Visit to the Wye Valley NHS Trust – 29th March 2019

Wye Valley NHS Trust (“WVT”) is the provider of healthcare services at Hereford County Hospital, which is based in the city of Hereford, along with a number of community services for Herefordshire and its borders. It also provide healthcare services at community hospitals in the market towns of Ross-on-Wye, Leominster and Bromyard (but not Ledbury which is run by Shaw Healthcare).

The Trust provides acute and community healthcare but not mental healthcare which is provided by 2gether NHS Foundation Trust which covers Gloucestershire and Herefordshire.

The Wye Valley NHS Trust faced some considerable challenges and was put into special measures. In 2017 a “Foundation Group” was formed between South Warwickshire NHS Foundation Trust and  WVT whereby the former mentored the latter. In 2018, the George Eliot NHS Trust in Nuneaton joined the group. Glen Burley is chief executive of the group with Jane Ives, who we met and who gave us a tour, being managing director of the WVT.

Hereford Hospital was built under a PFI contract (Private Finance Initiative using private money to pay for the upfront costs of design, build and maintenance) . This is not the place to argue the merits or otherwise of PFI apart from pointing to their lack of flexibility. The central problem with the Hereford Hospital PFI contract was that there were simply not enough acute beds, with knock on effects on Accident and Emergency and elsewhere. This requires more money to solve. The structure of  the NHS has made this difficult (Foundation Hospitals can fund capital projects from different sources other than applying to the Department of Heath but WVT is not a Foundation hospital and while it had problems cannot be – a Catch 22). The good news is that being part of a “Foundation Group” – the inverted commas signifying that this is an innovative structure, is making it possible to apply for funds. Some of the wards date back to the last war and were built for the Canadian Army. There is funding and a timetable in place to replace these wards and increase the number of acute beds.

There has been a repeated theme that we have observed in regulated institutions. When they get a poor inspection, part of the solution to which is clearly capital funding, that funding is not available. Meanwhile, the media have a field-day blaming management. The public and media need to be rather more sophisticated in their analysis. Hopefully, the WVT have broken out of this funding trap using their partnerships and we can look forward to more improvements to those which have already been made. We were very impressed by the “can-do” approach that we saw.

Another example of the trap is the need to use expensive agency staff because there is not enough accommodation for in-house staff. There is a clear plan to deal with this with an major upgrade of the accommodation. This would then free up funds for other benefits – a virtuous circle. Let us hope that the capital funding is made available.