The NHS regulator Monitor has indicated that a North East hospital trust is to be investigated owing to poor financial performance.
County Durham and Darlington NHS Foundation Trust faces a budget deficit in the region of £15 million for the next financial year.
Monitor has stated that it intends to examine the trust in order to “better understand the causes of the financial challenge” that the organisation evidently faces.
This issue is just the latest indication of massive financial problems in the NHS.
With several trusts having already been investigated for similar difficulties, Monitor has been occupied on a very regular basis with economic issues.
The busy nature of the regulator reflects the fact that the NHS faces a £2 billion total deficit in the existing financial year.
The County Durham and Darlington NHS Foundation Trust provides a range of acute and community services to nearly 600,000 people in and around Durham and Darlington.
Commenting on the issue Paul Chandler, regional director at Monitor, was cautiously optimistic that the regulator would be able to help the trust make steps in the right direction.
“We know the trust, like much of the NHS, is facing a serious financial challenge but we are going to help find out what more what can be done to get a grip of the situation. Thousands of people across the region rely on the services this trust provides, so we will work quickly to determine what support the trust needs to help ensure the necessary improvements are made.”
There has yet to be a decision on whether regulatory action will be taken. But precedent has been set recently, with Monitor insisting on such action with several NHS trusts.
Sue Jacques, chief executive of County Durham and Darlington NHS Foundation Trust, defended the trust, stating that it was the first time that it had been in deficit.
“A key challenge is the cost of medical and nursing bank and agency. This has been a pressure for trusts nationally in meeting new recommended staffing levels, at a time when unplanned activity continues to increase. Steps we have taken include new in-house bank arrangements and recruitment abroad, and these are already having an impact. The Trust’s nurse agency costs are down from £1.33m in June to £635,000 in November. There is more to do, particularly in addressing the cost of medical agency staff.”
90% of NHS trusts have recorded a deficit in the most recent financial year.
And this latest investigation follows intervention from the Care Quality Commission, which stated back in September that inspections indicated that numerous trusts need improvements to be conducted.
The boss of NHS in England has suggested that specialist hospitals can play a major role in clinical innovation going forward.
Simon Stevens stated that such institutions should share best practice and develop new care models in order to play a major role in the future of the health service.
Stevens has just penned a forward to a report by the Federation of Specialist Hospitals (FSH).
The report was launched in Parliament on 25th November.
Commenting on the potential of specialist hospitals, Stevens suggested that such institutions have already established an excellent track record across the NHS.
“As we radically redesign care, now more than ever before we need to seize the opportunities that science and new treatments offer patients. We must maximise the impact of these centres of excellence and spread their learning across the rest of the health service,” Stevens opined.
Continuing on his theme, Stevens outlined the successes of the new care models programme.
“Through the new care models programme, we are already supporting specialist networks, like those led by The Christie, The Royal Marsden, Moorfields Eye Hospital and other federation members, to serve a wider population.”
In the published report, it is recommended by the FSH that specialist hospitals can make a particularly valuable contribution to the fields of clinical research and innovation.
This potential should be recognised and supported by the implementation of national policy, with the Accelerated Access Review considered particularly important.
The launch event for the report saw a team of significant figureheads from across the whole service assembled.
These included former care minister Norman Lamb MP, minister for life sciences George Freeman MP, and FSH chair and national director of clinical quality and efficiency at the Department of Health, Professor Tim Briggs.
Commenting on the report at its launch, Professor Briggs suggested that specialist hospitals have particular characteristics that support their ability to engage in cutting-edge innovation and research.
“Specialist hospitals are characterised by their focus on a single speciality and, usually, by a disproportionately complex casemix. As such, specialist hospitals are often home to investment in cutting-edge innovation and are substantial contributors to clinical training and research.”
Briggs continued by emphasising the importance of such institutions to research in the NHS, and the commitment of those present at the launch of the support of this concept.
