Agenda item

The Committee will hear from Mr N Macdonald, Chief Executive, Buckinghamshire Healthcare NHS Trust on the key challenges faced by the Trust and the impact on services as well as the Trust’s key priorities over the next 12-18 months.



Mr N Macdonald, Chief Executive



Report attached


The Chairman welcomed Mr Neil Macdonald, Chief Executive, Buckinghamshire Healthcare NHS Trust, to the meeting. Before introducing his report, Mr Macdonald welcomed any new or existing Select Committee Members contacting him separately to arrange seeing some of the health services provided in Buckinghamshire.


The Trust was operating under challenging circumstances. The NHS was busier than ever, which was unusual for the time of year. This was, in part, due to pent up demand during the pandemic which led to a local and national backlog of work and waiting lists. The current third wave of Covid-19 was continuing to impact current services and limited areas the Trust operated in.


A key priority was the Trust’s workforce and the impact Covid had had on the staff wellbeing. It would take time to address these issues and it was expected some staff would leave the profession due to the impact of the working during the pandemic. The future pipeline of people entering the healthcare profession through higher education was at its highest level which would take 2-3 years to come through.


The Trust was also working on its future Clinical Strategy which would be available later this year. There were challenges around infrastructure at sites in High Wycombe and Stoke Mandeville, and a programme would be put together to update these sites and address other future challenges, such as capacity and population increase.


Following this introduction, the Committee raised a number of points:


·       Members thanked the work of the Trust’s staff throughout the pandemic.

·       Community hospital sites, which were central points for community based health and social care, were important and appreciated by the Trust. There was outstanding work to be done at the community hospitals in Marlow and Thame. The Chartridge inpatient ward had been closed due to CQC conditions imposed around staffing levels and would reopen as an inpatient ward in late-August.

·       The Trust had a net loss of staff originating from the European Union. It was suspected this was due to the travel restrictions introduced during the pandemic rather than Brexit. There were no legislative barriers to recruit overseas with extensive national NHS campaigns in India and the Philippines. Buckinghamshire had recruited a cohort of nurses from India over the past 2-3 months.

·       The NHS 111 service was best placed to advise patients of the correct service pathway. The A&E service was built to facilitate people’s need through providing A&E GP services and nearby pharmacies.

·       Stoke Mandeville’s A&E site required redevelopment and a new A&E Pediatric Department was being built which would alleviate short term capacity issues. Generating capital was a challenge for the Trust which made hospital redevelopment difficult. Currently, the only source of additional capital for infrastructure improvements was from the national Hospital Improvement Programme which had a competitive process.

·       Primary care had processed the most appointments than ever before in the past six months however demand was still incredibly high. Most workforce investment was taking place in primary care networks (e.g. pharmacists and therapists). The Chairman noted that posts and recruitment could also be considered as part of a review of PCNs by the Committee.

·       The Trust followed best practice of working with multiple universities, such as University of Bedfordshire, Bucks New University and Oxford Brookes, to recruit its nurses. This increased the robustness of the recruitment supply chain. Routes into nursing included higher education, nursing associates and nursing apprenticeships.  The Buckinghamshire Health and Social Care Academy, which was a partnership between the Mental Health Trust, the Healthcare Trust and Buckinghamshire Council, was progressing well despite the pandemic and offered opportunities to join and support the profession.

·       The Wycombe Birth Centre was a valuable anchor-point in the community and was due to reopen in December 2021. The birthrate in Buckinghamshire had remained steady and there had been an increase of midwifery applicants. Additionally, all midwives trained by the Trust last year had been retained by the service. The Trust acknowledged the importance of continuity of midwife care which was a recommendation in the Ockenden report.

·       Use of the private sector had always taken place as part of the Government’s agenda to offer patients choice. A long-standing contract was in place with BMI at the Chiltern Hospital, Great Missenden, and Shelburne Hospital, High Wycombe, which would assist with reducing waiting lists. It was estimated that the waiting list for admitted procedures was around 7,000, and the total waiting list, including outpatients and diagnostics, was around 30,000.

·       New models had been designed in the Ambulance service to maximise space for offloading to safe areas. This was developed due to the pressures caused by the second wave of the pandemic.

·       A Member was concerned about the impact of increasing demands on the service and patient outcomes alongside upcoming changes to the ICS. However the pandemic had led to the Trust having more data about its population, such as future healthcare needs, and developments in digital transformation in the hospital network.


The Chairman thanked Mr Macdonald for the update and for answering questions from Members.

Supporting documents: