agency staff to provide safe care, but we think that reducing our combined reliance on agency staff would improve the quality of care we provide.
Will the merger threaten staff jobs?
Our partnership is based on the principle of sustaining local services and our workforce is key to delivering these. Indeed, one of the key challenges that both Trusts face at the moment is in not being able to recruit enough clinical staff at varying levels, which means there are lots of opportunities now, and in the future, for people to grow their careers with us. We are also in the early stages of developing our plans to bring together certain “shared services”, such as finance and human resources, among others, as our ambition is to create an outstanding support service for our clinical teams. We will be working through these plans in the coming months and talking with staff as they develop.
We are not anticipating any compulsory redundancies as a result of the merger.
At this stage we have not progressed enough in our thinking to offer more detailed information but we will keep staff fully informed about any changes, as well as any potential opportunities on offer.
Does a plan exist for where services will be based once we merge?
Based on current clinical recommendations we have an outline of what clinical models could look like when they integrate and what this may mean for how we use our hospital sites. However, further work is required from an operational and estates perspective to review the feasibility of the recommendations. Likewise more detailed work is required to mature the clinical models and test thinking. This work will need to be completed before we have a complete understanding on where services could be based and what changes, if any, are required.
Where changes are proposed to how or where services are delivered, we would also want to know what our staff and the public think of the recommendations and would seek their input either through informal engagement or more formal consultation. We would do this before final decisions are made on the recommended changes.
Do you have any evidence to demonstrate that mergers improve services?
Merger will enable us to come together and reconfigure services and deliver the improvements we want for our patients. It is the reconfiguration that will improve services, not the merger itself. There is plenty of strong evidence from other parts of the country that services treating higher volumes of patients deliver better outcomes. This evidence is supported across a number of specialities, such as vascular, hyperacute stroke, nephrology and trauma & orthopaedics.
Is the merger proposal all about saving money?
The proposal to bring services together into single teams covering the whole city has been clinically led and the main focus is about improving access to services for all patients, the quality of services and their sustainability. Both trusts, like others across the country, have deficits. They also have increasing demand for services, which must be met without increasing costs. The merger would not cancel these out. However, in the absence of more money, the merger is a way to improve care without it costing more. At the moment, running separate services means there is duplication, which creates unnecessary waste and delays to care. By making services efficient we can ensure the money we have is spent in the best possible way.
When you become one Trust, will you carry forward the debt for the new Royal, or will it be written off?
The new merged organisation will have one financial envelop, which will include carrying forward the income and the financial deficits of both Trusts.
With regards to the new build, the one benefit in the collapse of Carillion is the financial relief it creates for the new organisation. The original agreement was that the new hospital would be built through a private finance scheme (PFI), which would have cost the trust £20million a year, for 20 years. Effectively this would have been the cost for the mortgage for the building. The cost of completing the hospital has increased due to the work that needs to be done to repair the building. However, the fact the government has taken over lending the money means what the new organisation will be paying back will be a fraction of what the Trust would have been paying to the private sector.
The Royal Liverpool and Broadgreen University Hospitals NHS Trust are still calculating the financial impact of completing the hospital and there are some additional costs that need to be factored in. For example, the private sector would have picked up the maintenance cost of the building for the duration of the mortgage. That said, even with the additional costs, estimated repayments will be in the region of £12-13 million a year. This is still a significant saving in comparison to the original PFI scheme.
Will the delays to the new Royal delay the merger taking place?
Whilst the collapse of Carillion in January 2018 was a huge disappointment, the Board of the Royal Liverpool and Broadgreen University Hospitals NHS Trust have remained committed to completion of the project and worked hard, with the support of local politicians and the public, to reach a solution.
The merger, subject to approval from NHS Improvement, can go ahead while the new hospital is being completed, as the two are not directly linked. By this we mean the merger is not dependent on completion of the new hospital and the new hospital will be completed regardless of whether the trusts merge.
What we do need to consider is how the revised date for completion of the hospital will affect our plans to bring services together. Our clinical teams will need to think about how care is delivered across the existing hospitals, and how care could be delivered once the new Royal is complete. This may involve a phased approach to service changes.
What happens if patients have to travel to other sites for their treatment which might be further away than where they are treated currently?
We would always aim to keep care as local as possible. However, if the recommendations from our clinical teams suggest it may lead to improved care for the location of some services to change, we would complete an Equality Impact Assessment. This helps us to consider the impact (positive and negative) on patients and what we can do to minimise any negative impact.
Following this, for any major service change we would undertake a public consultation in which we would describe the proposal, the benefits and how we believe it would impact patients. The public consultation would allow us to understand the views of patients and the public and consider them before making a decision on how services are delivered.
