DH chases up service changes with an undisguised urgency

5 October, 2011 | By Alastair McLellan

The Department of Health’s report on the NHS’s record in the months April to June presents an impressive list of achievements and the NHS staff responsible for them should rightly feel proud. But look closer and a less reassuring picture emerges.

In June 2010 just two trusts and no primary care trusts were predicting year-end deficits. This year the figures are six and three.

The 2010-11 first quarter forecast deficit was £55m. The actual figure turned out to be £103m. The year-end projections for 2011-12 are for deficits at the six trusts of £170m, and an overall surplus for trusts of just £61m. Tiny sums compared with overall NHS expenditure, but a worrying trend.

The DH report does not, of course, cover the foundation trust sector, but a similar picture is emerging there. Nearly one in five acute foundation trusts (15 out of 79) have financial at-risk ratings of one or two, 50 per cent higher than the last quarter.

Waiting times for care are holding steady, true, and there even seems to be some small success at last in controlling emergency admissions. But since December 2010 there has been a sustained rise in diagnostic waiting times – the time honoured way of managing waiting lists.

So what about progress against the £20bn quality, innovation, productivity and prevention target? The DH declares PCTs are “seeking £5.9bn of savings” in 2011-12, £3.1bn from acute services, which is “slightly ahead of schedule”. Heartening, except that the DH declined to tell HSJ how much has been saved to date. We encourage it to come up with an answer before health secretary Andrew Lansley and NHS chief executive Sir David Nicholson appear before Stephen Dorrell’s Commons health committee next Tuesday.

Drill deeper and two more significant concerns emerge. The first is that the worst financial pain is being felt in and around London. All the PCTs and trusts predicting a deficit can be found within a 22 mile radius of central London.

All of the NHS will be asking: is London “different” or simply first to feel the impact of reduced funding growth? The answer is that it is the particular challenges of the region which have led it to feel the pinch before others.

The second concern is that those trusts with problems appear to have very big ones – for example Pennine Acute Hospitals Trust accounts for over 10 per cent of all diagnostic waits of longer than six weeks. There are numerous other examples across a range of indicators – particularly financial ones.

Little wonder the DH report is full of exhortations, such as “organisations with large numbers of long waits for diagnostic tests must improve their performance quickly”. There is real concern that outliers on both finance and performance are getting even further away from the acceptable norm.

A very senior DH source told HSJ that those organisations and health economies unable to get a grip could expect “forensic” attention from the department. There is no one size fits all model being applied, but solutions are being sought with a rapidity that may surprise and perhaps alarm the local NHS, particularly GP commissioners.

It is encouraging to see the DH thinking about offering support to health economies facing service reconfiguration. Many HSJ readers will welcome the “cover” as they make difficult decisions, especially after a politically motivated moratorium delayed much planned service change.

The move is also a recognition that unless service change is driven much faster, the financial and performance problems may start to become critical in dozens of NHS organisations. The scale of the challenge, in London particularly, is now as much Mr Lansley and Sir David’s problem as that of NHS London chief executive Dame Ruth Carnall.

Readers' comments (6)

Anonymous | 5-Oct-2011 3:06 pm
"A very senior DH source told HSJ that those organisations and health economies unable to get a grip could expect “forensic” attention from the department. There is no one size fits all model being applied, but solutions are being sought with a rapidity that may surprise and perhaps alarm the local NHS, particularly GP commissioners."

If the GP's were wavering before, this certainly won't help. Those who believed the guff about the NHS being overmanaged by incompetent managers may begin to revise their views, when they see at first hand what 'forensic attention form the DoH' means in reality. Interesting times lie ahead.
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Patrick Newman | 5-Oct-2011 3:43 pm
Intense scrutiny of the 20bn QIPP savings is essential. If the DH have not got a master spreadsheet of all NHS organisations showing progress at least quarterly and 'troikas' going (A la Greek austerity) out to validate the implementations the savings will at best be paper savings at worst service cuts.
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Anonymous | 5-Oct-2011 4:49 pm
Is it more important to have a functioning NHS or £20b in QIPP? I feel everyone knows the correct answer except for George Osborne, poor man. Oh, actually he is not so poor, I hear.
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Anonymous | 6-Oct-2011 8:08 am
"Those who believed the guff about the NHS being overmanaged by incompetent managers may begin to revise their views, when they see at first hand what 'forensic attention form the DoH' means in reality."

What does this rhetorical question mean? In what way does forensic attention offset a perception of overmanaging incompetent managers? Penned by one of the incompetents I guess.

"...George Osborne, poor man. Oh, actually he is not so poor, I hear"

Slag off the Tory, play to the cheap seats. Very helpful. Here's a rhetorical question for you - if we can't get decent comments here what does that tell us about the calibre of 'NHS management'?

These are new, awful times for many of us. Hosing money around is no longer an option. Time to manage. Redesign, and deliver. And yes you'll get flak and people won't like you. That's why you're paid well. Put aside your cheap or cryptic comments and get on with what is needed. That 'forensic attention' will discover - as I have - that many managers are - whisper if you dare - incompetent. Nice people, but incompetent. Don't manage, don't follow up. Basic stuff. Without decent core skills in place this already monumental task becomes an intractable problem, and someone somewhere will eventually tire of funding a 'unique' managerial class and blow the lot up.

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Anonymous | 6-Oct-2011 10:20 am
I have to say that as a manager in an Imaging department, increase in waiting list is not all about cash. It isn't about number of radiologists employed as we have more than most other imaging departments.
The basic problem is that senior managers within the Trust bury their heads in sand for issues such as non-attendences of clinicians who are rostered and whilst being paid by the Trust on a regular basis. Management of annual leave, so that necessary numbers are in the department. We found that every year during August and Christmas we were down to 2 radiologists on many of the days out of 10 who are employed by the Trust. This not only increased patient waits but also meant that substantial amount of money was being spent on locum to keep some services within the department running.
It wasn't that senior managers were not made aware of these facts. They were. This included the Finance Director and the Chief Exec.
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Anonymous | 6-Oct-2011 10:33 am
It would be useful for DOH to provide details of how much public money has been wasted on getting rid of whistleblowers. This would include costs on legal fees, staff members either suspended or placed on 'garden leave'. Wastage of expertise within NHS.
These costs are further escalated by having to cover these staff members, who undertook their responsibility seriously, having to be covered by locums and/or having rises in the waiting lists.
DOH currently do not appear to support or protect any whistleblowers and this is costly to all concerned.
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