NHS Improvement Hands Leadership Power to Four Outsanding Trusts

NHS Improvement has announced its intention to provide four particularly high performing trusts with the power to lead groups and / or chains of other NHS hospitals.

Bosses at the foundation groups in question will have the permission to oversee current partnerships and federations of hospitals, as well as being instantly involved with the process of merger and acquisition.

This new accreditation from NHS Improvement is intended to ensure that the outstanding trusts have the authority to execute the acute care collaboration vanguard projects.

The four trusts given “foundation group leader” status are Guy’s and St Thomas’ Foundation Trust, Northumbria Healthcare Foundation Trust, Royal Free London Foundation Trust, Salford Royal Foundation Trust.

All four of these organisations have been rated that least good by the Care Quality Commission, with Northumbria and Salford Royal considered outstanding.

NHS Improvement chief executive Jim Mackey believes that the announcement can be considered a big step forward for the health system, enabling patients and providers to benefit from superior leadership within the health service.

Mackey himself worked as chief executive of Northumbria Healthcare Foundation Trust until last year, and commented that the accreditation process will offer both quality and financial performance advantages.

“Being in a group isn’t right for everyone. The accreditation process considered not only the quality of services on offer and the management trusts have, but also the benefits that trusts will get from being part of a group and the potential risks they face.”

Northumbria management commented that thee new accreditation will make it easier to share best practice, knowledge and expertise with other trusts.

Chief executive David Evans indicated that the trust as already built up a significant reputation within the NHS as an innovator.

“For many years we have been at the forefront of innovation in the NHS, pushing the boundaries of excellence, pioneering new models of care and always thinking one step ahead about the challenges of delivering modern healthcare. The NHS is constantly changing, the needs of our patients are constantly changing and as medicine and technology advances, we must keep pace and create a healthcare system which switches our focus on prevention and keeping people well.”

Salford Royal has already begun working with local trusts in the area with the intention of establishing the first chain under the vanguard program.

Chief executive Sir David Dalton commented that the digital revolution that has been essential to the successes of the Salford will be central in the process, enabling a similar quality of care to be established across the NHS as a whole.

“The key aim of leading a Group of NHS providers is to deliver high quality care that is standardised and replicated across all organisations to improve patient outcomes and deliver better value for money. Assuring the reliable delivery of high standards, at scale to a greater population, allows quicker decision making and ensures that those decisions are taken in the interest of the population. This contrasts with delays in decision making which often occur when multiple organisations are assessing the impact of changes on themselves rather than the wider interests of the population they should be serving.”

Dalton also outlined details of the work that Salford Royal is already conducting with the Pennine Acute Trust.

“Salford Royal, which is one of only five Trusts in the country to be rated ‘outstanding’ by the CQC, has started this improvement journey with Pennine Acute Trust and I am optimistic that this is the beginning of an arrangement which can provide positive changes which will be appreciated by staff, patients and the communities we serve.”

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NHS Referred to Regulator Over Pension Concerns

An NHS Trust has been referred to a regulator following apparent breaches over pension policy.

It was reported last month that the health service had offered nurses a pay deal which encouraged them to swap pension rights for cash.

And now the NHS Pensions Board has made a formal referral to the Pension Regulator with regard to Oxleas NHS Trust in south-east London.

Concerns had previously been raised with the board regarding the Oxleas deal, which ensures that nurses can obtain a higher salary if they choose to opt out of the NHS pension scheme.

Oxleas commened that “we have previously received confirmation from the Pensions Regulator that our actions do not constitute inducement [to give up a pension] and are lawful.”

The scheme would seem to be in breach of pension regulation, which suggests that the decision to opt out of any such financial arrangement should be taken independently.

It is suggested in this case that nurses have been unduly influenced by the employer.

Commenting on the issue, Rachel Court, chair of the NHS Pensions Board, was of the opinion that Oxleas has a significant case to answer.

“The board recognises the challenges that trusts such as Oxleas face in competing with agencies when seeking to recruit staff. However, the board considers that the offer that has been made does meet the criteria for being considered an inducement, since there are reasonable grounds for considering its sole purpose to be to encourage staff to opt out of the NHS Pension Scheme in return for an additional salary payment.”

Court also believed that the issue could potentially impact upon other trusts and wider NHS policy.

“Given this, and also the potential wider implications should such offers proliferate, the board feels that there are grounds to ask the regulator to investigate this matter further.”

The Union responding to the claims of the Pension Board have stated that they believe that the NHS trust in question did have a financial motivation for this scheme.

All NHS Trusts in fact have a process in place for increasing national pay rates, without inducing staff to leave the pension scheme.

Paul Moloney, a representative for the Society and College of Radiographers and member of the NHS Pension Board, pointed out that the regulator may not be privy to this particular morsel of insight.

“This is information that we do not believe the regulator has seen, let alone taken into account. It is therefore wrong to say that Oxleas had no financial incentive in doing what they have done.”

Responding to the accusations, the Oxleas Trust was adamant that it had not behaved inappropriately.

“We are aiming to give staff a choice of reward packages which cost the same amount to us as an organisation. We have introduced this because we want to encourage back to the NHS qualified nurses who have already chosen to work for agencies.”

The regulator has indicated that it will make a decision once it has acquired all of the requisite information.

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Hospitals and Regulators Clash Over Targets

NHS providers and the Department of Health are set for major clashes over stringent financial targets, which could ultimately result in significant disciplinary action.

As the department moves to enforce financial conditions over the health service as a whole, numerous hospital board could ultimately be suspended over plans for rebellion.

Hospitals and other NHS services were told last month they would have to eliminate soaring budget deficits by the end of the next financial year.

And the Department of Health has further warned that boards which fail to adequately cut expenses could forfeit their share of the £1.8 billion in new funding and risk takeover that has already been promised by health sector regulators.

Chris Hopson, chief executive of the NHS Providers umbrella group, has already commented that hospitals that meet the demands of regulators will do so “with conditions, or with a heavy warning around the level of risk that is being run”.

Such is the stringent new regime that the Department of Health will impose on health sector institutions in the immediate future.

The NHS provider sector in England – which includes hospitals, mental health, community and ambulance services – had anticipated a deficit of well over £2 billion by the end of this financial year.

But recent news has indicated that even this pessimistic estimate appears to be shy of the real figure, with a deficit in the region of £3 billion now likely.

In addition, many finance directors have warned that the new spending targets demanded of hospitals for 2016/17 are unrealistic.

Commenting on the issue, a spokesperson for NHS Improvement suggested that financial conditions may be challenging for NHS organisations, but that both the government and Department of Health will provide all the necessary support to ensure that such institutions thrive.

“There is extra funding being pumped into the NHS to help us deal with the financial and operational challenges the service is facing, but providers need to do their bit too. We have set them challenging, but achievable targets so we can to get to grips with the short-term financial challenge and help provide the stability the health service needs to bring about meaningful and lasting change for patients.”

The spokesperson also pointed out that “a majority of providers have agreed to the new control totals and we are in an intensive period of reviewing and discussing progress with trusts as they finalise their financial plans.”

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Monitor Concerned by Financial Decline at Heart of England Foundation Trust

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.

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Monitor Report Outlines Dire Financial Position of NHS Trusts

A comprehensive financial report from the health regulator Monitor indicates that the NHS faces terminal financial difficulties.

NHS trusts in England managed to accumulate a collective deficit of nearly £1 billion in merely the first three months of the existing financial year.

According to regulators, this represents the worst financial position for the NHS in a generation.

Figures released by Monitor show that NHS Foundation Trusts had a deficit of £445 million for the surveyed period, while other NHS trusts racked up a £485 million deficit for the first three months of the year.

Although the overall picture can be considered alarming, the health regulator was particularly damning regarding the financial position of foundation trusts.

Monitor warned that this sector is “under massive pressure” and simply cannot continue in the same vein for much longer.

The report in question surveyed the financial health of 151 NHS foundation trusts, while Monitor sought the assistance of the Trust Development Authority (TDA) to cover 90 NHS trusts.

It is not merely the quantity of debt that is alarming for the health sector, but also the proportion of bodies suffering from financial difficulties and deficits.

Of 90 trusts in the TDA report, 72 ended the financial quarter in deficit, with 118 foundation trusts also in the red according to the health regulator.

This means that nearly 80 per cent of NHS trusts in England are currently running a deficit. Additionally, 75 per cent of the trusts that were in deficit are acute hospital or specialist trusts.

Although several reasons for the overspend were cited in the Monitor report, it is suggested that higher staff costs than expected and an over-reliance on expensive agency staff particularly contributed to the problems.

In addition, the report also reflects that foundation trusts were unable to meet several national waiting time targets.

Perhaps most critically, the A&E target for people to be seen within four hours was not met. Targets for routine operations and some cancer treatments also went by the wayside.

Commenting on what are unquestionably alarming figures for the health sector, Dr David Bennett, chief executive at Monitor, commented that real change is necessary in order to address the situation.

“Today’s figures reiterate that the sector is under massive pressure and must change to counter it. The NHS simply can no longer afford operationally and financially to operate in the way it has been and must act now to deliver the substantial efficiency gains required to ensure patients get the services they need,” Bennett opined.

However, Unite union national officer Barrie Brown suggested that efficiency savings were in fact the root cause of difficulties for the health sector. Brown instead asserted that increased spending and more extensive funding was required for the NHS to avoid a national emergency.

“The financial chickens are coming home to roost big time. This is what happens when you have growing demand for NHS services and then decide to impose £20 billion of so-called ‘efficiency savings’. Health Secretary Jeremy Hunt needs to start banging the Cabinet table to get more funds in real terms from the Chancellor, George Osborne, otherwise the NHS will go into a financial meltdown,” Brown stated.

This latest deficit follows overspending of £820 million by NHS and foundation trusts over the last twelve months. But it seems likely that the deficit among the same organisations could ultimately top £2 billion for the existing financial year.

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Heymann appointed as non-executive director of Monitor

Leading clinician Dr Timothy Heymann has been appointed as a non-executive director of Monitor.

With a background in regulation, Dr Heymann is a key appointment for Monitor and he brings a wealth of expertise to the healthcare financial regulator.

As well as being the senior Consultant Physician and Gastroenterologist at Kingston Hospital, Dr Heymann also holds a post at Imperial College London as Reader in Health Management. Further expertise includes being a fellow of the Higher Education Academy and a host examiner of the Royal College of Physicians of London.

Dr Heymann has been a member of the Government’s Better Regulation Committee, and the Risk and Regulation Advisory Council. He has also been a non-executive director for NHS Direct.

Baroness Joan Hanham CBE, Chairman of Monitor, said: “I would like to warmly welcome Timothy Heymann to Monitor. His mix of extensive clinical experience and knowledge on regulation will be of real value to the decisions we take as we concentrate on making the health sector work for patients.”

Dr Timothy Heymann takes up his position as non-executive director on 16 February 2015. His appointment is for a period of three years.


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