Star turn for York Hospital

:: York Hospital

THE main consequence of York Hospital regaining its coveted third star in the annual health performance ratings is that it is now back on track to gain foundation hospital status.

The hospital was all set to apply to become a foundation when, a year ago, it was tripped up over cleanliness and bed blocking. This meant it dropped to a two-star rating and so was no longer eligible to apply.

That barrier has now been removed. So is foundation status now inevitable, and what would it mean for patients in York if the hospital decided to go down that route?

No final decision has yet been taken, the hospital's chief operating officer Mike Proctor said. The question of whether to pursue foundation status will, however, be high on hospital bosses' agenda, with a decision likely to be made by September or October at the latest.

There could be a number of advantages to going down the foundation route - not least for patients in York.

When he took over at the hospital almost two years ago, chief executive Jim Easton was full of enthusiasm.

There were three key benefits to foundation status, he said then. It would give local people a greater voice in the running of the hospital. It would unlock access to private funding for much-needed redevelopment. And it would make it easier for the hospital to recruit and retain quality staff.

None of that has changed in the past two years.

Foundation hospitals remain part of the NHS. But if it were to become a foundation, York Hospital would effectively be taken out of direct Whitehall control and into the ownership of the local community. Local people who are interested in having a say on the hospital's future would become members of a York Hospital Foundation Trust. They themselves would appoint a board, which would in turn appointment a chairman and chief executive.

And the advantages of such a system? Speaking back in 2003, Mr Easton said: "I would place my trust in the community of York and Selby more than Whitehall to guide the future of this hospital."

One of the key benefits, Mr Proctor said this week, would be in the hospital's ability to respond to local health needs rather than simply conforming to nationally laid-down health policy. A lot of health policy was formulated by people with an "M25" mindset, he said. Being able to choose which hospital you go to for treatment might be relevant for people living in London, who have a number of hospitals virtually on their doorstep. It is less relevant, however, for people living in a small city such as York, which has only one NHS general hospital. "So what people here want is for their own local hospital to be as good as it can possibly be," he said. Being a foundation trust would help that, because it would give the hospital greater autonomy to identify local health priorities.

Another advantage would be that it would make it easier to consult with patients over what their priorities are, with a ready-made body of people - the Foundation Trust members - keen to take a more active role in the management of their hospital.

All the signs are that York people are eager to take on such a role. After a consultation and mail shot a year or so ago, when foundation status was being actively pursued, 15,000 people applied to be members of a York Hospital Foundation Trust - one of the highest levels of interest in the country.

The other main potential benefit of going down the foundation route is the possibility of unlocking private-sector cash. The ageing hospital was built on the cheap in the 1970s - and it is in constant need of upgrading and redevelopment.

The most urgent need at the moment is to upgrade the ward block. It is too small, and not up to the standard patients should be able to expect in the 21st century, Mr Proctor admitted. There are not enough single rooms, and many of the wards are 'through-routes' between one part of the hospital and the next, so there is not enough privacy or quiet.

Hospital chiefs recognise this - but estimate it would cost between £60m and £70m to do the job properly.

Even breaking this down into phases over five years, it is still a lot of money - and at the moment, it is unlikely the hospital could persuade the Government to give it the money it needs.

Being able to get access to private-sector cash at market interest rates, however, would offer a "ray of hope" that a revamp of the wards could be undertaken more quickly, Mr Proctor said. And it needn't mean putting the hospital's future in hock, the hospital's financial director Patrick Crowley insisted. The money would be borrowed through an NHS scheme, and there would be strict controls and limits to ensure hospitals didn't get in over their heads.

If it meant York patients getting the wards they deserved, it might well be worth it.

:: Big improvement in cleanliness

How did York Hospital fare in the latest ratings.

