The use of agency workers and contract staff contributed to FT providers spending £419m more on staff than planned, plus the rest of today’s news
4.22pm The Guardian reports that the EU has promised to include additional safeguards in the Transatlantic Trade and Investment Partnership, following concerns that the deal could be used by US firms to win health service contracts in the UK instead of the NHS.
In an interview with the paper, the EU trade commissioner Cecilia Malmström said courts that would arbitrate in-camera on corporate disputes needed to give US multinationals only a “limited possibility” of winning compensation if governments were to cancel privatisations or award public contracts to in-house bids.
Guardian columnist Christina Patterson writes that the best way to get an effective NHS workforce would be “for managers to get good people and let them get on with their jobs”.
Her comments come in light of reports that a review into NHS management by former M&S chief executive Stuart Rose has not be given a date to be published despite being submitted to the government.
It has been claimed that report will criticise the “totally shocking” management of the health service, which too heavily relies on “top-down diktats” and “mediocre managers” who are able to move from job-to-job with little accountability.
4.03pm Will Hazell tweets:
And Monitor says the £375m deficit forecast itself could be “understated” because previous forecasts by trusts have been “optimistic”
— Will Hazell (@whazell) February 20, 2015
Worth bearing in mind that this £375m forecast should be set against a planned deficit of £16m…
— Will Hazell (@whazell) February 20, 2015
4.00pm Here are some tweets from HSJ’s Will Hazell, with updates on his story earlier on Monitor’s quarter three report on the performance of the Foundation Trust sector:
Our story on Monitor’s Q3 report has been updated http://t.co/PV2BqHgcwf Stand by for some highlights from the report…
— Will Hazell (@whazell) February 20, 2015
Monitor is forecasting a £375m end of year deficit for the FT sector, which is £104m worse than what they were forecasting in November
— Will Hazell (@whazell) February 20, 2015
3.35pm Commenting on the quarterly report on the performance of NHS foundation trusts published by Monitor today, Richard Murray, director of policy at The King’s Fund said: “The figures published today show that foundation trusts’ financial performance continues to deteriorate, with Monitor expecting an end-of-year deficit of £375m.
“The mounting deficits make an NHS overspend this financial year more likely, meaning that the extra funds that the government made available to the health service for the next financial year may be needed to pay off this year’s deficit.
“If a solution is not found to these mounting financial difficulties, then patients will bear the cost as staff numbers are cut, waiting times rise and quality of care deteriorates.
“The position in the acute sector continues to be particularly difficult, with nearly three out of four hospitals currently in deficit. The prolonged slowdown in funding that the NHS is facing means that even well managed organisations are struggling to avoid significant debt. Emergency support is needed for otherwise sound organisations that are running up deficits as a result of the unprecedented pressures on their budget.
“A new health and social care transformation fund should also be established to meet the cost of essential changes to services. This is a big ask in the current financial climate but the money to do this cannot be found from existing NHS budgets.”
2.55pm An independent investigation into the handling of whistleblowing concerns at a West Midlands trust, commissioned by the NHS Trust Development Authority, is expected to report soon, HSJ has learned.
The TDA has confirmed to HSJ that independent company Verita was asked last year to examine a “complex whistleblowing” case at Royal Wolverhampton Hospitals Trust involving allegations of covering up high mortality rates.
HSJ has learned the inquiry is finalising its conclusions ahead of the report being published “very shortly”.
The investigation is believed to be looking into how trust chief executive David Loughton and the organisation responded to concerns raised by its head of clinical coding and data quality, Sandra Haynes-Kirkbright.
2.24pm Commenting on today’s third quarter provider finance figures from Monitor, Siva Anandaciva, head of analysis at NHS Providers, said:v“Over half the foundation trust sector is in deficit, including trusts with good financial track records, and the size of the foundation trust sector deficit is likely to reach £400m by the end of 2014/15.
“Despite years of under-funding in the face of rising demand the NHS has coped remarkably well in large part down to the hard work of frontline staff. But we are now at a critical point and this situation is simply not sustainable.
“NHS health and care providers are coping with increased pressure and patient demand by deploying more staff and keeping their winter pressure resources operating all year round. But quality and patient safety cannot be delivered indefinitely in the current funding environment without leading to financial unsustainability across the whole NHS provider sector.
“As we have seen with the response from the provider sector to the tariff consultation, and the level of deficits, asking providers to once again make 3-4% annual efficiency savings is simply not a credible position. It places too much pressure on providers from all sectors and passes financial risk around the NHS without addressing the fundamental problem.
“The NHS needs and deserves a commitment to transformation, a more stable multi-annual financial planning framework, and a more realistic answer to the funding challenges it faces in the short and medium-term”.
2.00pm The Report of the Kirkup Investigation into Morecambe Bay Foundatoin Trust will be published on Tuesday 3 March.
