Evidence submitted by David Dufty (Def
20)
Personal Background. Selected almost direct
from the national NHS administrative training scheme to run a
major district general hospital, I served as deputy group secretary
in West Suffolk and district administrator to East Suffolk, bar
Waveney before becoming an African specialist health management
consultant. In August last year, because of the developing
NHS financial crisis in Suffolk, I joined Suffolk Coastal PPIForum.
Since then I have produced one paper to inform Suffolk OSC and
Suffolk PPIForums discussions on the funding crisis and have been
ensuring HM Opposition Parties have been updated on any NHS developments,
particularly in Suffolk and East Anglia but also nationally.
Summary. Blame for the overspending generally
is laid squarely on the Department of Health, mainly for misapplying
the funding formula to Trusts but also listing numerous more minor
funding failures.
1. Reasons for the deficits. There are very
many reasons but undoubtedly the major factor has been disregard
by the Department and possibly Cabinet, of the timing for implementation
of the recommendations in the Black and Wanless Reports.
As a result financial allocations have been made based mainly
on mortality and morbidity levels compared with the national average,
with complete disregard for the initial steps required, in both
reports, before that stage was reached.[120]
2. The remaining mistakes will undoubtedly
be reported to the Committee in depth but can be summarized as:
Misunderstanding of the financial impact of
PFI building projects on trust budgets.
Misapplication of Gershon Report recommendations
ie The large 2004-05 consultant contract salary increases were
only 70% funded to trusts.
Extraordinary generous new contract terms for
both consultants and GPs. The GPs contract increased out
of hours overheads substantially despite a negotiated reduction
in GPs income for opting out of oncall. It is understood
the Prime Minister undertook to raise NHS income to the average
level in Europe: not to make our senior medical staff the highest
paid in Europe, which appears to have been how the Department
understood it.
Poor Department ISTC contract negotiations resulting
in large financial losses to trusts.
Central enforcement of targets which required
extra expenditure eg Additional weekend operating sessions on
very high rates of pay.
Retention of a nurse training programme with
excessive wastage rates (Which is commonly held by many
senior nurses to develop a nurse lacking in "TLC" (Tender
loving care attributes for which UK trained nurses were acknowledged
international leaders).
Failure to make any funding allowance for inappropriate
distribution and size of health buildings (Surrey and Sussex seem
to be the hardest hit).
Failure to make any funding allowance for the
additional travel required in rural areas.
3. This list identifies the causes as Department
of Health systemic. Of recent years it appears to have become
routine for the Department to blame local management for deficits
without prior self-analysis (An essential management step before
any other consideration of blame is taken). In any large organisation
there are bound to be some below average performers but the experience
in Suffolk would indicate the need for an HR assessment throughout
the UK NHS to ascertain if redeployment at senior level has been
excessive and wasteful of valuable staff resources as a direct
result of this somewhat inept performance. In this connection
the profound statement by Peter Hoima, Chief Executive St George's
Healthcare Trust reported 16.2 06 is apposite: "Troubled
organisations often get the most inexperienced leadership. The
troubled organisations need to get the most experienced managers,
who should regard it as among their most important career challenges
to have the privilege of helping transform an organisation and
liberate the talent. A lot of relatively inexperienced individuals
appointed to work in troubled trusts become casualties—not
because they are not good, but because the system has not cared
for them. We have done some scandalous things. Second, we
need to move from slogans to precise diagnosis and action . We
use slogans as a substitute for deep thought and that's not good
enough. Third, we think in quantum leaps but we implement in small
steps".(HSJ P.23)
4. Effect on Care & Job Losses. Suffolk,
so far, thanks to recently appointed capable management, has not
suffered greatly. It is the general view amongst recently retired
consultants and GPs that unless there is soon some adjustment
in the funding, standards will fall in a number of areas. It is
already evident that hospital nurse staffing levels are inadequate
to reduce hospital generated infections fast enough and care correctly
for the elderly.
There was a contract dispute between Suffolk
East PCT and the Ipswich Hospital NHS Trust that went to arbitration
and which favoured the PCT, As a result the hospital is having
to lose staff. It is easy to understand the drastic impact this
could have when one knows peak winter ward occupancy with present
staff is frequently well over 90% which is far too high to consistently
maintain quality care.
5. Period over which the Balance should
be Achieved.
If my first major point is accepted this should
cease to be a problem in many trusts though, due to bountiful
largesse in others, it may create some financial problems.
If it is not accepted, then at least three
years as a minimum but in the case of those trusts hit by the
problem mentioned in paragraph 2, until a major building reconfiguration
is completed, additional financial support is likely to be a sine
qua non. Even given the extended period, quality and standards
are likely to suffer. A simple example of this is in the recent
White Paper's requirement, very rightly, to expand community hospital
services. Most of the deficit trusts include at the very least
"rationalisation" of their community hospital to save
money. The aims are incompatible.
I have no objection to giving oral evidence.
David H Dufty
Health Management Consultant
5 June 2006
120 It has been reported that a very recent survey
by The Journal of Health Service Research and Policy (Published
by the Royal Society of Medicine) supports this argument. Back
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