Overall: three stars - making it one of the top-performing hospitals in the UK

The hospital met all its key targets in:

A&E waiting times

Cancer waiting times

Non-urgent waiting times

Financial management

Hospital cleanliness

Outpatient booking

Outpatient waiting times

uTotal time patients spend in A&E

The big area of improvement was in hospital cleanliness. As the Evening Press reported earlier this year, the hospital has made huge strides in terms of hygiene over the past year, piloting a 'clean-hands' campaign to urge all staff, patients and visitors to wash their hands regularly with handy, bedside alcoholic gel to reduce the spread of hospital-acquired infections and bugs.

From next year, it plans to ditch contract cleaners and take the responsibility for keeping wards clean in-house. At the same time, it will almost double spending on cleaning, from £1.2 million to £2 million a year.

:: Selby and York Primary Care Trust

The primary care trust manages every aspect of non-hospital health care in the York and Selby area.

That includes GPs, dentists and district nurses, as well as mental health services and things such as stop-smoking clinics.

The fact that the trust's performance rating has plunged from three star to one star since a year ago is clearly not good news. It doesn't mean all York's GPs, dentists and community nurses have suddenly become bad at their job.

Far from it. In terms of things such as cervical screening, treatment of cancer and heart disease, screening of diabetics for eye problems, flu vaccinations and child protection, the primary care trust provides some of the best services in the country.

"I wouldn't go anywhere else than York to get my health care," says chief executive Jeremy Clough robustly.

"We have great primary care services, a really good hospital, and specialist facilities nearby in Leeds for those who need specialist care."

There are two reasons for the trust's comparatively poor performance this year - and both are very specific.

First, its financial management. The trust "significantly underachieved" here - an indication that it has big cash problems.

A year ago, says Mr Clough, the trust overspent by about £6.6 million. This year, that overspend is projected to rise to more like £24.4 million. It has been seriously marked down because of that.

But the reason for the overspend, says Mr Clough, is the trust has been referring more people to hospital more quickly to meet the Government's targets on waiting times - so nobody has to wait more than six months for a hip operation, say, or more than 13 weeks to get an outpatient appointment.

It is effectively paying the price for doing its job well, in other words. Easing back on waiting times isn't an option, says Mr Clough - so the only way of really trying to balance the books will be to try to reduce the number of people who need hospital treatment in the first place.

The trust has already become one of the first in the country to introduce new "community matrons" - senior district nurses who visit patients in their homes and help them receive a range of treatments at home rather than having to go into hospital.

But it may also be necessary to cut back on the number of people who receive hip operations, for example. Where appropriate, alternative methods of treating them - such as physiotherapy, or shoe inserts to relieve pain - may have to be looked at, says Mr Clough.

The trust also - just - failed to meet its target on the number of people helped to stop smoking. This is surprising given the number of high-profile campaigns it has been running, and the fact it has, for several years, run a number of successful stop-smoking initiatives, including group clinics held throughout the area and even one- on-one sessions.

"They helped me without a doubt," says Bob Cook, a former Army sergeant-major who gave up smoking three years ago with the help of a group clinic run by the trust.

"The smoking group was extremely helpful, very focused and extremely supportive."

In fact, the trust last year actually increased the number of people using its stop-smoking service by 40 per cent - from 870 to more than 1,200. With smoking being one of the main contributors to ill health, however, the Government wanted trusts to double their stop smoking success rate. So, even a 40 per cent increase wasn't good enough.

The performance of mental health services - which are also, in York, run by the primary care trust - are assessed separately. Mental health services in York and Selby also received a one-star rating this year.

This time, there was one factor to blame - finances. Unfair, says Mr Clough - because since the service is run by the primary care trust, the finances that were assessed were those of the trust itself.

A case of being penalised twice for the same failing. On every other indicator, the mental health service met its target.

:: How the trust and York's mental health services fared in the ratings

THEY both received one star for overall performance - putting them well down the league table of services.

Despite this, the primary care trust met six out of eight key targets. These were:

Access to a GP

Access to a primary care professional

Drug misusers accessing treatment

Waiting times for non-urgent patients

Outpatient waiting times

Time spent in hospital A&E

The trust failed to meet its targets on:

Financial management

Helping people quit smoking.

The mental health service also failed on financial management. But it hit all its other key targets.

Updated: 09:07 Thursday, July 28, 2005