Annual Report and Accounts 2012/13 - Royal Devon & Exeter Hospital

1. Our Year
Royal Devon and Exeter NHS Foundation Trust
Annual Report and Accounts 2012/13
7
served us well for our winter planning,
though more remains to be done.
As stated elsewhere in this Report,
services were stretched at times over
the winter period, but not to breaking
point, as in some hospitals.
We now need to extend that
partnership approach more generally.
The RD&E has to deliver £17 million of
savings year-on-year. That’s a significant
sum of money. What’s more, we want
to deliver the savings whilst continuing
to maintain, or ideally improve, the
level and quality of services we offer.
It’s just not possible to keep taking
money out of services whilst costs and
demand are increasing.
Meeting the
challenges
First, we need to dispel the myth that
financial sustainability and high quality
clinical care are somehow divorced or
even in competition. To provide high
quality and safe clinical services we
need to employ sufficient high quality
staff to operate in a high quality
environment; we can only provide
high quality clinical care sustainably if
we as an organisation are financially
sustainable.
Second, we need to work hard to
make the system more efficient, not
only within the hospital walls but in
the wider system too - and not only
in healthcare but in social care also.
If we focus solely on making cuts,
for example by reducing the ratio of
nurses to patients, then the quality of
care will decline. And we have already
seen from the Francis Report the
unacceptable and tragic consequences
that can bring.
Third, we must start to have honest
debates as to how we will spend
increasingly scarce resources. In a
time of austerity, how do we balance
the attachment some people have to
existing facilities even where these
may offer less good clinical outcomes
or be delivered more expensively?
Choices will need to be made: if there
is willingness to maintain such facilities,
what other services will we then need
to reduce or stop? There are no easy
answers to these questions, but over
the coming years it is precisely these
trade-offs that will shape public debate.
In my view, it is best to engage in these
debates openly now to jointly develop
an approach that is right for the
communities we serve and avoid the
inevitable polarisation that can occur
once proposals are put on the table.
It is my opinion that the best way to
ensure a sustainable future for the NHS
is to take a whole-service and wholesystem
approach. If we allow clinical
leadership to configure truly integrated
health and social care services, then
the by-product will be improved
service, greater efficiency and financial
savings. Working more closely with our
colleagues in Clinical Commissioning
Groups will be a step towards this, but
we will need to go much further and
be bold in embracing radical service
redesign.
I am keen that the RD&E plays its part
in engaging with our communities,
through our Governors and
Members, to debate how we can
become more efficient and allocate
scarce resources to their benefit and
do so in an honest and transparent
manner. We must not allow denial of
the challenge to deflect us from dealing
with it and we must be clear on the
consequences of evolving policy, for
example in relation to competition.
We are very fortunate at the RD&E that
we have great clinicians, leaders and
support staff, the vast majority of whom
are completely focused on doing their
best for our patients each day.
During my tenure as Chairman, I
intend to work with our staff, partners
and stakeholders to find innovative
solutions and new pathways that
will deliver the sustainable future
our patients deserve. There will be
many bumps along the road but I am
confident that we will be able to look
back with pride on how we achieved
much more for less to the benefit
of our communities, staff and other
stakeholders.
James Brent
Chairman
We are very fortunate
at the RD&E that we
have great clinicians,
leaders and support
staff.