Wednesday, 26 October 2016

NHS England hold Lancashire Hospital Trust to Ransom

A local Hospital Trust have been told to get their deficits under control or face bankruptcy.

Lancashire Teaching Hospitals (LTH) NHS foundation trust still have a deficit¹ of £10.8million. They blame temporary changes to emergency services at Chorley & South Ribble Hospital for driving all of the deficit including both the income and expenditure.

The deficit as a result of the Chorley A&E closure was reported as £1.7million which has resulted in the trust being refused £3.3 million from the sustainability and transformation fund (STF) from NHS England.

The LTH Trust have applied to the Department of Health for a loan of £15.3million of which £13.1million would support the revenue deficit² and £2.2million would support capital expenditure.

Before becoming a foundation trust the Dept of Health were obliged to help out a trust without resorting to the trust asking for a loan. So the real tragedy of being a foundation trust has now hit home and LTH are having to 'borrow' more money to cover the loss of the A&E tariff due to the temporary closure (a tariff is a fixed amount of money the trust gets per patient with the amount depending on the procedure, more high-risk/complex procedures demand more money).

The Trust have indicated to the health regulator NHS Improvement (formerly Monitor) that a further revenue loan may be required to offset the costs associated with the temporary closure of the Chorley emergency department and any resultant effect to the sustainability and transformation fund (STF).

The above is worrying. the cost of closing Chorley A&E is £1.7m plus the £3.3m loss of the STF results in potentially borrowing another £5m. If LTH can't make up the shortfall in the meantime, they don't get the STF funding. Yet if they don't get the STF money they might just 'have' to continue to borrow more placing their part-time re-opening of Chorley A&E at risk.

The Finance Director added that there would be further impact on the Trust’s financial position following introduction of the urgent care centre (UCC) service in November 2016.

Now we have a REAL problem. 'further impact on finances' means the deficit is likely to go up and not down. WHY on EARTH have the trust not undertaken a financial risk assessment when their bid for the UCCs failed?

There's no excuse since they were already managing the UCC's so the problem must be down to the something else?

The trust are asking the new UCC service provider GTD Healthcare* if they may have access to recorded activity [from UCC activities] to include within trust performance data.

This seems strange since the trust seem to be claiming credit for operations undertaken by a separate organisation (GTD Health who will be running the UCC from Jan 2017).
The LTH trust board again confirmed that demand and ambulance transfers had increased since the closure of C&SRH A&E. Indicating the problem still exists.
Due to changes in the Health & Social Care Act 2012, Clinical Commissioning Groups (CCGs) are now under no obligation to provide healthcare services to people who are not registered with a GP practice. This means that patients presenting at hospital could be turned away and redirected to a doctor instead. The Lancashire Hospital Trusts medical director Mark Pugh seems to emphasise this in the board report topic on 'A&E improvement programme'..
"The Medical Director noted that data was also available to show changes in behaviours, for example patients not registered with GPs who would need to be diverted to GPs for appropriate advice".
It had been confirmed that the urgent care centre service may not mobilise from November 2016 and it may take until January 2017 to introduce the service.

There are already communications problems between the GoToDoc healthcare Ltd and the trust.

Weeks have now passed and GTD have yet to reply to the trusts request for information. Disputes between GTD and LTH trust already seem to have arisen over a contract for accommodation and...
It was explained that the Trust had been asked whether the urgent care centre service could be covered by GPs working with the Trust at the moment to bridge the gap. A copy of an email had been received from the CCGs which asked GoToDoc to contact the Trust although this had not yet happened. The Company Secretary was currently working on the accommodation contract as the Trust would be acting as landlord for the urgent care centre facility and it was noted that no Trust staff would TUPE to GoToDoc and would remain as Trust employees. Mr M Welsh commented that GoToDoc might attempt to recruit existing Trust staff which would increase the staffing deficit within the Trust’s urgent/emergency services. It was agreed that this should be included on the risk register.

More Doctors Leaving?

"this week the Trust had lost two doctors to a Trust in Derby owing to a more attractive night-time rota and attempts were currently being made by the Trust [LTH] to secure three more doctors".

Only last week [20th Oct], Huddersfield Royal Infirmary, run by Calderdale and Huddersfield NHS Foundation Trust, was proposed by the local CCGs to be closed and demolished under their STP program titled 'Right Time Right Care Right Place'. Due to similarities, LTH trust are now considering following the same program as Calderdale and are discussing joint communications with the Calderdale & Huddersfield trust. From the LTH board report....
"A slide presentation had also been circulated which provided an outline of a visit that had been undertaken to Calderdale and Huddersfield NHS Foundation Trust to discuss their [STP] programme which was similar in content to the Our Health Our Care programme".
A patient safety risk had been introduced as the Preston Primary Care Centre group were not prepared to support out-of-hours cover at Chorley and the Chorley Medics had relocated from the Chorley and South Ribble Hospital site [to Euxton]. Risks highlighted through loss of income and financial consequences in relation to the urgent care centre service.
  • The trusts October board report states that 78 out of 90 beds had been introduced following the CQC inspection in July 2014 but have now been decommissioned. Ironically, the Lancashire Trust now claim there is not enough capacity in acute services which is impacting directly on the delivery of key access targets.

STP related contracts have been brought forward and must be signed by 23rd of December 2016 indicating accelerated plans for privatisation before public consultation periods end. NHS England are basically holding hospital trusts to ransom if the trusts don't meet financial targets by fixed dates.

This will inevitably result in trusts cutting corners resulting in poor quality patient care.

LTH Trust are rated RED in 6 out of 8 of the required NHS England standards potentially involving NHSI intervening. The trust could go bankrupt or be taken over by another provider.

source: LTH board papers 5 October 2016

*Go To Doc Limited aka GTD Healthcare Limited are registered with the Care Quality Commission as a 'limited' company. See Here under 'Who runs this service'...

GTD Healthcare Limited refer patients to clinics and surgeries operated by GTD Primary Care Limited. GTD Primary Care Ltd are registered on company house as a 'for-profit' company.

¹deficit is where a sum of money falls short of what is needed; debt

²revenue deficit is where the net amount received by a company in revenue (income) is less than the net amount projected (expenses).

TUPE is the Transfer of Undertakings (Protection of Employment) Regulations, 2006, and its purpose is to preserve staff contractual terms and conditions of service, following their transfer from one organisation to another. 

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