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Trust issues and dreaming spires

NHS Improvement has taken enforcement action against Oxford University Hospitals Foundation Trust for breaching the conditions of its licence due to ongoing problems with long waits, accident and emergency performance and unravelling finances.

The university city trust was under regulatory scrutiny throughout last year for missing major national targets.

It closed quarter four 2017-18 14 percentage points short of the 95 per cent national target of admitting or discharging emergency patients within four hours. It also failed to meet referral to treatment targets.

OUHT’s finances continue to deteriorate. The trust has rejected its 2018-19 control total of a £23.7m surplus, and instead is forecasting a deficit of £25m, excluding sustainability and transformation funding. It finished the last financial year £31.7m short of plan.

NHS Improvement’s enforcement undertaking means the trust has to create and implement improvement plans across six priorities: emergency care, planned care (including cancer and other elective care), financial sustainability, governance and strategic workforce planning.

It has told the trust that if it fails to comply with the undertakings it will be “liable to further formal action by NHS Improvement”.

OUHT told HSJ it is “committed” to improving performance.

While it needs to step up its performance, to alleviate pressure it is still reliant on the Oxfordshire health economy to come together to solve system wide problems such as demand, patient flow and delayed discharges of care. This is not an easy ask – earlier in the year the Care Quality Commission warned that organisations across the region still struggled to trust each other.


Arbitration is the NHS version of the small claims court, although in one case HSJ reports this week, the claim was far from insubstantial.

The process kicks in when trusts and commissioners cannot agree who owes what at year end. 

In Barking, Havering and Redbridge, more than £25m was disputed between the clinical commissioning groups and their main acute provider Barking, Havering and Redbridge University Hospitals Trust.

The trust is having a difficult time financially, with a £50m deficit blackhole opening up towards the end of 2017-18.

Having failed to reach an agreement locally, the matter was escalated to NHS England to arbitrate on (commissioning disputes involving NHS England also get escalated via NHS England, the national body lost a case against Brighton last year then tried to keep it a secret fearing it would encourage more challenges).

No one likes to talk about the arbitration process because it shows up the failure to act like the single NHS the public expects it to be.

The lay person would probably be unimpressed when it is explained that a costly (in time, at least) process had to be undertaken because, legally, trusts and commissioners are obliged to play shop – meaning real money gets spent arguing over which bit of the NHS some pretend money ends up in.

It’s similar to when the NHS trumpets “integration” between organisations the public didn’t know were separate.