The must-read stories and debate in health policy and leadership.

Too great expectations

A trust chief executive has panned regulators over the decision to withhold winter capital funding, warning it was the patients who would ultimately suffer.

Chief executive for Mid Cheshire Hospitals Foundation Trust, Tracy Bullock, said the funding, which the trust had initially successfully bid for, had been earmarked for a portable ward to expand its accident and emergency department capacity during the frostier months of the year. And, while a portable ward might not be anybody’s first choice for a festive outing, many would still find it preferable to waiting in a corridor.

Why was the funding denied, you ask? Ms Bullock told HSJ the trust would not meet three conditions prescribed by the regulators. According to the trust, these were:

  • Reduce A&E four hour breaches by 50 per cent over winter
  • 2018-19 financial plans must not be impacted by any work related to the funding
  • Funding must be spent by 24 December 2018

Readers may find the first requirement particularly eye watering. For a trust already struggling to meet the four hour waiting time target, a 50 per cent reduction over the busiest time of year would be a difficult task, to say the least. And, considering a substantial chunk of the trust’s breaches are caused by lack of space, the pulling of the money for the portable ward could now make any improvements even harder. NHS England said the trust application was not approved because it did not meet criteria.

Show me the money

An extra £10m is not to be sniffed at by any trust, so South East Coast Ambulance Service Foundation Trust is doubtless delighted at the commissioners’ decision to cough up the cash to help it meet the ambulance response programme targets.

SECAmb has been struggling with some of these and it, along with the 22 clinical commissioning groups across its area, had commissioned a review of the demand and capacity of its services. This review made it clear that SECAmb needed additional resources to meet the ARP targets.

On the other hand, the recent funding decision is likely to be unwelcome news for the CCGs, many of which had large deficits in 2017-18. HSJ highlighted earlier this year that several ambulance trusts were seeking extra funding to meet the targets – primarily to recruit more staff but also, in some cases, to fund more vehicles, reflecting the different demands of the ARP compared with the old system. Only four ambulance trusts met the seven minute response standard for the most serious calls in the last available data from NHS England so, although the picture is generally improving, there is still some way to go.

SECAmb is genuinely hopeful that the additional funding will make a difference, although it is also keen to point out it will need to change as an organisation to ensure it delivers the improvements everyone wants to see.

But will it be enough? The review suggested the trust would need £203-£208m to meet the ARP standards early in the next financial year and £215m-219m by the end of 2020-21. SECAmb currently expects to have around £190m, including the promised extra money, in its emergency pot for this financial year. It says it expects to finalise details of the contract for the next two years with commissioners in line with those amounts. That suggests commissioners may have to dig even deeper into their pockets to fund the service in coming years.