Evidence submitted by Laura Moffatt MP
(Def 40)
INTRODUCTION
As Member of Parliament for Crawley I have been
actively engaged on the subject of local NHS finance and performance
since first being elected in 1997. My local acute trust, Surrey
and Sussex currently has the largest single deficit in the NHS.
A succession of Chief Executives have failed to control the budget
which has therefore increased year on year. Pertinent issues such
as the high level of agency staff have not been effectively addressed.
The reasons for the deficit are complex, however the substantial
progress made since the "turn around team" have been
working with the trust management would seem to indicate that
this has fundamentally been an issue of poor strategic management.
SIZE OF
THE DEFICIT
AT SURREY
AND SUSSEX
NHS TRUST
The deficit at the end of the financial year
2004-5 was £30.7 million with the forecast operating deficit
for 2005-06 being £28.6 million. The Trust started last financial
year spending £3.2 million a month over income. By December
2005 that figure was reduced in month to £2 million.Including
the carry forward of historical accumulated debt—the total
deficit for 2005-06 is forecast to be £58.2 million. Arrangements
are in place for transitional support from the Surrey and Sussex
Strategic Health Authority of £17 million.
REASON FOR
DEFICIT FROM
TURNAROUND TEAMS
FINDINGS
The turnaround Team went into Surrey and Sussex
NHS Trust in January 2006.
Their findings relating to the reasons for poor
financial and performance delivery included:
— The lack of a culture of ownership
and accountability.
— Ambiguity of objectives and targets.
— Constant change of direction causing
both confusion and blurring of targets.
— Poor data and information to support
the control environment.
— Failure to follow through necessary
actions.
EFFECT ON
CARE
The effects on care have at times been significant.
Planning for service reconfigurations has appeared
inadequate and on occasion resulted in an unacceptable level of
service to patients.
Examples include:
— Ambulances waiting for hours outside
East Surrey A&E following the transfer of complex acute work
and the downgrading of Crawley A&E to a Walk In centre.
— Breaches on several key target areas
including waiting times in A&E, waiting times for routine
surgery and cancer treatment.
— Crawley patients being discharged
from East Surrey A&E in the middle of the night with no transport
available.
— Failure to transfer patients back
to Crawley Hospital to complete their recovery following the acute
phase of their care at East Surrey.
— Poor communication with staff surrounding
service transfers leading to unnecessary anxiety and confusion
amongst staff, local media, patients and the general public.
JOB LOSSES
The Trust announced at the beginning of April
2006 their intention to reduce posts at the Trust by around 400
of which permanent staff reductions were predicted at around 100.
With a normal annual staff turnover of between
4-600 staff, the hope is that the reductions will be managed through
re-training and natural wastage.
LAURA MOFFATT'S
CONCLUSIONS AND
RECOMMENDATIONS
The Turnaround team at Surrey and Sussex NHS
Trust (SASH) have been very helpful and there is general agreement
that their impact has been positive. The nine "work streams"
identified provide a real focus for the team now working on turning
around finance and performance at the Trust.
I believe they have demonstrated value in spite
of the additional cost burden (around £700,000) as they have
effectively "stemmed" the leaking of money. The savings
within the first month exceeded the team's costs significantly.
There remain issues of relating to capitation
which need to be addressed. Extra support ceases when a Trust
reaches 1½% .
My primary concern has always been the quality
of patient care.
Significant improvements have already been seen
with performance at the Trust and that must be recognised.
— Waiting times for surgery are at
their lowest ever—12-14 weeks on average with a maximum
of six months.
— Cancer waiting times are now amongst
the best in the country.
— The wait for routine outpatients
is now around 11 weeks.
— There have been dramatic improvements
in A&E waiting times (within two point of target) when a year
ago SASH had one of the lowest levels of performance in England.
The interface between deficits and the campaigning
undertaken by some organisations has been unhelpful. It is important
to deal in facts particularly relating to the changing models
of modern healthcare as set out in the White Paper and in the
joint statement from the Royal Colleges of Physicians and General
Practitioners—Making the best use of doctors' skills—a
balanced partnership.
This refocusing on care delivered out of the
acute hospital setting, combined with the transfer of Crawley
Hospital to the management of the PCT means Crawley is potentially
well placed to develop cutting edge services for the future. The
resulting and inevitable post transfers and workforce re structuring
do not necessarily represent job cuts or service deterioration.
However there needs to be rigorous and on-going
scrutiny of both finance and performance across the local health
economy.
Laura Moffatt MP
7 June 2006
| 