Adding to Briggs’ comments, Rob Webster, the chief executive of the NHS Confederation, suggested that there was a fertile environment in the NHS for this initiative.
“There has never been a more important time for this, as innovation is fundamental to transforming NHS care and finding greater efficiency. As a champion of the Accelerated Access Review, I am grateful that this report reinforces that the ultimate test of the Review will be how effectively the health system is able to adopt and spread innovations like these for the benefit of our staff, our patients and the NHS.”
NHS trusts in England have been informed to ensure that criminal record checks are up to date.
The prospect of such checks having not been completed adequately has been underlined by a new study.
This survey revealed that numerous trusts throughout the NHS have failed to undertake annual reviews on the topic of criminal record checks.
The measure was a key recommendation of former barrister Kate Lampard’s report on improvements needed to protect patients in the wake of the Jimmy Savile scandal.
Concerns were raised back in February that there had been a lack of management and leadership with regard to this issue.
Of particular concern are volunteers in the health service, with an estimated 78,000 needing to be checked.
The study in particular highlighted an alarming 14 separate areas where improvements are necessary.
Following the Lampard report, The Department of Health failed to accept any of the recommendations included in the document.
This decision can perhaps be blamed for the existing situation.
Ministers indicated that criminal record checks should typically only be necessary for volunteers in close or unsupervised contact with patients, in conflict with the report.
The Department of Health’s update on the NHS response to Lampard, published on Wednesday, stated that progress had been made in implementing most of the changes she demanded.
Central to this is the assurance that every hospital has an appropriate policy in place for agreeing to and managing visits by VIPs, celebrities and other official visitors.
There has also been a focus on ensuring that volunteers are appropriately recruited, selected and trained. Supervision has also been assessed.
Yet the NHS regulator Monitor, in accordance with the Trust Development Authority, discovered that there is a considerable split with regard to how NHS trusts across England are responding to the recommendations of the report.
Monitor surveyed trusts between March and June and found that the number of three-yearly checks being carried out were insufficient.
While some trusts had adequately implemented the checks, others were reviewing procedures or awaiting further guidance.
It was also suggested by some trusts in the NHS that the financial cost of implementing checks had made the process prohibitive.
Commenting on the issue, the Department of Health stated: “Trusts should make sure their information on volunteers is up to date…Trusts should encourage staff and volunteers who are eligible to join the DBS update service. It is free for volunteers and allows an individual to register with the DBS and have a portable certificate. This means a volunteer can work for several organisations with only one DBS application and an employer can check the status of their volunteer at any time and make safe recruitment decisions.”
Monitor has announced that it will publish plans for a national whistleblowing policy.
The health regulator will insist on every organisation within the NHS adopting this new policy.
This singular whistleblowing policy, that will thus operate across the NHS, has been drawn up by a collaboration of three organisations.
Monitor, the NHS Trust Development Authority and NHS England drafted the policy co-operatively as a result of the Freedom to Speak Up review published earlier this year by Sir Robert Francis QC.
The proposed policy provides a guideline for health professionals with regard to whistleblowing action in the future.
In particular, there are provisions contained within the legislation to ensure that bullying or acting against a whistleblower is an act liable for disciplinary action.
A key aspect of the policy reads thus:
“Don’t wait for proof. We would like you to raise the matter while it is still a concern. It doesn’t matter if you turn out to be mistaken as long as you are genuinely troubled. If you raise a genuine concern under this policy, you will not be at risk of losing your job or suffering any form of reprisal as a result. We will not tolerate the harassment or victimisation of anyone raising a concern.”
The policy continues:
“Nor will we tolerate any attempt to bully you into not raising any such concern. Any such behaviour is a breach of our values as an organisation and, if upheld following investigation, could result in disciplinary action.”
The intention behind that policy is to ensure that individuals can feel comfortable in coming forward to legitimately reveal inside information about the health service.
Anyone acting in good faith can therefore be confident that they will not be punished.
On the other hand, malicious rumours are not to be encouraged, and this is also outlined explicitly in the policy.
Monitor revealed in the document that it has consulted with numerous organisations in order to produce this critical policy.
“Having listened to organisations representing whistleblowers and employers, we believe this policy expresses the spirit and intent of the Freedom to Speak Up vision. Our intention is that the policy should be adopted by all NHS organisations in England except for primary care providers. We hope it will also be adopted by independent providers of NHS healthcare,” it is stated in the document.
Meanwhile, a consultation process is currently taking place ahead of the finalisation of the document.
This will be included on 8th January, but a provisional version of the document will be published in the next 24 hours.
Commenting on the policy, Dr Kathy McLean, medical director at the NHS Trust Development Authority, emphasised its importance.
“We know that when trusts take concerns seriously and investigate them properly they are often the ones which provide the best standard of care and treatment to patients. It is hugely important that trust boards are able to listen to what their staff have got to say and then use that to take action to deliver improvements for patients. This policy should help them do just that.”
The outgoing boss of the health regulator Monitor has suggested that NHS providers will face massive problems in ensuring that the deficit of the health service dips beneath projected figures.
Recent predictions related to the health service indicate that a hefty deficit of £2 billion is expected by the end of the fiscal year.
With regard to this, Bennett has suggested that national bodies must ensure tariff prices for next year impose a savings requirement of no more than 2 per cent.
In fact, Bennett believes that trusts across the NHS will actually do well to keep the deficit as low as £2 billion.
The latest comments are just another indication of the problems that the NHS faces.
At the same time that the Conservative government has stated that the health service must switch to a seven-day culture, massive financial difficulties are quite evident.
The NHS also faces a deficit of £30 billion between now and the end of the decade, with the Tories suggesting that this will mostly have to be plugged via efficiency savings.
Meanwhile, recent reports have suggested that the occupancy levels in the NHS are already running at winter levels, ahead of the busiest time of the year.
Monitor is jointly responsible with NHS England for setting tariff prices.
Bennett commented that the balancing of payments between Monitor and NHS England could have been handled better, but that there were more fundamental problems in the NHS leading to financial difficulties.
Although Bennett’s comments were relatively guarded considering his position, the remarks are yet another indication that the NHS is facing arguably the most critical period in the entire history of the health service.
While the government has already pledged £8 billion of extra spending on the NHS between now and 2020, it seems increasingly certain that this will be a mere drop in the ocean compared to what is required.
Indeed, it has already been suggested by one prominent Chief Executive that the entire health service could grind to a halt over the next 12 months.
While some of the prognostications related to the NHS and the existing financial year have raised eyebrows and paint a worrying picture, in fact Bennett suggests that they are a best-case scenario.
Increasingly, it simply appears that the government’s position on the health service is little short of delusional, and that the entire ethos of the policy must be rethought in the coming years if disaster is to be averted.
Figures acquired by Monitor indicate that the Heart of England Foundation Trust is suffering from a serious financial deficit.
According to the health regulator, a lack of rigorous financial control at the foundation trust will lead to a deficit in the region of £63 million during the fiscal year.
Monitor has emphasised that it is essential for the Heart of England Foundation Trust to implement a recovery plan as soon as possible.
Papers published ahead of a board meeting show that spending on clinical staff has increased by 10 per cent this year alone at the Birmingham trust.
The documents indicate that the trust overspent by nearly £6.5 million in September, with a £7 million overspend in August.
Figures acquired from the Birmingham-based foundation trust indicate that the year-to-date deficit of the organisation is in the region of £36 million.
Mitigating action is clearly required immediately, with a likely deficit of £63 million resulting even if such initiatives are implemented.
A financial recovery plan, now being validated by consultancy EY and the trust’s new leadership, seeks to cut this to £32.8m.
Just last month, Dame Julie Moore and Jacqui Smith, the chief executive and chair of neighbouring University Hospitals Birmingham Foundation Trust respectively, were named as the new bosses of Heart of England Foundation Trust.
Based on documents provided by the board of the foundation trust, the deficit is reflective of the fact that investment has been required during the financial year in order to improve performance.
But Monitor stated that the deficit also indicated that the foundation trust had failed to display rigorous financial control during the assessed period.
Monitor sent improvement director Diane Whittingham to the trust in February to address Heart of England Foundation Trust’s failures against a range of performance targets.
Yet despite financial warnings from Monitor, the health regulator noted that the total medical expenditure of the foundation trust has risen by 10 per cent over the last 12 months.
Nursing spending had also shot up significantly, with Monitor assessing this as having increased by 11 per cent.
As a result of the deficit, cash reserves at the foundation trusts are significantly lower than anticipated.
The Heart of England Foundation Trust had a cash balance of just over £34 million in September. This was £37.5 million worse than expected.
With the foundation trust struggling with financial difficulties, the health regulator has put a financial recovery plan in place.
This initiative centres around measures to cut the volume and variations in price between locum doctors and temporary nursing staff.
Monitor has stated that it is currently in the process of investigating the finances of a hospital trust.
Doncaster and Bassetlaw Hospitals NHS Foundation Trust is currently running at a £12.6m deficit.
The health regulator indicated that the foundation trust had reported a significant deterioration in funds over the last few months.
Monitor remains concerned that the trust will ultimately record a massive loss over the existing financial year, which would be particularly disturbing considering the figures predicted for this trust previously.
At one time earlier this year it was expected that the trust would record a surplus of £2.2 million.
Considering the rapid decline in its financial situation, the trust has indicated that it will be fully cooperating with the investigation, and has conceded that such an initiative is justified.
Doncaster Royal Infirmary, Bassetlaw District General Hospital, Retford Hospital and Montagu Hospital in Mexborough are run by the trust.
Monitor stated with regard to his ongoing investigation that the financial position of the trust may necessitate the foundation trust to apply for further support for funding in the future.
Central to the investigation will be an examination of how the unexpected deficit has occurred in the foundation trust.
Paul Chandler, regional director at Monitor, commented on the issue at the Doncaster institution, striking a note of caution regarding the investigation.
“People are relying on Doncaster and Bassetlaw to provide them with high quality healthcare now and in the future. Therefore, we need to make sure the trust can do this in a sustainable way and within its budget.”
Mike Pinkerton, chief executive of Doncaster and Bassetlaw Hospitals, conceded that the investigation being undertaken by Monitor was a reasonable course of action.
“On 20th October, the trust announced inaccuracies in the reporting of the trust’s financial position. An internal and external investigation into how our finances have been managed is already under way. As a trust, we will be working hard to maximise savings by remaining focussed on putting patient care first and scrutinising how we currently do things.”
Just last week, the Care Quality Commission reported on Doncaster and Bassetlaw Hospitals NHS Foundation Trust and found that the hospital trust required improvement.
The Care Quality Commission indicated that staff vacancies were “impacting on the quality of service” in some areas, but did praise the trust over several areas of outstanding practice.
Doncaster and Bassetlaw Hospitals NHS Foundation Trust is certainly not the first foundation trust investigated by Monitor in recent weeks, and the depth of its financial problems are perhaps less severe than some.
The health regulator Monitor has criticised ambulance bosses in a move that could greatly influence the future of the emergency service.
It has been suggested that managers of the ambulance service could be forced to resign their positions after systemic failings over the handling of NHS 111 calls.
Monitor specifically criticised the South East Coast Ambulance Service over a project which increased how long some patients were forced to wait for ambulances.
The organisation was guilty of transferring some NHS 111 calls to the 999 emergency system, in order to give the staff a further 10 minutes of time to respond to calls.
This project was implemented as a response to massive pressures that the ambulance service faced during the winter last year.
Extra time was given to calls which were placed in the second most serious category.
