• East Sussex board was not challenging enough
  • CCGs lacked expertise and discussion of finances
  • Regulators warn that finances still ‘unsustainable’

A trust with financial problems was told to consider “refreshing” its board to ensure more challenge and expertise. 

A governance review was carried out earlier this year by Deloitte consultants into East Sussex Healthcare Trust, which has grappled with major finance and quality problems in recent years. The report was published this week.

It praised the chief executive Adrian Bull and progress made on care quality.

However, it highlighted “relatively low levels of scrutiny and challenge” from non-executives, especially about finance.

It was critical of the level of insight and contributions from non-executives at a board meeting with questions said to be too basic, and some non-executives being “passive” with a lack of consistent follow up questioning. “There is still scope to effectively challenge without being confrontational,” the report said.

The review recommended making changes to the board. The trust told HSJ this week: “As part of our normal governance cycle, two non-executive board members came to the end of their terms of office this year and two new non-executives have recently joined the trust.

“One of these is chairing our audit committee. We are confident that we have an effective mix of skills and experience on the board.”

The review also said the chief executive should reinforce the message that “the financial situation is critical, and that the staff need to own the issue and tackle it collectively”.

The trust recorded a deficit of £55m at the end of 2017-18 and is in financial special measures. It is part of a particularly challenged health economy with two local clinical commissioning groups – Hastings and Rother CCG and Eastbourne, Hailsham and Seaford CCG – having a combined deficit of £37m at the end of 2017-18.

A governance review of the CCGs – completed in August and also published this week – found poor financial control and noted an “unprecedented” savings target of 8 per cent of allocation in 2017-18, which was missed. It said there was significant risk of missing their 2018-19 control totals.

A lack of commissioning expertise, “inadequate” levels of discussion of the financial position, lack of structured development of the governing bodies, and limited succession planning also contributed to problems, it found.

Amanda Philpott, the former accountable officer for the two CCGs, has since moved to the role of executive director of health and care strategy across all Sussex and East Surrey CCGs.

South East regional director for NHS Improvement and NHS England Anne Eden said since the reviews took place East Sussex had improved leadership, decision making and care quality. “However, the shared financial position remains unsustainable,” she added.

“Despite some short-term improvement to ensure the in-year financial position does not deteriorate further, the system must take urgent action together to restore financial balance while maintaining and improving the quality of care for local patients.”

The CCGs and the trust said in a joint statement: “We are working together to respond to the challenges we face, taking action in a more joined up way and ensuring we are making better use of the resources available.”