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Still fragile

Brighton and Sussex University Hospitals Trust has had a difficult journey over the past two years, having been subjected to a lot of regulatory intervention over poor care concerns and inadequate governance and management.

The trust’s financial health has also been a driver of regulatory pressure from NHS Improvement.

On both quality and finance, BSUH had showed signs of improvement under the leadership of Dame Marianne Griffiths. First, the trust exited financial special measures in July last year and then got the Care Quality Commission seal of approval in January this year with a rare jump from an “inadequate” to a “good” overall rating. The trust was also taken out of quality special measures in January. 

But a new undertakings document, published by NHSI, reveals the trust’s continuing poor performance across a whole gamut of metrics, including accident and emergency, referral to treatment, 62-day cancer and diagnostics.

Maintaining safety and quality of care under such pressured circumstances is not easy and BSUH is looking fragile.

Meanwhile, the trust’s finances, although improved, still show significant overspending with a forecast control total target of a £53m deficit.

Given the circumstances, NHSI’s demand for new undertakings and both a financial and performance plan are, on one hand, entirely understandable.

On the other hand, if regulation and intervention by managers far away from the frontline were the solution to such issues, the NHS provider sector would’ve broken even a long time ago, with a bunch of Care Quality Commission “good” and “outstanding” ratings to boot. 

In demanding BSUH staff meet with them regularly and get agreement on any plans, NHSI officials need to make sure they don’t make matters worse and erode BSUH’s delicate improvement further.

Public sector bodies are usually loath to take each other to court, but that has not prevented a legal dispute between a well-regarded NHS foundation trust and the government’s tax collector.

In June, Northumbria Healthcare Foundation Trust won a judicial review against Her Majesty’s Revenue and Customs over £14m of VAT claims which the trust argued it was entitled to reclaim.

The money relates to the trust’s innovative car scheme, NHS Fleet Solutions, which is used by many public sector organisations.

The case was a significant triumph for the trust, though it is unclear how the money will be redistributed among Fleet Solutions’ clientele.

But HMRC decided to appeal the outcome and granted permission to do so by the High Court.

This means it is very likely no money will be forthcoming to the trust for at least another year.

Inevitably the question of “is it worth it for the taxpayer” crops up when the public sector fights itself in court.

In this case, however, there are thousands of NHS Fleet Solutions’ individual customers who could, in theory, be entitled to a refund if the trust fends off the appeal.

Daily Insight believes most of those customers would feel the trust’s cause is worth fighting.