Great Western Hospital gets some warnings of winter squalls to come
It seems we have reached the point in the NHS' continuing woes when we have to resort to the Anglo-French writer Hilaire Belloc. He wrote prolifically in the early part of the twentieth century and provides an appropriate text for today's NHS:
And always keep a-hold of Nurse
For fear of finding something worse
All we have to do is to take his 'a-hold' to mean keeping nurse safely on the staff pay role - rather than its probable 'hand-holding' meaning. (We know what ignominy hand-holding can bring.)
We have reported on the problems faced by Great Western Hospital in keeping and recruiting staff - especially nurses - in the face of the pay cap and many other hurdles deemed proper by the government.
'Something worse' seems to have been happening to GWH in the opening months of this financial year. As regards money, Financial Director Karen Johnson told the July Board meeting: "We are on a knife edge financially." And some major risks lie in wait in the months ahead, especially the winter months.
Much of the problem is down to staff costs. Their cost reduction programme for this year aims to save £14 million and about half of that is attached to pay - staff shortages mean that high agency costs are proving hard to reduce.
One of the non-executive directors reacted to the first months' figures: "The biggest concern is still about pay. There are a lot of mountains to climb."
The likely risks to meeting their required end of year surplus are huge. These include: £5m in extra funding at risk if conditions not achieved - £2.25m if the agency ceiling is breached - £2m if income from private care target is not reached - £1.2m extra costs of the Junior Doctors' additional contract costs - and so on.
There is even a line for the non-budgeted costs of the delay in the takeover of Wiltshire's community hospitals by NHS Property Services. The takeover happened several months late on 30 June (for all the buildings except for Savernake Hospital which is under a PFI agreement - making the takeover very complex indeed.)
This delay left GWH having to pay £200,000+ to service and maintain the buildings for three months.
An example of the cost problems came with a news that its cataract operations are being subsidised by the GWH - that means they are costing more than the NHS commissioners are willing to pay for them. So GWH is having to see how economies can be made without affecting standards and safety of patients.
Compounding the financial issues, came news that none of the national treatment standards had been met. There was better news from GWH's A&E department - in May 92.1 per cent of patients were discharged, admitted or transferred within four hours of their arrival. That was better than April by more than five per cent, but still missed the national 95 per cent target.
GWH has had outstanding success in meeting cancer treatment time standards. All of a sudden it has slipped.
In April some 31 per cent of those referred by GPs with breast symptoms were seen within two weeks - the target is 93 per cent. The other measured time delays were closer to target, but none was met.
With breast cancer there were solid reasons for the slump in figures. GPs are referring many more women with breast cancer symptoms - there was a spike of referrals at the start of the year and this has plateaued out. This, unsurprisingly, has led to the cancer screening department being swamped with referrals - and these 'referrals' are very anxious women.
In part it is thought this is because of criticism that GPs were falling down on breast cancer diagnoses: "GPs are adamant they are going to refer." They are now referring women with breast pains which are not generally a symptom of breast cancer.
New measures are in place - a new manager for cancer has been appointed and recovery to meet the national targets is due to be complete by the end of August.
Problems come thick and fast and not all are in day surgery, in wards or operating theatres. GWH was found to have some cladding of low level fire risk and not in areas where there are patients. Tests have begun.
Hard on the heels of that problem, the Chief Executive must have taken a sharp intake of breath on Monday (July 10) when the construction giant Carillion's share price fell off a cliff - down nearly 40 per cent after a severe profits warning. And it had not stopped falling by lunch the next day -n reflecting anxieties about the company's future.
Carillion hold the part of the PFI contract that covers all the servicing and maintenance of the building. Any cutbacks there cannot be allowed to impact on the hospital's cleanliness.
By the way that quotation from Mr Belloc comes from one of his Cautionary Tales for Children...and for politicians.