• BSUH agrees formal undertakings with NHS Improvement
  • Regulator is concerned over poor performance and financial deficit
  • Trust left special measures earlier this year

Brighton and Sussex University Hospitals Trust has agreed a revamped recovery plan with NHS Improvement amid concerns over its financial and waiting time performance.

The regulator believes the trust is in breach of its licence and could take formal action if it fails to improve.

BSUH left financial special measures in July 2018 and quality special measures in January this year. This followed a Care Quality Commission inspection, in which inspectors raised its rating from “inadequate” to “good”.

However, the agreement between NHSI and BUSH states: ”In light of the scale of the trust’s underlying financial position and [its] 3Ts [capital investment] programme, there is clearly considerable risk to achieving financial sustainability.

“It is therefore critical that the trust has a robust and stretching medium-term financial recovery plan in place.”

The agreement added: “The trust has taken effective action to address its governance failures since the undertakings of March 2017, but further improvements are required. In addition, the performance issues outlined above demonstrate that further work is required to effectively implement the systems and processes outlined above in so far as they relate to operational performance.”

According to documents published by NHSI, the trust reported 160 12-hour trolley waits in January and February this year while performance against the four-hour accident and emergency standard dropped to 76 per cent in February.

The regulator also said the trust was one of the worst providers nationally for diagnostic waits, reporting 25 per cent of patients waiting six weeks or more in January, compared to the target of 1 per cent.

On referral to treatment waits, the trust waiting list had grown by 10,000 by March 2019, compared to a year earlier. The trust also reported new 52-week waiters, having managed to reduce these to zero in 2018. Overall, RTT performance was 77 per cent against the 95 per cent target for patients to be seen in 18 weeks.

On 62-day cancer waits, the trust achieved 65.7 per cent of patients beginning treatment against the target of 95 per cent.

For the coming year, the trust has agreed to end the year with a deficit of £53m (excluding provider sustainability fund funding of £24.5m) and told HSJ it was on target, with a deficit of £17.8m for quarter one. The trust has agreed to achieve savings of £27m, equivalent of 4.5 per cent of turnover.

NHSI has required the trust to draw up a medium term financial plan which must be agreed both by the trust board and the regulator.

This plan must address the underlying drivers of the deficit “to a scope and timescale agreed with NHS Improvement” and incorporate demand and capacity planning as well as being aligned to STP plans. The trust must also develop a performance plan with trajectories to improve across all waiting times which will be agreed with NHSI.

The undertakings insist trust staff must be made available to NHSI “as needed” and there must be management action to deliver the agreed plans. The trust must also attend any meetings considered necessary by NHSI should circumstances change.

In a statement, trust chief executive Dame Marianne Griffiths told HSJ the trust had made “significant improvements over the last two years”.

She added: “The new undertaking agreed with NHS Improvement also recognises the progress made by the trust and the confidence NHSI has in the organisation’s financial management and performance plans.

“BSUH has agreed a finance plan which will reduce its current deficit and achieve financial sustainability.”

She said the trust was on target and would “continue to work closely with NHSI during the delivery of both the financial and performance plans”.