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Turning the tables

Not that long ago, Sir David Nicholson was sending missives to troubled NHS organisations, ordering them to get their house in order.

Now, the former NHS England chief executive (and national and regional chief) chairs a troubled hospital trust which is on the receiving end of such missives and which, under Sir David, has rejected its latest marching orders from the centre.

Worcestershire Hospitals Acute Trust is one of just four in England to have declined to agree to a control total – essentially a financial plan – with NHS England/Improvement for 2019-20.

The centre told the trust to hit a £64.4m deficit. The trust responded earlier this year by saying the most it could commit to was an £82.2m deficit. The trust has since shifted to £73m, but this is still well short of the saving the centre insists can be achieved.

Last time the trust agreed to its control total, for 2018-19, it was different people doing the agreeing. Sir David was only appointed (initially interim) chair in May last year, while the current chief executive, Matthew Hopkins, started in January this year.

Back then, the trust agreed to a deficit of £41.5m. It ended up reporting a £73.3m deficit, the third largest shortfall against plan in the country.

This time, the trust is more wary of unrealistic saving targets, although it has still committed to a 5 per cent efficiency target for 2019-20.

Instead, it has spent money on 100 beds (and staff) to relieve pressure on the hospital.  While it could have made further savings to meet the centre’s target (or at least promised to do so), Sir David’s trust has instead spent money on safer and better quality care, which is sorely needed at the under pressure organisation.

Of course he is also a former local senior manager and general hospital chief executive – and may feel that now as in his executive days, if he can defy the odds and turnaround finance, quality and performance in Worcestershire, he will be forgiven a few clashes with the regulator.

Frustration is growing among NHS procurement professionals about the lack of detail on savings expected from a new centralised purchasing model.

From April, trusts have had portions of tariff income withheld by NHS England. These amounts have been used to fund the operating costs of NHS Supply Chain, which has been reorganised in a bid to deliver savings for the NHS.

But NHS Supply Chain have recently told trusts a “system issue” was preventing the organisation from working out accurate savings forecasts.

In a nutshell, this means trusts are paying for a service with little idea of what they are getting in return. This makes it harder for local procurement chiefs to deliver much-needed savings within their own organisation, and NHS Supply Chain has acknowledged the “challenging conversations” these unfortunate souls will now likely face with their finance teams.

Previous estimates released by NHS Supply Chain suggest the anticipated savings from the procurement of common medical equipment and consumables range from hundreds of thousands of pounds to several million, depending on how much a trust uses NHS Supply Chain.

NHS Supply Chain has made solving the problems its utmost priority, but it’s unlikely that this will happen fully until at least the autumn.