One of England’s most financially challenged foundation trusts had no “basic performance management systems” in place as it ran up a £8.3m deficit in six months, HSJ has been told.

Philippa Slinger, the recently appointed interim chief executive at Heatherwood and Wexham Park Hospitals Foundation Trust, said the organisation is “reforecasting” its finances to find new savings and produce a realistic prediction for the rest of 2011-12. She said the trust will finish 2011-12 in deficit, and she expects it to remain in the red during 2012-13.

The trust will review the local health economy before Christmas. This will determine whether Wexham Park – the district general hospital in Slough – is financially sustainable given the demands of the population and the finances available.

The Berkshire primary care trust cluster has acknowledged that elective activity in the county is higher than planned and that the area has a relatively low level of funding per head of population.

The trust is also subject to demographic pressures, including a population that local councillors, MPs and health leaders claim is significantly underestimated in official figures.

Ms Slinger joined the trust on an interim basis in late October, following the departure of Julie Burgess for health reasons a month earlier. She is on a six-month secondment from Berkshire Healthcare Foundation Trust.

The ups and downs of a trust in trouble

The Department of Health granted Heatherwood and Wexham Park a low interest £18m loan in September 2010 in an attempt to maintain services.

At the end of 2010-11 the trust reported it was in surplus after completing a year-long turnaround programme saving £12.5m. But by June 2011 the trust reported an “extremely adverse” financial trend, with rising monthly spending and an in-year deficit of £3.5m.

The trust revised its expected year-end shortfall to £4m the following month. But by September the year to date figure stood at £8.3m.

On arriving at Heatherwood and Wexham Park, she found there were no “basic performance management systems” in place, she told HSJ.

The trust had run a year-long turnaround programme beginning in early 2010 and was reporting a surplus by the end of 2010-11. However, its finances nosedived in the early part of 2011-12 as the strict controls imposed during turnaround were removed.

“There is not something you can see that says whether a division is hitting its targets, meeting its contract, [and is] on budget, [or that] its quality checks and safety checks are OK,” she said.

“I would have kept those turnaround structures in place probably for six months – I would have said: ‘We’re just going to keep the hands on this really tightly until we’re positive the things we did had worked.’”

“The good thing is, that’s quite fixable,” she said.

Systems are now being implemented to enable executives and divisional managers to monitor performance and address issues as they arise.

Despite the trust’s grim recent financial performance, Ms Slinger said she did not expect to close wards or stop providing services. Significant reductions in agency spending could be made through cutting average recruitment times from 72 days to 20, she said. Further gains could be made by paying local community services to set up a 24-hour nursing service, which would reduce reliance on costly “escalation beds” provided in the acute sector.

Ms Slinger said her “gut” feeling was the trust “ought to be” sustainable as a district general hospital.

Question mark over Heatherwood

The future of Heatherwood hospital, in Ascot, is uncertain. The facility has six operating theatres and carries out most of the trust’s elective surgery, along with outpatient and diagnostic work. Its birthing centre closed “temporarily” in September due to high levels of staff absence.

Interim chief executive Philippa Slinger said elective work was vital to the trust and those services could not easily be moved to the Wexham Park site.

She said: “It’s likely that there will [continue to] be a healthcare facility on the Heatherwood site. But the exact shape and nature of that isn’t known and I think there are all sorts of options for who might own and operate it”.

Options for consideration included the site being taken into private or voluntary sector ownership, or a combination of providers delivering services at Heatherwood.

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