As described above, we received very positive feedback to the Trauma and Orthopaedics proposals as patient felt the benefits they would receive outweighed the additional ad-hoc travel and having surgery further from home in this case was acceptable. In the small number of cases where travel was a challenge we received suggestions for how this could be overcome and were able to include these in our proposal for the services.
Will the new Trust have a different name?
If our merger proposal is successful, the new merged Trust would require a name. At this stage we have not agreed what that name for the overall Trust will be but recognise its identity is really important – both to patients and our staff – and we would want this to be the starting point in our conversations regarding a name for the Trust.
Our current proposal is to develop a new Trust name for the organisation that will be responsible for managing the individual hospitals but retain the names of our hospitals, meaning they would still be called Aintree University Hospital, Broadgreen Hospital and the Royal Liverpool University Hospital and Liverpool University Dental Hospital.
This will be an important decision and we want to hear what staff and local people think before making a decision.
Has there been a purposeful lack of transparency in the process?
We are fully committed to transparency and continue to look at ways of ensuring that staff, governors, patients, their families and carers, as well as the general public, have a direct say in helping us to shape the future.
Conversations have already taken place with patients and members of the public regarding local hospital services as part of the Healthy Liverpool Programme and Shaping Sefton plan. There was a clear mandate from all involved for the benefits we aim to achieve. In fact many of the design principles for how we will bring services together have been based on this feedback. You can read more about the feedback here:- https://www.liverpoolccg.nhs.uk/get-involved
The Full Business Case is now being developed with engagement and input from staff, and wider input will be sought from governors, patients, the public and other stakeholders over the coming months. People’s views are very important to us and we will have a dedicated website/web-zone on the merger which brings together all the key information and provides everyone with a chance to have their say and give us valuable feedback. We are also planning to attend a wide range of meetings which involve patients, councillors, GPs, local MPs, our commissioner partners, Health and Wellbeing Boards and Healthwatch organisations, to help share information and hear what people have to say about how we are progressing.
We are also open to any invitations from community groups and organisations who would like us to attend their meetings.
Any proposed service changes will follow all required consultation processes for patients, the public and staff.
Will the new Trust lose Foundation Trust status?
The merged organisation will retain Foundation Trust status. Having Foundation Trust status is important as it allows the Trust more control over finances and we will retain this for the new organisation.
What is the risk of regulators stopping the merger from happening?
With any proposal requiring approval by external regulators, there is always a risk it will not be given. However, all the evidence shows that our patients will be better served if we work more closely together. This “clinical case” for merger has such backing from our commissioners, local regulators and the public that from very early into the process we have had strong support for what we want to achieve with the merger.
To ensure we retain the support we’ve been shown and to reduce this risk of our merger proposal not being approved, we continue to be in regular communications with our regulators.
What are the benefits of merging the two hospitals?
Work to understand the patient benefits of the merger is ongoing and evolving but already our doctors, nurses and allied health professional have identified a significant number of potential benefits that include:
- Providing safer and more joined up care that is patient centred.
- Access to the very best services wherever a patient lives or is treated in the city,
- Improved care – single teams working across the city, treating more patients will ensure that staff have the best skills and patients get the best results.
- Access to cutting-edge technologies and experimental treatments, such as new drugs.
- Ability to attract and retain the best staff
- Better use of resources through less duplication
The full range of benefits will be described in the patient benefits case and the full business case.
What is the Council of Governors and how are they involved in the merger programme?
It is a statutory requirement that Foundation Trusts have a Council of Governors.
The Council of Governors is a valued and effective body, which advises trusts on issues that are important to patients, members and the wider community. It consists of elected public and staff members and appointed individuals who represent the Trust’s membership and other stakeholder organisations.
The Council of Governors provides challenge to the Non-Executive Directors on the performance of the Board. It is not responsible for the day-to-day running of the organisation but influences the Trust’s strategic direction and future plans, ensuring that the voice of members and partners is considered in the Trust’s decision-making.
Both Aintree University Hospital NHS Foundation Trust and the Royal Liverpool and Broadgreen University Hospitals Trust both have a Council of Governors. However, the Royal Liverpool and Broadgreen University Hospitals Trust’s Council of Governors operates in shadow form as the Trust is not a Foundation Trust. This means that, whilst they have the same role, they have no statutory responsibility.
Further information about each Trusts’ Council of Governors can be found by following the links below:-
The Council of Governors are involved in the merger process, specifically in the following areas:
- approving an application for merger
Governors will be asked to vote on whether they believe the Board of Directors has been through a comprehensive process in reaching its decision to merge and has obtained and considered the interests of members and the public as part of the decision-making process.
- approving a draft new constitution
- approving relevant Interim Board appointments
The Council of Governors for both Trusts will be involved in the above processes.
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