NHS Trust facing £37.7m deficit

Brighton and Sussex University Hospitals NHS Trust is forecasting a deficit of £37.7 million for the end of March, £21 million higher than planned.

The trust’s position reflects many other organisations across England, who between them are forecasting a deficit of more than £2 billion.

On top of this, the trust also has to save more than five per cent of its £540 million annual budget – about £27 million.

Trust director of finance Spencer Prosser said the situation both locally and nationally was “as tough as I can remember”.

Part of the problem has been the need to pay for expensive agency and temporary nurses, doctors and other frontline staff to cover shifts.

There is a national shortage of nurses and medical staff so hospitals have found it difficult to recruit permanent workers.

The trust’s hospitals have also been under consistently high pressure over the last year, meaning it has had to open up extra beds and find enough staff to manage them.

It runs the Royal Sussex County Hospital, Sussex Eye Hospital and Royal Alexandra Children’s Hospital in Brighton and Princess Royal Hospital and the Hurstwood Park centre in Haywards Heath.

There have also been large numbers of particularly sick and elderly patients who need longer stays in hospital and delays in getting people discharged home or into a community bed.

This has added to longer waits in accident and emergency departments as patients wait for a bed to become available on a ward.

There has also been rise in the number of patients waiting longer than they should for non-emergency operations and procedures, which has led to some being sent to private hospitals and clinics for treatment.

This has added to the financial pressures, along with an increase in costs of expensive drugs.

Mr Prosser said the trust had struggled earlier in the financial year but had been making changes and improvements which he hoped would have an impact over the next two months.

This should help bring finances further under control and bring them closer to its original plan of ending the year with a deficit of £16.7 million.

He said: “We have been working very hard to deal with the issues and we are seeing improvements in some areas, particularly in agency spending.

“We are now focusing very hard on the details of what we are spending and where.

“Patient safety and care is always our highest priority and we will not compromise on that.

“However we need to ensure we have absolute value for money for every £1 we spend.”

The Trust Development Agency is closely monitoring the trust’s performance and if it is unsuccessful in managing the deficit there is a chance an external expert will be sent in to turn things around.

Mr Prosser said redundancies among staff were not on the agenda.

GMB representative Gary Palmer said: “The trust continues to suffer as does the whole NHS from major underfunding in real terms.

"This overspend, against the pressure on services hospitals like here in Brighton provide, can unfortunately only lead to one outcome – that despite the very best efforts of frontline healthcare professionals, it’s a hopeless battle to maintain the provision of services or the quality expected by the public and staff alike.”

The trust’s former chief executive Matthew Kershaw left in December and Amanda Fadero is currently interim chief executive.

The Trust Development Authority will announce a permanent replacement later this year.

SAVINGS TARGETS AND LOST FUNDING

EVERY NHS trust is required by regulators to make efficiency savings each year.

Brighton and Sussex University Hospitals NHS Trust has to save more than five per cent of its annual £540 million budget, about £27 million.

These savings targets have been in force for several years but trusts are now coming to the point where they are struggling to find anywhere else they can make savings without impacting on patient care.

This can get right down to the details, including looking at the spending being done by individual departments and checking all decisions made.

This includes looking at the suppliers being used by the trust and the possibility of joining forces with other organisations to share costs of supplies.

It can even go right down to the types of pens the trust buys – that may only lead to thousands of pounds of savings but it all adds up.

Some funding has also been lost through services previously provided by the hospital being put out to tender – such as hearing aid services – and given to a private company.

Redundancies are not on the cards for the trust but there could be some changes to how people work.

PATIENT DEMAND AND CAPACITY

BRIGHTON and Sussex University Hospitals NHS Trust deals with more than 900,000 patients a year.

It provides general hospital services for Brighton and Hove, Mid Sussex and the surrounding areas and is also a specialist regional centre for cancer, heart and kidney care as well as a having a major A&E trauma unit at the Royal Sussex.

There is a huge demand for its services and it has been consistently busy over the last 12 months, with large numbers of particularly elderly patients who need extra care.

The number of patients has been unexpectedly higher than usual this year, meaning extra beds had to be opened up to meet demand and extra agency staff have been needed to work on them.

