FAQ

Why are NDHT and the RD&E making plans to become a single integrated organisation?

This is the next step in a long-standing partnership between the two organisations and is the logical progression to ensure that services in both Trusts can be strengthened and made more sustainable. The RD&E has supported the delivery of acute services in Northern Devon for several years through clinical networking arrangements to ensure patients in Northern Devon have local access to specialist care. In June 2018, this arrangement was strengthened as part of a Collaborative Agreement which supported NDHT to address some of the challenges faced in providing acute services from the most remote hospital in mainland England.

Our experience shows that the Collaborative Agreement has been of benefit to both Trusts and has underlined what could be achieved through formally strengthening our partnership.

The RD&E is motivated to support NDHT from a desire to play a full role in supporting improved patient experiences of care and performance across the area served by both Trusts in Devon It also aims to prevent provider or service failure which would have a negative impact on the RD&E and importantly the patient and their families. It is also clear that NDHT has developed a culture of innovation and agility that would benefit the RD&E and their stakeholders.

As one organisation, we will enhance how we collaborate both in our strategic planning and day to day operational delivery. Bringing the organisations together within the SEND (Southern, Eastern and Northern Devon) acute care network presents opportunities to improve resilience and local access across Northern and Eastern Devon.

Why can’t the Trusts just carry on informally supporting each other through partnership-working?

The Collaborative Agreement has been successful in ensuring a significant improvement in leadership, clinical engagement, quality and performance at NDHT. It is also clear that it has benefitted the RD&E through learning from NDHT’s agility and innovation.

The Collaborative Agreement between the Trusts has given both Boards a sense of confidence about the benefits working more closely together can achieve for patients across Northern and Eastern Devon.

The Boards came to the view that it was only through becoming a single organisation that many of the barriers to collaboration and problem-solving would be reduced and good practices transferred more easily.

Why has this been announced now?

This has been announced now because towards the end of December 2020, the Trusts received formal feedback from the regulators NHS England and NHS Improvement in relation to the Strategic Case document This formal document signalled the organisations’ intent to join together and set out the benefits this proposed merger would provide for patients, staff and their local communities. This Strategic Case was agreed by both Boards in November 2020 and submitted to NHSE/I for review.

The approval to proceed from NHSE/I means the organisations can now proceed to develop an Integration Business Case which will describe in more detail how the two organisations could become a single integrated organisation working across Northern and Eastern Devon for the benefit of both communities.

This will now take place over the coming months and NHSE/I will support us through this process.

Why are you doing this at the time of a global pandemic?

It is important to recognise that this is not a sudden decision that has been taken during the pandemic. The two organisations strengthened their partnership in 2018 through the Collaborative Agreement, and in December 2019, both Boards agreed to explore joining together on a more formal basis.

Throughout 2020, the Trusts continued to work in partnership and developed a Strategic Case, detailing the benefits joining could have for staff, patients and our communities. The organisations worked together in response to the pandemic and this experience has further strengthened our partnership. The Boards have ensured that sufficient management capacity will be allocated to the next stage to ensure we can do this without negatively impacting the response to the pandemic and our ongoing services.

The approval of this Strategic Case by NHSE/I represents the next step in our partnership journey.

When was the decision made to join RD&E and NDHT?

At the end of 2019, the NDHT and RD&E Boards separately agreed that the two organisations would explore joining together on a more formal basis, on the premise that any new arrangement benefits all communities served by both Trusts and is supported by NHS regulators.

A Strategic Case setting out the potential benefits of integrating for our organisations, staff, patients and local communities was submitted to NHSE/I in October 2020. NHSE/I have now approved this Strategic Case, which means we can move ahead on developing a detailed business case describing how we could establish a single organisation across Eastern and Northern Devon.

Are we asking for any support to ensure this is a success?

Both Boards agree that this needs to have the full support of our regulators as we proceed and includes recognition of and support for three key enablers to help facilitate the potential integration. These are: supporting the creation of a single digital platform between the Trusts, progressing NDHT’s infrastructure programme (titled ‘Our Future Hospital’) and formally recognising within the acute contract in Northern Devon the rural subsidy required to support 24/7 services from the most remote hospital in mainland England.

How much money are you hoping this will save?

The proposal is driven by clinical need and patient benefit, rather than the financial case, so there is no specific plan to save money. However this is likely to be made as a result of the integration and would be an added benefit.

Will the RD&E be paying off NDHT’s debt?

No. Both Boards are clear that this process must be based on the premise that any new arrangement helps people in all the communities served by both Trusts. It is therefore important that this doesn’t have a negative financial impact on the RD&E. The integration must be fully supported by the NHS regulators and this includes recognition of and support for three key enablers to help facilitate the integration.

How long will this process take?

