Princess Alexandra Hospital NHS Trust chief executive Thom Lafferty issues rallying call to staff amid challenges and change

The man in charge of the NHS trust that runs the hospitals in Harlow, Bishop’s Stortford and Epping wants the organisation to be “an exemplar” in the face of massive financial challenges and structural change.

Last month, the Government announced that NHS England, the body that manages how health services are run, will be abolished to “cut bureaucracy”. An estimated 9,000 administrative roles there and at the Department of Health and Social Care (DHSC) – roughly half of all posts at the two organisations – will be axed.

Health and Social Care Secretary Wes Streeting told Parliament: “We are putting the final nail in the coffin of the disastrous top-down reorganisation of the NHS.”

Over the next two years, NHS England, the biggest quango in the world, will be absorbed into the DHSC to cut duplication. Sir James Mackey will lead the transformation team.

Mr Streeting said: “We will set local NHS providers free to innovate, develop new productive ways of working and focus on what matters most – delivering better care for patients.

“The reform… will mean fewer checkers and more doers. It will cut through the complex web of bureaucracy and devolve more resources and responsibility to the front line to deliver better value for taxpayers’ money and a better service for patients.”

Thom Lafferty, chief executive of Princess Alexandra Hospital NHS Trust (PAHT), which runs the PAH in Harlow, Herts and Essex Community Hospital in Bishop’s Stortford and St Margaret’s in Epping, told the Indie what the “very dramatic” announcement means in East Herts and West Essex.

“Jim Mackey came out with a fairly hard-hitting statement on the need for the NHS to wash its own face and to live within its means,” said Mr Lafferty.

He said the integrated care boards (ICBs), which replaced clinical commissioning groups in the NHS in England in 2022, would need to cut their costs by 50% and narrow down their areas of responsibility.

ICBs are responsible for planning health services for their local populations; there is one for Hertfordshire and West Essex. They manage the NHS budget and work with local providers of NHS services, such as hospitals and GP practices, to agree a joint five-year plan which says how the NHS will contribute to the local integrated care strategy.

Mr Lafferty said: “We, as providers, also will need to reduce the amount of growth we’ve seen in our corporate cost areas when compared with pre-pandemic levels.

“The other bit for providers that I think is particularly pertinent to us is that there’s a real narrative nationally about the fact that it’ll be up to local providers to decide how best to respond to local population health needs.”

Mr Lafferty said that change had already begun at PAHT since he took the helm five months ago.

“We want to be an exemplar of genuinely responding to place-based need in an integrated way. We’re working with partners across primary care, mental health and the community.”

While the changes create opportunity, there is also uncertainty and anxiety for staff. Mr Lafferty admitted: “We work day in and day out with colleagues who are directly affected at NHS or the ICBs.

“Equally, all this uncertainty and… reducing corporate costs is driving significant anxiety in our staff base. We’re trying to do as much as we can and as much as is sensible to do to reassure staff.

“I want us to get on the front foot and own the changes and challenges and owning our own destiny – and actually embrace the changes that are coming.”

PAHT has a raft of proposals for improving provision on and off the Princess Alexandra Hospital site, including the possibility of delivering services in Harlow’s revamped town centre.

Mr Lafferty hoped co-ordinating care better, for example linking GP primary care networks to a named geriatrician, would cut demand for beds.

“We already know that a very high proportion of our patients who come here and are in our inpatient beds don’t actually require acute care. It’s just that there are no suitable alternatives closer to home or out in the community,” he said.

“That’s why we feel so strongly about more formally integrating with primary care colleagues and community colleagues so that care is more joined up and patients can get proportionate care in the right location.”

Coupled with local government devolution, the new integrated care structures may have an Essex focus, but Mr Lafferty was clear about PAHT’s commitment to the 40% of patients who live in East Herts.

As well as working more closely with GPs, patients can expect more outpatient facilities to be moved to the Herts and Essex and St Margaret’s. That shift is also driven by the deteriorating state of PAH in Harlow.

In January, the Health Secretary confirmed a “significant delay” in building a replacement for the Hamstel Road site. Land off the M11 near Sheering has been earmarked for the £2 billion new health campus, but building will not now begin before 2032.

PAHT’s chief strategy officer, Michael Meredith, outlined the impact of that delay, including bridging a £70m budget blackhole.

“We recognise that in order to keep the lights on, keep the hospital warm, we need to continue investing in the existing infrastructure,” he said.

“And there’s a significant investment required to deliver that. We think it’s around £12 million a year over the next 10 years, which is about £120 million.”

Without the challenges of the 1960s buildings, the trust would expect to spend about £50m in maintenance.

Mr Meredith said: “Significant investment is required, and we’re working with the national teams to understand where we’ll get that money from.”

Without extra funding, the hospital faces the prospect of using money to drive innovation like digitisation and spending it on ageing heating, ventilation and sewage systems.

To ease pressure on the estate, Mr Meredith added: “We’ve been reviewing all of our services… to understand which services we can move out of the hospital closer to a community setting, not because it’s cheaper or easier to do it, but because it meets patients’ needs more effectively.”