A growing backlog of patients needing non-emergency care, partly caused by recruitment issues in some departments, has led to extra costs, such as asking staff to work weekends or using private firms.

Delays in discharging patients ready to go home or into a nursing or care home bed have also added to pressures.

Work on improving services provided by other NHS organisations and councils in the community is also continuing to speed up discharge and they are trying to prevent so many elderly patients being admitted in the first place.

Increasing access to GP services and pharmacists is also a priority in the city.

DRUGS COSTS

A GROWING number of expensive drugs are coming on the market each year but it is not always possible to know when they are going to become available and for trusts to plan in advance how much they will be spending.

Brighton and Sussex University Hospitals NHS Trust has spent about £8 million more than it expected on drug costs this year, due to a higher than expected number of medications being officially licensed and approved by organisations such as the National Institute for Clinical Excellence.

As well as this, sometimes the trust may see a higher than expected number of patients being referred for treatment that needs high cost drugs, such as cancer.

This leaves an organisation like the trust between a rock and a hard place, as it is duty bound to provide the drug for a patient if it is available, but it does have an impact on its finances.

The trust’s director of finance Spencer Prosser said the patient always comes first but there is a knock-on effect.

Drugs and medical equipment costs are increasingly becoming an issue with trusts around the country, particularly as developments in science are leading to more patients living longer and needing more treatment.

STAFF SHORTAGES AND RECRUITMENT

THERE is a national shortage of 20,000 nurses caused by reductions in the number of places on nursing degree courses between 2010 and 2013.

Places subsequently rose in 2014 but a nurse takes three years to train, so the previous cuts now mean a smaller number of newly qualified nurses is available.

In addition to this, the Mid- Staffordshire hospital scandal and subsequent Francis Report means there is now a renewed focus on safe staffing levels and hospitals are boosting the number of nurses they need to employ.

This means hospitals are having to look further afield for more staff a lot more than in previous years but in the meantime they need to use expensive agency staff to provide cover.

The Government has recently introduced a spending cap on agency staff to save money, leaving hospitals with the difficult choice of going over budget or not having enough staff to cover.

The Government temporarily changed the restrictions on nurse recruitment from outside the European Union in recognition of the urgent need for trusts around the country to find more workers and Brighton and Sussex University Hospitals NHS Trust has already recruited more than 200 workers from the Philippines alone to help boost numbers.

UNDERFUNDING AND HIGH DEMAND PILE ON PRESSURE

How is the trust performing compared to other organisations?

Brighton and Sussex University Hospitals NHS Trust is forecasting a deficit of more than £37 million at the moment but it is aiming to bring the figure down much closer to its target of £16.7 million by the end of March.  Although it has its problems, there are many other trusts around the country having a higher level of debt. For example, East Sussex Healthcare has a planned deficit of £35.2 million but is currently higher than that. St George’s in London is expecting a deficit of £46.2 million.  Nine out of ten 10 NHS trusts will finish this financial year in deficit and, at six months, the whole NHS was £1.4 billion overspent.

Why is it struggling with finances?

Unions believe major underfunding in real terms, combined with an increase in demand for services, is placing particularly busy trusts like Brighton under severe pressure. Other problems have included staff shortages and drugs costs.

Is this a national problem? 

Yes. The NHS as a whole is forecasting an overspend of more than £2 billion, with about four in five trusts saying they will end the year with a deficit.

How could the problem be solved? 

The Government announced last year the NHS would receive £10 billion more in real terms by 2020-21 than in 2014-15, with £6 billion available by the first year.  However, unions believe this does not take into account years of underfunding. They also believe there needs to be increased investment in areas such as nursing training and working on preventing people from developing health problems in the first place.  Locally the trust has been managing to cut down on agency spending by recruiting more staff both in the UK and abroad, which will cut down on costs.  It has also been looking at ways to reduce waste within the trust, for example not double booking appointments or sending patients two letters by mistake, as well as making the best use of the services and facilities it has and making optimal use of its operating theatres.

What will happen if the trust cannot get its finances under control?

At the moment the regulatory authority , the Trust Development Agency, is closely monitoring the trust’s performance. and The trust is hopeful the work it has been doing will help it get back on track.  If unsuccessful, there is a chance an external expert might will be sent in to turn things around.