Monitor indicated that there had been a clear failure of management processes, and the health regulator has intervened in order to rectify the situation.
The Health regulator added in a statement that there are major concerns about the way that the trust is being run, and particularly the decision-making process related to ambulances.
Monitor also said it has reasonable grounds to suspect the trust is in breach of its license to provide NHS services.
With an investigation into the matter imminent, the health regulator has indicated that it will commission a review into the way that the project was handled, and more widely into the way that the trust makes decisions.
Paul Streat, Monitor’s regional director, commented that the project was fundamentally flawed and is a massive cause of concern for the health regulator.
“Over the winter, there were significant demands on the NHS and it is understandable that trusts want to explore better ways of delivering the best possible care. But this project was poorly managed from the start, done without the proper authorisation and without enough thought given to how it might affect patients. We have asked the trust to review the action it took to make sure there was no harm to patients, and look again at the way decisions are taken to prevent something like this happening again.”
Paul Sutton, chief executive of the South East Coast Ambulance Service, defended the ethos behind the procedure, but also acknowledge that the health regulator’s concerns were reasonable.
“The process was undertaken to ensure that the right response was provided to patients and that we were able to respond promptly to the most seriously ill patients. However we recognise that it was not well implemented and we did not use our own corporate governance processes correctly. These are serious findings,” Sutton stated.
In addition, Sutton indicated that the organisation had already begun to implement new measures in order to ensure that there was no repeat of the incident.
“We have already begun to take steps to address Monitor’s concerns and as part of this process, independent reviews will assess how decisions are made within the Trust, governance processes and our approach to patient safety. As a Trust, we remain extremely proud of the high quality and compassionate clinical services that SECAmb provides to our patients,” Sutton indicated.
An important contract relating to NHS Improvement will be awarded this week as organisation in the health service continues to evolve.
The contract to design the structure of the NHS Improvement organisation is reported to be worth more than £1 million in total.
As part of the process of drawing up the structures related to this organisation, the successful consultancy will work alongside an integration director, producing a comprehensive operating model by February.
It is suggested that the work could also incorporate a leadership review and leadership development interventions of existing employees within the NHS Improvement organisation.
This wide ranging modus operandi will cover every aspect of the way that the new monitor will operate, with both structure and culture considered particularly important.
The new regulator has been created by the merger of Monitor and the NHS Trust Development Authority, and early plans suggest that it will come into force at some point in 2016.
Reports indicate that the principal focus for NHS Improvement will be to drive and support both urgent operational improvement at the front line and the long-term sustainability of the healthcare system.
As is increasingly the case across the NHS as a whole, it is suggested that collaborative working will be central to the plans of this organisation.
A successful bidder for the contract will ultimately work alongside an internal program management office.
It is suggested that this office will comprise around twenty people, with an integration director in place in order to oversee the operation.
The consultancy selected will have been judged on organisational design and a “high level transition plan and pipeline”.
This process will lead to a draft organisational structure being produced by the beginning of December, with a final version to follow by the end of 2015.
A comprehensive operating model is also considered particularly important to the bidding process, with metrics for assessing quality, finances and sustainability central to this notion.
The final strategy document is to be submitted by March of next year, and major organisations Deloitte, McKinsey and KPMG have reportedly been shortlisted.
Northumbria Healthcare Foundation Trust chief executive Jim Mackey was named as the first head of the new organisation earlier this month.
The creation of NHS Improvement comes at a time when regulation of the NHS is particularly important.
The existing regulator Monitor has had to take action against numerous trusts in recent months as financial difficulties across the NHS become increasingly apparent.
This was only too succinctly illustrated by recent financial results which suggests that the NHS as a whole will be £2 billion in deficit by the end of the existing fiscal year.
The health regulator Monitor has stepped in to address problems in a trust based in Somerset.
Monitor has decided to take action on behalf of patients at Taunton and Somerset NHS Foundation Trust, with the organisation is struggling to deal with financial difficulty.