A report publication event will held at The Cumbria Grand Hotel, Lindale Road, Grange-Over-Sands, LA11 6EN, a spokesman for the investigation confirmed.
1.52pm James Titcombe, advisor on safety at the Care Quality Commission, tweets:
— Liza Brady (@LizaJ_Brady) February 20, 2015
1.33pm A group of Hampshire GPs has teamed up with the country’s largest mental health and community services trust in a bid to create an integrated primary care centre.
Six member practices from New Forest Healthcare have submitted a bid alongside Southern Health Foundation Trust for funding from the second tranche of the prime minister’s challenge fund to set up the service.
If the bid, worth approximately £1m, is successful then the centre will provide routine and urgent care at Lymington New Forest Hospital, which is run by Southern Health.
1.20pm London teaching hospitals have “unanimously” turned down an offer from NHS England to pay just a quarter of their previous allocation for highly specialist treatments.
The £62m fund, known as “Project Diamond” by the London trusts, used to be provided by the Department of Health and covered the increased cost of highly specialist treatments.
However, the DH announced in June that it would no longer be funding the work because its approach to research and development across the NHS had to be “fair to all trusts across the country”.
1.10pm Responding to Monitor’s third quarter report on the foundation trust sector’s performance, Paul Briddock, director of policy, Healthcare Financial Management Association, said: “The latest Monitor Quarter 3 Performance report for Foundation Trusts shows a disturbing position in terms of how the sector is performing.
“The combination of unprecedented levels of demand, with an 8 per cent increase in A&E attendances above last year and a 20 per cent increase in delayed transfers of care, together with the cumulative effects of year-on-year high levels of efficiency requirements, and the costs of implementing quality initiatives such as safer staffing levels continue to take their toll.
“An overall financial overspend for the sector of £321m is alarming, with 52 per cent of all FT’s and 73 per cent of acute foundation trusts now being in deficit. Key performance target failures on A&E 4 hour waits, 18 week admitted care and 62 day targets are equally concerning.
“Foundation trusts are working harder than ever against the sustained operational and financial pressures facing them and we continue to support our members who are carrying out very difficult roles at this time.
“But the Quarter 3 figures speak for themselves. Given the challenges facing the NHS, it cannot continue to work in the same way that it has in the past.
“Major changes to the way it delivers services, particularly around more joined up models of care across health and social care economies, are needed. And the speed at which these changes are taken forward needs to gather pace quickly.”
12:58pm The foundation trust sector finished last calendar year with a deficit five times higher than planned, in the latest sign of the ‘exceptional pressure’ the NHS is under.
According to new figures from Monitor, the sector reported a deficit of £321m over the nine months to 31 December, with 78 of the 149 FTs in England in deficit (53 per cent).
As well as struggling financially, FTs have now failed to meet national waiting time targets for accident and emergency, routine and cancer care for three successive quarters in the 2014-15 financial year.
The sector failed to achieve the A&E waiting time target of seeing 95 per cent of patients within four hours for the 2014 calendar year.
Patients waiting on a trolley for more than four hours in A&E increased by 134 per cent to 42,600 due to reduced bed availability between October and December.
12.08pm Colchester Hospital University NHS Foundation Trust has pledged to improve emergency care for patients and strengthen its financial position.
It has agreed to legally binding undertakings with Monitor, the health sector regulator, under which it will fix issues with how its emergency services are organised, led and staffed.
As a result, Colchester will now:
- develop and implement a focused and credible accident and emergency improvement plan
- take positive steps to improve nurse staffing levels
- work effectively with any future additional support arranged for the trust by Monitor
Monitor acted after an inspection of Colchester’s A&E and Emergency Assessment Unit by the Care Quality Commission rated it as ‘inadequate’. As a result, Colchester is now rated as ‘inadequate’ overall by the CQC.
Colchester has also agreed to take action to address the financial challenges it faces by developing and implementing an effective financial recovery plan for 2015/16.
The trust has been subject to enforcement action by Monitor since November 2013, including being placed in special measures for problems with its cancer services.
Katherine Cawley, regional director at Monitor, said: “Colchester isn’t providing its patients with the high quality emergency care they deserve, so we expect it to make improvements and quickly.
“Our action is designed to make sure Colchester’s emergency services are organised, well managed and adequately staffed. We also want Colchester to improve its finances, so it’s able to provide the people of North Essex with quality health services for the long-term.
“We will closely monitor the trust’s progress on making these improvements and won’t hesitate to take further action if necessary.”
11.52am The Foundation Trust sector has reported a deficit of £321m, which is five times more than planned, according to the regulator Monitor.
78 Foundation Trusts (53 per cent) were in deficit, of which 60 were acute trusts, figures from the nine months to 31 December show.
Analysis by the regulator shows that FTs saw 2.7m people in their Accident & Emergency units between October and December 2014, 8 per cent higher than the same period last year.
Subsequently, hospitals admitted 570,000 for further treatment, which is an extra 40,000 patients compared to last year.
