The chief executive of Ipswich Hospital has called for people to show the same passion about saving the NHS as they have for keeping the Great British Bake Off on the BBC.

%image(15350289, type="article-full", alt="Nick Hulme. Pic: Colchester Hospital.")

In a wide-ranging exclusive interview with the EADT, Nick Hulme questions whether people who have suggested paying £2 extra on the licence fee to stop the baking show from moving to Channel 4 would be prepared to pay more for the health service.

His comments come as the NHS faces unprecedented financial pressures, with huge debts expected to rise this winter.

He also raised the prospect of patients having to travel up and down the A12 for appointments as part of a new shared services plan which is gathering pace.

He also said the historic junior doctors’ strike will cause “untold” disruption to thousands of patients in Suffolk and Essex and called for it to be cancelled.

%image(15405662, type="article-full", alt="File photo dated 05/07/13 of Health Secretary Jeremy Hunt who is willing to "pause" the introduction of the new contract for junior doctors for five days to allow further talks, peers have been told. PRESS ASSOCIATION Photo. Issue date: Thursday May 5, 2016. Health minister Lord Prior of Brampton said Mr Hunt would be writing to the Academy of Medical Royal Colleges (AOMRC) later this morning. See PA story HEALTH Doctors. Photo credit should read: Neil Hall/PA Wire")

But he also revealed how Colchester General Hospital met, for the first time in 17 months, the weekly four-hour target for treating A&E patients.

Mr Hulme, who has been chief executive of Ipswich Hospital since January 2013, was unveiled in May as the latest chief executive of the embattled Colchester Hospital University NHS Foundation Trust.

He is the fifth chief executive in the last two-and-a-half years at the hospital, which has been in special measures for over two years and was criticised over poor leadership, care standards and staffing levels.

%image(15405663, type="article-full", alt="Colchester General Hospital.")

Tax hike

The public should seriously consider paying more tax to help the NHS manage the growing cost of health care, Nick Hulme said.

He told this newspaper: “There are some aspects of health care that we don’t believe add benefit to patients or indeed, we are prepared to have a conversation and say that is something we can’t offer anymore in the NHS. I was reading a blog about Bake Off and somebody had suggested that people would be prepared to pay an extra £2 on their licence fee in order to keep Bake Off on the BBC.

“It’s interesting that they were prepared to do that. I just wonder if we have the same conversation about an extra 2% of income tax – would they be prepared to do that to invest in the NHS? The public would need the assurances that every penny is being well spent.”

He added: “The NHS is under unprecedented pressure. We have seen a significant change in the demographics of patients at A&E. We have seen a 6% increase in the first quarter nationally and that has been even higher locally – 10% across Ipswich and Colchester.

“We are seeing older, sicker patients with complex conditions. The NHS was designed when the life-expectancy in Suffolk was 67. It is now 87, and I think what we haven’t done is redesign services, reallocate resources to accommodate or to recognise the change in the profile of patients.

“There is more that we can do in the hospital in terms of efficiency and productivity – we need to invest more in IT – to make sure staff are not spending all their time doing paperwork. We need to make sure that doctors are not doing work that nurses can do, or healthcare assistants or therapists.

“There are many people I am sure who come to hospital for a follow-up appointment or an outpatient appointment and leave thinking ‘Well, what was the point of that? … all they do is give me information that they could have given me over the phone’.

“But even if we completely redesign our services and become very efficient, we are still going to have, I think, a financial gap, and that requires having a conversation with the public about their willingness to either pay more through taxation or having a conversation with the public about what is the health service that we can afford. What is the health service we want to pay for?”

Shared services

Mr Hulme said: “Clearly there are massive workforce challenges. Neither hospital is financially or clinically sustainable in the long term. The joint deficit across both hospitals is over £60m this year, so clearly there may well be opportunities in terms of either clinical or non-clinical services working differently, coming together to address some of the workforce issues, to make sure that if there is real pressure on services on both sites, is there an option for running out of one site?

To look at our back office functions or non-clinical functions to see whether or not any merging of those services will allow us to release cost and make ourselves more efficient.

“We haven’t got any clear plans yet about what clinical reconfiguration might look like and there certainly is the possibility going forward, obviously following all the normal regulation and consultation and discussion with the public, that patients may have to move between the sites. So, people who currently receive some care in Ipswich may go to Colchester and vice versa.

“But it is incumbent upon me to make a really coherent argument and get the narrative absolutely right to explain to the public that either by travelling a bit further you will get a better outcome, or you will get a quicker service, or better access to diagnostics, rather than just saying we are doing this purely for financial reasons.

“If you have to wait six weeks for a procedure at one site but you can get it done in three weeks if you travel up and down the A12, the half-hour from one hospital to another, then I think that people may be prepared to travel.”

Junior Doctors’ Strike

Junior doctors were in the High Court yesterday in a bid to block the Government’s decision to introduce a new contract.

They claim Health Secretary Jeremy Hunt is seeking to impose “unsafe and unsustainable” terms and conditions as he presses ahead with controversial plans for seven-day NHS services.

The dispute has already led to thousands of operations and appointments being cancelled since strikes started in January.

Next month, when the new contract is due to be introduced, thousands of junior doctors are planning the first five-day walk-out.

Mr Hulme said: “It is a huge disappointment that we have got ourselves in a position where junior doctors feel so frustrated that they feel their only option isto take this very drastic action which will have a huge impact on patients. The amount of disruption five days of striking will cause is untold.

“Waiting times will also increase and the commitment to see patients within 18 weeks will be a severe challenge.

“So my plea would be for the junior doctors, for the BMA and for the government is to do everything in their powers to ensure this strike doesn’t go ahead, because it will be extremely disruptive for patients.

“There (has been) a lot of hearsay and claims. I think social media has driven a frenzy… I don’t think anybody walks away from this with any sense of honour.”

Colchester General Hospital

Colchester General Hospital has been one of the worst hospitals for treating A&E patients in the country for the last few years.

But earlier this month it met the crucial A&E target for the first time in 17 months. Some 95.6% of Type 1 emergency A&E admissions – the most severe cases – were seen and either treated or discharged within four hours between September 5 and 11. The week before it was 74%. The number of patients was broadly the same.

Mr Hulme said: “Patients were staying in hospital for longer than they needed to be, and the red-to-green is something we developed at Ipswich which has now been picked up by many, many hospitals across the country: we concentrated the whole hospital for one week to unblock those delays – those stoppages – across the organisation, which meant that we freed up A&E at the front door.

“We didn’t do anything particularly different. There is no rocket science involved in this. We didn’t open new wards. We used our existing resources and our existing staff, but differently

“The hospital has felt very different (in the last two weeks) because people realise that they can make a huge difference. There is more confidence now.

“We have been in the bottom 10 hospitals for most of the last 12, 18 months. It is only one week, and a lot of the staff said ‘is this sustainable?’ I said that is entirely up to you. You delivered this. You’ve done this. Nobody else has come in and done this for you.”

He added: “It’s been good to spend the last four months understanding more about the organisation. There is no doubt the organisation faces significant challenges. I’ve witnessed some concerning care and I have spoken to patients who have had poor care.

“But we are working, with external support, to really drive up the standards. New structures and people in place will give myself and the board, but most importantly the public the assurance, that Colchester is on the road to significant improvement.”

Winter Pressures

The weather will be a huge factor… If we get a flu pandemic and the weather is particularly cold, then clearly we are going to be under more pressure, and even with the best planning in the world and all the contingency plans we will develop, we are still going to be under significant pressure.