London Eye: ‘The plans are mainly b*&^%~ks’

What a mess financial planning has been for 2024-25.

“We are all being pushed to do ‘at least’ 2 per cent reductions [in spend] but this seems to vary depending on who you talk to,” said one senior leader in the capital.

At its board meeting last week, £2.5bn-turnover behemoth Guy’s and St Thomas’ Foundation Trust declared it had made a small surplus in 2023-24 and would break even in 2024-25.

The latter commitment would come on the back of a 4 per cent cost saving, around £100m.

Hmm.

Both of these sound, well, surprising given the internal communications from GSTT on its financial straits.

In February Amanda Pritchard’s old trust said it was anticipating a £55.3m deficit if it could hit a £93.8m savings target. Now it will break even.

So heroic optimism on the part of the board?

A senior manager in another part of the capital: “The issue is the staffing reductions and general budget envelopes are undeliverable. Everyone knows this but will sign up to get the year up and running”.

Reminder, planning for this financial year might not be complete until this month, the second of this financial year, because the planning guidance came out three months later than usual – one working day before the start of the financial year.

What does this mean?

“It should be obvious by the end of quarter two that the plans are mainly bollocks”.

London Eye has written before about how senior managers, who are supposed to model candour and integrity to the rest of their organisations, shouldn’t be put in the position of submitting knowingly wrong plans for the year. Especially plans that look like they are going to involve significant job cuts (even if in practice it just means fewer bank shifts – that’s still staff going into summer having to re-plan their family finances, even before we reckon with the standards of care in even more poorly staffed wards).

And can Wellington House really think we’ve reached the threshold where we have too many nurses? That we’ve reached the threshold above which more nurses (registered nurses) won’t make a difference?

In reality, the threshold regarding safe care is in the other direction. Ask any clinician.

And even if the gamble is “no one can really measure how safe care is anyway, and there’s no freedom to speak up guardian for trust chief execs”, what is more easily measurable is what happens when you cancel all the weekend waiting-list initiatives.

But then that’s a target the government isn’t putting much store in at the moment.

Maybe the entire provider sector will be put in the mandated intensive support regime.

NHS leaders London Eye spoke to feel strongly about their lowest-paid workers getting the London Living Wage in 2024-25. Whether this happens or not is a live question. Unite workers at Barts are also due to go on strike next week over a lump sum they are owed from working during covid.

But with junior doctors potentially striking over the summer (likely in the school holidays for maximum disruption) and trusts being asked to plan for fewer staff we might see a lot of black alerts in the run-up to the election.

The future of medicine

Talking of junior doctors, NHS England (the part of it that used to be Health Education England) withdrew 11 general surgical trainees from Barnet Hospital last month.

Training isn’t just the future of medicine and a significant source of income and prestige for trusts, it’s also one of the best gauges of culture at an organisation.

In December a consultant working at Imperial College Healthcare Trust was investigated for confiscating the shoes of junior doctors until patient discharge admin was completed. London Eye understands a formal process was carried out.

The General Medical Council education director in the Barnet case said trainees reported “a culture of fear, worry and feeling unsupported and unable to raise concerns”.

In theory, a service could be safe despite a culture of fear, worry and a lack of support. In theory. But no unit where staff feel unable to raise concerns is likely to be safe.

Incidents like Barnet and the shoes have always happened because medical training has often been brutal, one way or another.

What might be different is the willingness of juniors to speak up now.

If there is a change of government in the next eight months it will be interesting to see whether there is a sudden outbreak of candour higher up the ladder also, about the state and safety of services since the pandemic.

Chair of the Trust of the Year

The role of chair in an NHS trust is not always an exalted one. The former regional director got rid of many of them in the capital, and they were routinely seen as roles that could be casually doubled in scope by creating joint posts across multi-billion-pound turnover organisations.

But one chair stepping down this month received a notable level of praise from former colleagues.

Andy Trotter has led the non-executives at Oxleas Foundation Trust for eight years and leaves an organisation that won HSJ Trust of the Year in November.

One former colleague told London Eye retired senior police officers made good chairs “because they’ve seen everything, unflappable”.

Another pointed out that Mr Trotter had brought three first-time chief executives successfully through Oxleas, an uncommon feat in the NHS. The former Met deputy assistant commissioner remains chair at the London Ambulance Service Trust, appointed in 2022.