January 2012 - Sandwell & West Birmingham Hospitals

SWBTB (1/12) 286 (a)
with any of the short listed options however the work to describe medical staff rotas in detail
is ongoing and further analysis is required in relation to the potential impact on the General
Medical/Acute Medicine rotas.
In terms of nurse staffing levels it has not yet been possible to identify nationally
recommended ratios for stroke service and based on some internal benchmarks associated
with recent changes to Newton 1 and Newton 4 there may be a need for an additional £280k
or 6.63 wte (based on 83 beds - 33 acute and 50 rehabilitation) The required bed numbers
will reduce either as a result of catchment loss or through reduced length of stay (see
previous section) and if less beds are required these nursing staff costs will reduce. This can
be seen in the catchment loss modelling where at a high level it is estimated that 6 less beds
will be required with a 25% catchment loss and 12 less beds with a 50% catchment loss.
These are summarised in table 7.
Table 7: Impact on Staffing
Existing Bed
Numbers
Reduction of 6 beds
Reduction of 12 beds
WTEs WTEs WTEs
Medical staffing 0 0 0
Nursing 6.63 -1.82 -10.28
Total 6.63 -1.82 -10.28
Additional Cost/Saving (280) (17) 246
To date no detailed work has been undertaken in relation to revenue costs for Imaging. Given
recent investment it is assumed there is no additional Imaging revenue costs associated with
any of the short listed options. However the exception to this might be those revenue costs
associated with a second CT scanner at Sandwell if the Hyper-Acute Stroke Unit is located at
Sandwell Hospital especially if this is in addition to the two at City Hospital rather than a
replacement.
It should be noted that to date no detailed work has been undertaken for other staff groups
e.g. therapists.
8.4 Income and Expenditure Impact
Table 8 below summarises the results of the high level activity and financial analysis so far in
terms of the potential impact on income and expenditure. In summary given the higher
number of admissions at City if a % catchment loss is applied there is potentially a greater
loss of activity if the Hyper-Acute Stroke Unit is based at Sandwell Hospital, the difference in
income being a £93k greater loss if there is a 25% catchment loss and £186k if a 50%
catchment loss. However given most stroke patients are likely to present to hospital via an
ambulance the catchment loss assumptions need to be informed by the results of the
ambulance flow modelling currently underway.
When the impact on nurse staffing levels is considered the net financial impact is that all
options result in a cost/loss of income to the Trust with the differential between scenarios
remaining the same i.e. impact is greater if the Hyper-Acute Stroke Unit is based at Sandwell.
These changes require a funding solution and this is being addressed as part of internal
financial planning and the negotiations with commissioners regarding the implementation of
BPT (best practice tariffs) and other mechanisms necessary to secure affordability.
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