Hospitals are bankrupt

Auditors sound alarm bells in Surrey and Sussex cash crisis- the government must hand over millions of pounds to crisis-stricken Surrey and Sussex Healthcare trust to prevent effective bankruptcy, according to its auditors PricewaterhouseCoopers.
The auditors have told the Department of Health that unless the trust receives 'substantial further financial support'- via the DoH and Surrey and Sussex strategic health authority- it will fail to meet its statutory duty to balance the books at the end of its three- year break- even period in March 2006.
The zero- starred trust is over £30m in the red after its spectacular failure to deliver on its financial recovery plan for 2004-05. PwC describes its cash position as 'extremely serious' and warns that 'considering the scale of the financial challenge we do not believe that the trust is capable of achieving break-even by the end of 2005-06 without substantial further financial support.'
The report adds that 'if the trust was to meet all of its obligations up to 31 March 2005 without further support it would have a cash deficit of £36m'.
The auditors' comments were made as part of its public interest report on the trust. Its decision to make the report - which is sent to the health secretary and the SHA as well as the trust board - is a rare step which auditors would only take in dire financial circumstances.
The report reveals that in January the trust board considered delaying staff salary payments to April and withholding 'major sums' owed to the government in the form of pay-as-you-earn, national insurance and superannuation contributions in order to shave off £7.2m from the debt.
The drastic measures were only avoided through a last-minute deal with local primary care trusts, who provided a loan of £4m, and another loan for an undisclosed amount from the SHA.
PwC lists a catalogue of serious errors made by the trust's finance department - including failure to include deficit repayments or adjust assumptions on funding for the consultant contract. This led to board reports that showed the trust had millions of pounds more at its disposal than it actually had in the bank.
The report said the credibility of the trust's financial team and its board as a whole has been damaged, and echoes the recommendations of an earlier independent report commissioned by the SHA by calling for an overhaul of the trust's financial governance. Both chief executive Ken Cunningham and chair Aidan Brown left in February.
Financial troubleshooters Quo Health were sent in by the SHA in February and the company's co-director, Anthony McKeever, is running the trust as acting chief executive.
Mr McKeever told HSJ that he is 'consulting with colleagues on a full financial recovery plan' for 2005-06, which will be presented to the board in May.
He added that he has submitted interim budgets to each department in the meantime, allowing staff to 'focus on working within the realities of the money they've got.'
He said that the trust was recruiting to three senior financial positions to ensure the trust's financial governance is quickly improved.
'I need to get in a set of firm figures that tell me the full scale of the out-turn deficit, and I need firm figures relating to this year's local delivery plan, including the commissioning intention of all the PCTs we work for before I can then take stock of the trust's position and put in measures to improve it' Mr McKeever said. He expects proposals to improve the trust's financial position to be drawn up by the end of the month.
He added that the trust had 'no realistic prospect of breaking even' without additional support by next year, and would be looking to other parts of the health economy to work with the trust on identifying a fix. He said this could include 'selling off property, non-recurrent support or a loan'. He declined to reveal how his proposals would impact on frontline services.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource=2217967

Trust given foundation status despite £3m debt

Lancashire Teaching Hospitals trust was given foundation status this month despite debts of £3m. The trust was awarded foundation status on 1 April, along with five other trusts, even though it is in the red.
The other five in the most recent group to win foundation status were all financially balanced or in credit by the end of the financial year.

Lancashire Teaching Hospitals is the first trust to be authorised as a foundation trust by independent regulator Monitor despite having a significant debt. The move could add weight to critics' arguments that the policy will create a two-tier system.

Non-foundation trusts have to ensure they meet financial balance in order to win three-star status from the Healthcare Commission - to date, three-star status has been a condition of application for foundation status.

Lancashire Teaching Hospitals was given three stars before it went into the red. However, being in debt does not automatically bar trusts from being granted foundation status if they can demonstrate they are 'financially viable and sustainable', a Monitor spokesman said.

He added that Lancashire Teaching Hospitals trust management had submitted a business plan for the next five years demonstrating 'that they have plans in place to tackle the deficit'.

'Foundation trusts can incur a deficit and they need to have flexibility in their planning,' he said.

