Tuesday’s election news included in part warnings about the state of the NHS’ finances. Leaked figures gave gloomy news about the deficits many of England’s hospital trusts are showing – both in their accounts for last year (2014-2015) and their forecasts for the current financial year – 2015-2016.
A survey of 98 trusts (out of the 240 in England) showed projected deficits for this year totalling £750million – giving an average deficit of £7.7million for 2015-2016 against an average surplus for 2013-2014 of £1million.
Figures given at Great Western Hospital’s board meeting last week and repeated to Wiltshire Council’s Health Select Committee on Tuesday (May 5), show a deficit of £8.6million for last year. They were £9.8million off their budget target – that is they had projected to return a surplus of £1.2million. For the current year they are now forecasting a deficit “at least double” last year’s figure.
The hospital regulator Monitor have been working with GWR since October to see what can be done about this. Perhaps they will report that it is not much good just increasing NHS funding with real term rises of less than one per cent, when many people are living much longer and with more complex conditions, and pills, potions and the technology of treatment gets more and more expensive.
One of the breaches in GWH’s performance has been failure to meet the target for 95 per cent of attendees at A&E (or as GWH prefers to call it, their Emergency Department – ED) to be treated within four hours. But look a little closer at recent figures.
Attendance at GWH’s ED in March went up by 12.9 per cent on February’s figure – the so-called ‘winter pressures’ seem now to ignore the calendar. But 93.92 per cent of those attending but not needing to be admitted to a ward, met the four hour standard. For those needing to be admitted the figure was 60 per cent – nearly ten per cent better than in February.
How would a secondary school cope if one month it suddenly had 12.9 per cent more pupils?
Much of GWH’s financial problem is down to staffing. At the end of March its hospitals (the Swindon HQ and its community hospitals) had 213 vacancies – in terms of whole time equivalent posts and equals 4.6 per cent of its workforce. Of those vacancies 98 were for nurses.
Those vacancies need to be filled day in and night out – mainly by agency staff. GWH has recruited many more nurses and other clinical staff. But nationally the pool of nurses has dried up – especially as with no proper pay rises, some nurses leave to work for the higher paying agencies.
GWH always budgets to use some agency staff, but its pay line for the year was overspent by £12,430,000. This was “…due to the continued use of agency staff at premium rates to cover vacancies…” (however, it is not simply a matter of recruitment) “…and to meet the additional demands of patients requiring one on one care due to higher acuity levels and additional care needs.” Some of which translates simply as patients with serious dementia or mental health conditions.
Nobody at GWH is happy about employing agency nurses. But reductions in nurse training places early in the last government’s term means that more overseas nurses need to be brought in – recruiting them costs around £5,000 a head and they are not easy to find.
As GWH’s Director of Strategy, Kevin McNamara told the Health Select Committee: “Quality of care and finance are two sides of the same coin.” Within the pages of statistics GWH has to produce, there is evidence of really good news – good news that costs money.
Hospital-acquired infections are down – “way down” – and well below the targets set by the Department of Health. Falls by patients while in hospital are down and with no fatal consequences. But falls are targeted for special attention during the current year to get them lower still.
The other major indicator which has shown a huge improvement is the hospital mortality figures – or the level of expected deaths. Eighteen months ago GWH had one of the worst figures among acute hospitals across the south and south-west of England. Their latest score puts them in the best four trusts in that same area.
Councillor’s on the Committee were also full of praise for the ‘dementia friendly’ ward GWH opened in November.
Yet as one of the Councillor’s said at Tuesday’s meeting, GWH’s record is “a bit of a curate’s egg” – with waiting times, two ‘never events’ and a slight rise in ‘serious incidents’ and the finances making up the bad bit of the egg – and the bit attracting most headlines.
However, after looking more deeply into the figures, it will not come as much of a surprise that GWH has been nominated for a national Patient Safety award at the annual CHKS Top Hospital Awards – which are the UK’s only data driven healthcare awards.
A Patient Safety award recognises outstanding performance from hospital trusts that have provided their patients with a safe hospital environment. Nominees are chosen through a range of indicators, including rates of hospital-acquired infections and mortality. Award winners will be announced later in the month.