An investigation has been carried out into the finances of the trust, and the regulator has decided that Taunton and Somerset NHS Foundation Trust has failed in its responsibilities to its patients.
Monitor believes that the interest is effectively a breach of its license to provide NHS services.
According to the latest calculations from the health regulator, the trust is expected to lose in the region of £8.3 million during this financial year.
Although the Taunton and Somerset NHS Foundation Trust has put a plan in place to address the situation, its recovery scheme is currently failing to make sufficient inroads into the deficit.
Indeed, Monitor currently believes that there is a risk that the financial position of the trust may deteriorate further.
And the health regulator asserts that there are currently insufficient plans in place in order to mitigate against this threat.
Among the actions requested by Monitor is the appointment of a so-called ‘turnaround director’, whose responsibility it will be to support and challenge the trust as requisite improvements are put in place.
Commenting on the situation at the trust, Paul Streat, Regional Director at Monitor, expressed the concerns of the health regulator at the financial position of the Somerset-based institution.
“We’re concerned that the trust is losing money and hasn’t yet developed the right plans to tackle its financial problems. These problems are fairly recent. We are stepping in early to ensure that the trust can quickly get its finances back on track,” Streat commented.
Streat also confirmed the plans of the regulator to install a turnaround director.
“The trust will also be appointing a turnaround director who will use their expertise to help the trust board make the improvements needed. We are confident that with this support it can recover its finances and continue to provide quality care to patients in Somerset.”
Finally, Streat indicated that Monitor intends to keep a close eye on the situation, and that it is very much an ongoing one with the trust having the opportunity to prove that it has improved financially.
“The regulator will closely Monitor the trust’s progress against its financial recovery plan, and will take further action if necessary for patients,” Streat explained.
Monitor has confirmed that a new leadership team has been appointed at one of the most prominent NHS trusts.
The Heart of England NHS Foundation Trust has agreed to appoint a new interim leadership team, after the trust conceded that it was in breach of its license.
According to Monitor regulations, NHS trust services must operate in accordance with regulatory licenses.
And in the case of the Heart of England NHS Foundation Trust, Monitor recommended that the trust should reorganise its managerial hierarchy.
The trust board has agreed to the action required by the regulator.
Jacqui Smith, the former Labour MP, is currently the Chair at University Hospitals Birmingham (UHB), and will now become interim Chair of the trust.
Smith replaces Les Lawrence who has decided he will step down from the trust at the end of November.
Meanwhile, Dame Julie Moore – currently Chief Executive at UHB – has been appointed interim Chief Executive of Heart of England.
Moore replaces Andrew Foster whose secondment finishes at the end of October.
It has been announced that Smith will continue in her existing role of Chair at UHB while also carrying out her duties relating to Heart of England.
Dame Julie Moore will spend the vast majority of her time at Heart of England while fulfilling the Interim CEO role.
In addition, the board at the trust has made a clear commitment to Monitor that they will take time to develop and implement both short and long-term financial plans in order to improve the fiscal situation of the organisation.
The Heart of England NHS Foundation Trust is just one of many NHS trusts facing fiscal challenges in what is an extremely difficult financial period for the National Health Service.
Commenting on the issue, Dr David Bennett, Chief Executive of Monitor, pointed to these economic issues as being central to the decision to appoint new executives.
“Heart of England NHS Foundation Trust has significant financial problems, having run up a £29.5 million deficit already this year. It is clear urgent action is needed,” Bennett stated.
Bennett went on to point out that the individuals recruited already had an excellent reputation in the eyes of Monitor.
“By appointing two people whose leadership at University Hospitals Birmingham has been rated as outstanding by the Care Quality Commission, we can provide the trust with the strong leadership it needs to live within its means and keep delivering the care patients need,” Bennett asserted.
It is estimated that the NHS will accumulate a deficit of £2 billion by the end of the financial year, and the decisions made by Monitor in this instance will probably not be the last example of re-organisation among NHS trusts.