Lancashire Teaching Hospitals foundation trust finance director Beverly Peacock admitted the trust had financial problems. These included implementing the consultant contract and the provision of tertiary services for cancer, orthopaedics, renal services and plastics.

'These services were not fully recognised under the non-foundation trust regime but payment by results will address this,' Ms Peacock said.

Liberal Democrat health spokesman Paul Burstow said: 'This demonstrates just how absurd the government's foundation trust policy is.'

He added: 'It is right that hospitals go through a rigorous process of assessing their financial status but there should be a level playing field so that hospitals are judged on the same standards.'

http://www.hsj.co.uk/nav?page=hsj.news.story&resource=2217972

Docs- Bliar is worst nightmare

Doctors 'never dreamt Labour could do this much damage'. Many who backed the party say that increased management is damaging the health service.
When 59 of the country’s leading doctors urged the public to back Labour to save the NHS, it was one of the most powerful clarion calls Tony Blair could have asked for.
The list included a former chairman of the British Medical Association, former presidents and vice-presidents of several royal colleges, medical school deans and numerous emeritus professors and leaders in research. Their specialties stretched to all corners of the profession, from epidemiology, public health, paediatrics and orthopaedics to surgery, sexual infections, renal medicine and general practice.
Eight years on, and many of the same doctors talk not of a health service rescued, but of a Government that has pursued policies as damaging to the fundamental tenets of the health service as the Tory initiatives they so feared.
Many said that, although the number of doctors and nurses may have increased, the power now wielded by managers, who have doubled in number to more than 37,000 since 1997, was turning the NHS into a service that values accountancy over patient care.
Increased use of the private sector for healthcare and building hospitals has also raised the hackles of the medical establishment, and the introduction of competition between institutions is viewed as one of Labour’s biggest betrayals.
The alarm among signatories of the 1997 letter was already evident in 2003, when Vincent Marks, the former dean of medicine at the University of Surrey, was moved to seek the views of his colleagues about plans for foundation hospitals and treatment centres.
Of the 35 who replied to his concerns about the divisive impact of the policies, all but two said they shared his disapproval.
Nigel Speight, a consultant paediatrician based in Durham, told The Times that he and several colleagues had considered writing to the Prime Minister about the creeping privatisation of the NHS.
After 24 years as a Labour Party member, Dr Speight resigned two years ago because of the Iraq war and the Government’s “broken promises” on health. “I never dreamt that a supposedly Labour Government could do so much damage to the fabric and principles of the NHS, which they initially created,” he said.
Chaand Nagpaul, a GP from Stanmore in northwest London, said that, although some improvements were evident, the means by which Labour had achieved them had undermined the profession’s trust in the party as guardian of the health service.
He added: “Labour has undoubtedly made some progress, but there are policies that will fragment the NHS exactly the same way that the Tories did. Many doctors now feel disappointed and surprised. The administration has let down the goodwill of a great number of us.”
Although some doctors said that the extra government funding had achieved little, a minority praised a rise in standards and found little to criticise in Labour’s approach.
Aneez Esmail, Professor of General Practice at the University of Manchester, said that the NHS had undergone a big transformation and that critics should not forget its parlous state in 1997.