The go-ahead from NHSE/I marks the start of a 14 month programme of work to plan how we integrate, with an aim of submitting a Full Business Case by Autumn 2021 and becoming a single organisation from April 2022. The Full Business Case will need to be formally approved by the Board and by the regulators and have the support of the RD&E’s Council of Governors.

Does joining together NDHT and RD&E mean you’re going to close North Devon District Hospital or the A&E?

No. North Devon District Hospital serves a population of 175,000 people in North Devon and Torridge. More than a quarter of its patients are coming from further afield on the Cornish and Somerset borders, or are tourists to the area.

North Devon District Hospital (NDDH) is included within the Government’s New Hospitals Programme, which is an important vote of commitment. It is likely to be the most significant investment in healthcare infrastructure for the population of Northern Devon since NDDH opened in 1979. This comes on the back of the Acute Services Review for Devon which confirmed in 2017 that urgent and emergency care and maternity services should continue to be provided at NDDH.

Both organisations face many of the same challenges, particularly in relation to ensuring we have enough staff. We believe that joining will allow us to be stronger together and will enable us to make the best use of our collective resources to sustain and improve services for our communities.

Will we have to travel to Exeter for treatment in future?

Our aim is to ensure North Devon provides as many local services as it is safe to provide. As the most remote district general hospital in mainland England, there is universal clinical, commissioner and stakeholder agreement that the population of Northern Devon need local access to urgent and emergency care at NDDH. As well as an A&E this also means a local presence of trauma, ICU (in full), acute medicine, acute surgery and maternity services.

Patients have always had to travel to Exeter, Plymouth or Bristol to access certain specialist care, such as complicated heart surgery, and. this will not change as a result of the decision to integrate.

Does this mean RD&E staff will have to travel to NDDH more?

The RD&E has supported the delivery of acute services in Northern Devon for a number of years through clinical networking arrangements to ensure patients in Northern Devon have local access to specialist care.

Since the partnership between the two Trusts was strengthened in 2018 through the Collaborative Agreement, this partnership working has increased. We have been able to offer a number of joint appointments, for example in obstetrics and gynaecology services, and providing opportunities across sites allows us to offer unique and varied careers for staff whilst ensuring service provision.

Is this a merger?

Yes. The legal transaction that is the most commonly progressed between NHS Trusts is a merger by acquisition. This is also the route that enables the RD&E to retain its Foundation Trust status, but. will require a change in our Constitution.

However, the Boards are referring to this as an integration of services between two really close partners. This is to ensure that staff, patients and communities served by each Trust have confidence that our approach to this integration will ensure the best of both parts of each Trust’s service and should ensure our plans deliver the greatest benefit to both staff, patients and their families.

What have the benefits been so far of the Collaborative Agreement?

The Collaborative Agreement has been successful in ensuring a significant improvement in the leadership, clinical engagement, quality and performance at NDHT. It is also clear that it has benefited the RD&E through learning from NDHT’s agility and innovation in management and delivery of care. The Collaborative Agreement between the Trusts has given both Boards a sense of confidence about the benefits more co-operation, integration and resilience can achieve for patients across Northern and Eastern Devon.

What are the next steps?

The go-ahead from NHSE/I marks the start of an 18 month programme of work to plan how we integrate with the minimum of disruption. We aim to submit a Full Business Case by Autumn 2021 and become a single organisation from April 2022.

This integration planning work started in January 2021. It involved and continues looking in detail at services across both Trusts and agreeing plans with each team for joining them together.

This work will involve everyone. We will be supporting everyone to enter this with a spirit of curiosity and respecting difference. We will see if we can use this process as an opportunity to look closely at how we provide our service and create something stronger if joining together.

Over the next year we will also be developing a clinical strategy to influence the estates investments in Torbay and NDDH. We also aspire to create a common digital electronic patient record across NDHT and the RD&E and develop more closer working and delivery of services across the SEND network (South, East and North Devon).

Both Trusts are really different – how are you going to merge cultures?

We will ensure this is a supportive process, which builds on the best of both organisations, respects difference and engenders mutual respect. We recognise that it will take time to align cultures and we want to use this process to build on our partnership and become stronger together.

What is the plan for having governors from Northern Devon?

As part of the integration, we are developing plans to extend the Council of Governors to ensure we have the right representation for Northern Devon in the integrated organisation. There are certain guidelines we need to follow which mean that we are unable to appoint new governors until the integration is formally approved through Board, RD&E governors and our regulators (NHSE/I). However, we are very keen to involve our NDHT stakeholders in this interim period and appreciate their input into forums such as our Public Board meetings and Involving People Steering Group. We also encourage attendance at the RD&E Governors’ Public meetings, which can be attended by anyone.

There may well be other questions that you may have or that may come up in time and we will continue to respond and develop this FAQ document over time. We are really happy to receive any feedback on this so we can ensure it is as useful as possible.

You can contact us on ndht.rde.integrationcomms@nhs.net.

Last updated: August 2, 2021