1. Responding to the
challenge of delivering
high quality, safe patient
care in a small hospital
Susan Acott
Chief Executive
Dartford & Gravesham NHS Trust

2. Dartford & Gravesham NHS Trust
 Whole site PFI
 High % of fixed costs
 Greater % of activity from NELIP
 Emergency tariff
 Difficulty in recruiting & retaining skilled
staff (no London weighting)
 Low appetite for risk
 Tiny surpluses
 Difficulty maintaining rotas
 Few trainees

3. Why is my small Trust valuable?
 Fantastic culture
 Very efficient by any metric
 Patient focussed
 Committed clinicians
 Innovative and agile
 Can do
 Team – we know each other - grip!
 It is here when needed
 Local
 Value for money
 ACCESS…………….under estimated value

4. How have we survived so far?
 Unrelenting cost control
 QIPP
 Decommissioned or offloaded specialties we
could not make work (Rheumatology)
 Jumped into network solutions where we
might retain a stake (pPCI, CA)
 Gave up clinical ownership & converted to
landlord (ENT)
 Transferred services to community (GUM)
 Repatriate work from London (EBUS, Renal)

5. Survive rather than thrive

6. The Strategy

7. The Department Store Model
 We provide the core services and
infrastructure
 Enter into franchise or network
arrangements with tertiary providers
 Act as Landlord for other secondary
providers
 Enable local provision
 Plan to provide out of hospital ‘local’
services
 Better Care Fund

8. Why?
 Patients who are ill, frail, rural, don’t
drive, have children, other
dependants……….LOCAL has real value
 Health Inequalities
 My Trust is a PFI – has to be paid for!
 Cost of reprovision

9. Let’s be more creative!
 We may or may not make it as an
independent Trust
 But we are determined that our hospital can
show that it has a valuable role which can
meet most of the needs of the local
population
 Whole system planning is needed to make
the best use of local facilities, commitment
and culture
 Chains may have some value but lets stop
the talk of failing Trusts

10. Waving not drowning