Appendix 2

HEALTH AND SOCIAL CARE TRUST

LISTENING EXERCISE: AUGUST – SEPTEMBER 2004

Purpose

Following the public meetings of the three organisations in July of this year, it was agreed that a “Listening Exercise” should be undertaken with staff and other stakeholders to give them the opportunity to learn more about the proposed options and to give their opinions.

Programme of meetings

The following meetings were arranged in a variety of venues across the Island to enable the maximum number of staff to attend. The sessions were led by either Graham Elderfield, David Crawley or Glen Garrod.

16 August 11.30 – 12.30 St Mary’s Hospital

18 August 12.00 – 1.00 Arthur Webster Clinic, Shanklin

26 August 3.00 – 4.00 Brookside Health Centre, Freshwater

31 August 12.00 – 1.00 East Cowes Clinic

2 September 9.30 – 10.30 Ryde Social Services

3 September 9.30 – 11.00 County Hall

7 September 12.00 – 1.00 Riverside Centre, Newport

9 September 10.00 – 11.00 Lake Clinic

10 September 12.30 – 1.30 St Mary’s Hospital

16 September 10.00 – 11.00 Whitecroft

Communications

The events were advertised primarily to staff through a variety of communication mechanisms including the respective intranets, emails, team briefs, posters and reminders.

Structure of meetings

Each session began with a brief presentation giving the background to the PwC report and the purpose of the Listening Exercise. The presentation was followed by a question and answer session. Staff were also encouraged to feedback via a reply slip and these responses (11) are included in the summary.

Attendance at meetings

Approximately 180 people attended the sessions – these included staff from the three organisations, representatives from the Patient Forums, elected members and union representatives.

Summary of issues raised

a) Human Resources

Questions in relation to staff terms and conditions featured at all the sessions. The need for an agreed organisational change policy to be used by all three organisations was highlighted. Concern was raised about the three different organisations having different terms and conditions of service and how these would be resolved over time. A common theme was the scale of any possible redundancies and fears about future job security.

Specific questions related to the “support” functions such as HR and IT, how they would be integrated and whether there would be job cuts.

Concern was raised over the constant changes taking place within the organisations and the impact on staff including whether there would be a period of stability following the establishment of the new trust.

Other questions included whether there would be any compulsory redundancies, how any redundancies would be handled, what the system for transferring staff would be and if staff would have to move offices.

Staff asked what would happen to any ‘displaced’ chief executives and senior managers, and what future pension arrangements were likely – would pensions be transferred or continued.

b) The new organisation

There were a number of questions raised regarding how the new organisation would be structured, particularly in relation to which sections of housing would be included. It was felt that there was a risk of an imbalance in the new organisation as it could be dominated by health – would they all be equal partners?

The structure of the new Board was questioned in terms of local representation and the balance of elected to appointed members. The appointment process for Chairman and Chief Executive was also raised.

Concern was expressed about the very different cultures within the existing organisations and how these could be integrated in the new trust.

The need to preserve professional integrity featured at most sessions and the concern about being absorbed into a “huge faceless organisation”. It was also questioned whether the provision of seamless care could be achieved without the disruption associated with the creation of a new organisation.

Staff voiced frustration at the lack of compatibility between the current IT systems and questioned whether this would be resolved before the new organisation was in place.

The need for good communication was raised, as without this it was easy for rumours to spread across the organisations. The effect on health and social care teams was also questioned, although it was acknowledged that there is currently some duplication and overlap.

c) Children’s Services

A common theme at each session was how Children’s Services fitted into the proposed new organisation, particularly in relation to a potential Children’s Trust. The viability of the remaining Council services was questioned if a Children’s Trust was created.

d) Commissioning

There appeared to be a general lack of understanding about the role of commissioning and how this would fit into the new organisation. One of the questions was whether any other organisations were doing something similar and what we could learn from their experience. If commissioning remained an integral part of the new organisation, staff wanted to know how it would work in practice. Other questions included commissioning as a separate organisation, how this would function and the associated risk of losing commissioning to a mainland organisation.

How commissioning and public health would work together and whether public health would be strengthened in the new organisation was also questioned.

e) Governance issues

A number of issues were highlighted in relation to governance and accountability including the structure of the new Board, the scrutiny function, the need for legislation to create the new organisation. Other questions included the potential conflict of interest if commissioning is included in the new organisation and the need to ensure probity.

f) Professional identity

The need to ensure that professional identities were protected and respected was identified and there was a strong feeling that individual professions should be represented and heard within any new organisation.

g) Finance issues

The issue of financial stability was a key focus for questions, including if the proposals had the support of the government and whether they would help support the creation of the new organisation.

The current financial situation of the health organisations was of some concern to staff, who felt there was a danger the new organisation would start with a deficit. Another possible issue was Council Tax payers having to support a potential shortfall in the health sector.

The mechanism for bringing together budgets was another area where there was uncertainty as funding comes from different sources with different performance targets.

There was a belief that the creation of a new organisation could result in savings by reducing duplication and streamlining services. However, it was important to staff to understand how these savings would be used – would they be reinvested in Island services?

h) General issues

The new government models of working together in a community setting was raised in particular having one multi agency centre in local areas. This included looked at existing assets and the best use for these.

The size of the project and the resources required to deliver it were felt to be beyond the capacity of existing senior managers and it was questioned whether there would be external project management support.

The proposed time scale for the creation of the new trust was felt to be ambitious given all the other changes that were currently underway.

The need for public consultation in relation to any proposed changes was stressed.

The government’s current drive for foundation hospitals/trusts was seen to be potentially in conflict with this proposal.

Conclusion

The Listening Exercise has been successful in terms of gaining staff views and raising their awareness of all the issues involved. The sessions aimed to be informal and relaxed to enable staff to express their views and air their concerns. Each session lasted at least an hour and a wide variety of questions were raised. The opportunity was taken to discuss a range of associated issues in depth which staff said they appreciated.

Staff were informed that there would be further opportunities to make their views known as the project developed.

The overall view is that staff are not opposed to the concept of a single organisation on the Island although there were obviously some concerns in terms of employment, structure, finances and culture. It was felt generally that this was the best way forward particularly as professionals were already working closely together and this would enable the development of truly integrated services. There was a strong feeling also that this gives the Island the opportunity to shape its own destiny.

Stephanie Light -Communications and PR Manager, Isle of Wight Council

Viv Bennett - Communications Manager, Isle of Wight Healthcare NHS Trust

David Barker - Corporate Business Manager, Isle of Wight Primary Care Trust