In addition, foundation trusts treated over 2.3m non-emergency patients in the quarter, an increase of 7 per cent over the same period last year.
However, this increased activity, combined with the continued need to make cost savings and use expensive agency staff, is putting trusts under exceptional pressure, the watchdog said today.
IT reports that ambulance foundation trusts dealt with 933,000 calls, a 13 per cent increase compared to the same period last year, but some have staff vacancy rates of up to 24 per cent.
The 149 FTs (which make up nearly two-thirds of all NHS trusts) have failed to meet national waiting times targets for accident and emergency, routine and cancer care for three successive quarters.
A report to Monitor’s board on the performance of the foundation trust sector over the nine months ended 31 December 2014 also found:
- The sector as a whole failed the A&E waiting time target of seeing 95 per cent patients within four hours for the calendar year 2014;
- Trusts met some cancer waiting times targets for 62 day screening services, 31 first days treatment and two-week referrals;
- 42,600 people – an increase of 134 per cent - waited on a trolley for more than four hours between the decision to admit them to A&E and their arrival on a ward, due to reduced bed availability between October and December 2014;
- There was an 8 per cent increase (158,000 to 171,000) in the number of journeys made by FT ambulance services;
- Trusts had a combined waiting list of 1.65m, which was 40,000 less than between July and September 2014, but still 2.5 per cent higher than last year;
- Trusts spent £419m more on staff than planned because of high use of contract and agency staff;
- Trusts made £810m worth of cost savings which is £210m less than planned;
- Monitor took regulatory action against 28 trusts (19 per cent of the sector) because of governance or financial concerns.
Dr David Bennett, Chief Executive at Monitor, said: “Trusts are working harder than ever to overcome the challenges they face while still meeting patients’ expectations for quality care. However, the NHS needs to move rapidly towards more joined-up, efficient models of care if it is to deal with this continuing growth in demand for services”.
11.26am The number of people killing themselves has risen, with male suicides reaching their highest rate in more than a decade, The Daily Telegraph reports.
A total of 6,233 suicides were recorded among people aged 15 and over in 2013, the Office for National Statistics said, a 252 – or four per cent – rise on the previous year.
Seventy eight per cent, or 4,858, of recorded suicides were men compared with 1,375 female deaths.
11.11am Looking to this morning’s papers,The Times reports that a mental health task force has demanded an overhaul of failing children’s mental health services, according to a leaked government report.
Acutely ill children and teenagers fall through the gaps of a fragmented system that lets managers “pass the buck” for failures, a task force commissioned by ministers said.
It called on them to rip up a disjointed model of care and spend more on children’s mental health to head off lifelong problems.
Waiting times for care have risen as the children’s mental health budget has been cut by NHS chiefs who regard it as soft target, the task force’s draft report said.
The paper also reports that a failing mental health trust whose treatment was “uncaring” and whose patients were at risk because of a shortage of staff and beds has become the first to be put into special measures.
Too many patients at Norfolk and Suffolk NHS Foundation Trust were being restrained, men had to use the ladies’ lavatory and staff morale was low, the Care Quality Commission found in an inspection last month.
Regulators have stepped in to oversee management, offer leadership training and arrange help from a better-run organisation. Managers will be replaced if improvements are not made, the paper writes.
In a leader, the paper writes that successive governments have let Britain’s children down by failing to take seriously the scourge of teenage mental illness.
The cost of this failure is incalculable, it adds.
The leader says that the coalition has broken a promise it made in 2011 to invest in better, earlier treatment for vulnerable youngsters.
Funding for child and adolescent mental health services fell by £49 million in the first three years of this parliament and, with a few small-scale exceptions, the stream-lining of a complex “tiered” system that too often delays specialist care has not happened.
10.34am We are now just 2 weeks away from the entry deadline for the Patient Safety Awards. Whether you wish to enter as an individual, a team or an organisation there is a category for you. The entry process this year is quicker and easier than ever so there is still plenty of time. Register today and submit your entry by 6 March.
10.14am More than 200 patients have been waiting over a year for spinal surgery at North Bristol Trust, figures for December reveal.
The NHS England figures come despite a trust decision in October to close the service to new referrals in an effort to manage and reduce its waiting time backlog.
The December figures, which are the latest available, show that orthopaedics patients account for 201 of the 247 people who were waiting over a year for elective treatment.
7.00am Good morning and welcome to HSJ Live. We’ll start with news of a report by the Alzheimer’s Society, which finds that care for people diagnosed with dementia is ‘inadequate and still not fit for purpose’, three years after the government launched its dementia challenge.
The report, shared exclusively with HSJ, calls for carers of people with dementia employed or contracted by local authorities to be paid a minimum wage and for improved training and better post diagnosis support for sufferers and families.
While the Dementia Today and Tomorrow report recognises there has been progress, it says there are still wide variations in the quality of care.