http://www.timesonline.co.uk/article/0,,19809-1567070,00.html

NHS needs fundamental reform not more money

Here we are again with another election looming and the NHS in the centre of the fray. Only this time, the debate isn’t about whether the NHS needs more cash. Spending has increased by 40 per cent in real terms in just five years and all the major political parties are pledged to spend much more.
The question now is different. Has this money transformed the NHS, as Mr Blair boldly promised it would after the 1997 election? While there might have been improvements, they are at the margins and we are still nowhere near to having the kind of healthcare our European peers enjoy.
Waiting lists have been reduced since the explosion in spending but the average waiting time has remained stagnant and under some measures increased.
Have treatment outcomes improved? This is notoriously difficult to assess, but the international evidence shows we still perform poorly. Survival rates after cancer are amongst the worst in Europe with only the Eastern European countries performing worse. In a recent study examining mortality amenable to healthcare the UK was ranked 18 out of 19 European countries.
Many argue that the beauty of the NHS is that it provides access to care to everyone no matter their status or wealth. This is nonsense. The quality of service all too often depends on being articulate, having an intimate knowledge of the NHS or where you happen to live. This inequity discriminates against the elderly, the less well educated and the less well off.
Before suggesting that the answer is to continue pumping more money into the system, we should consider the Scottish example. NHS Scotland spends £200 more per head than England, but greater resources have not improved outcomes; waiting lists and waiting times have both increased. No-one would seriously hold up the Scottish NHS as a model for healthcare delivery.
What the NHS needs is structural reform. The only way to guarantee equity, universal access and remove politicians from controlling the minutiae of care is to give power directly to the patients. We should fund patients, either through the tax system or by way of universal insurance, to purchase healthcare from the provider of their choice. The poor and unemployed would have their contributions supplemented or paid for by the state.
Patient power would allow resources to be directed to those units providing quality and capacity. Competition would drive up standards. I believe that health professionals have as much to gain as patients from reforms which restore the doctor-patient relationship and eliminate the bureaucracy which is bedevilling our working lives. At last clinical priorities rather than political targets will govern the way we work.

This is the approach favoured by Doctors for Reform, the non-party independent group of nearly 1,000 NHS doctors of which I am a member. We do not advocate a single model of healthcare as each has its drawbacks, but it is clear that Continental systems of social insurance provide minimal waiting lists and quality outcomes. Politicians take the role of guarantor of care and occasional regulator. We should debate these alternatives maturely. It will need a lead from those of us in the NHS to show that real change is in the interests of professionals and patients alike.

Christoph Lees
Founding Member, Doctors for Reform
And NHS Consultant

http://www.doctorsforreform.com/page.asp?pid=80

MRSA in Great Ormond Street hospital

Four children aged three or under have died after suffering MRSA infections at Britain’s most famous children’s hospital, figures released under the Freedom of Information Act reveal.
They were among 20 infants whose bloodstream contained MRSA, the most dangerous form of the superbug infection, at Great Ormond Street hospital, London, in the past five years. While 16 of these toddlers recovered, four died and the infection definitely contributed to the death of at least one of them.
The infant, whose precise age was not disclosed, died in 2003 after being infected with MRSA at another hospital and moved to Great Ormond Street.
The figures also reveal that 357 children aged three and under have been found with MRSA at the hospital in the past five years. Most of these would have been less risky forms of infection found in the nose, saliva or an open wound.
Public relations managers at Great Ormond Street originally told The Sunday Times that only seven children aged three and under had been found to be infected with MRSA in the past three years. But, in response to an official request under under the new Freedom of Information Act, the hospital disclosed the full figures.
There has been mounting concern that MRSA has penetrated neonatal units and maternity wards. Last December 14- week-old Connor Bull became one of the youngest known MRSA victims when he caught the infection at Leeds General Infirmary. Claire Wilkinson, his mother, had to scrub down before she could touch him. He managed to fight off the infection after 19 weeks in intensive care.
As MRSA — methicillin-resistant staphylococcus aureus — has become an election issue, hospitals have come under increasing pressure to keep details of infections and deaths secret.
Leeds Teaching Hospitals NHS Trust last week claimed it could not reveal how many babies had been infected or died from MRSA at its hospitals due to government guidance about the disclosure of sensitive information in the build-up to the election.
The Department of Health is also understood to have complained to the Patients Association that the publication of its survey in February showing high rates of MRSA infections in newborn babies overshadowed the government’s NHS Think Clean Day.
The Conservatives have made the fight against hospital-acquired infection a central election pledge. Last week they promised £52m to fight MRSA in hospitals. Michael Howard, the Tory leader, said his party would put matrons back in charge of hospitals and give them the power to shut infected wards.
Tony Blair has called on the public to put the threat of MRSA “in context”. Labour also insists there is evidence that MRSA rates are beginning to fall.
Information obtained under the act also shows that a two-year-old baby infected with MRSA at Bristol Royal hospital for children in June 2003 died. The hospital could not say whether MRSA contributed to the death because the child did not die in the hospital.
Statistics obtained from Alder Hey children’s hospital in Liverpool show that 80 toddlers aged three and under have caught MRSA there, many on neonatal wards, in the past three years.
The figures also reveal that increasing numbers of toddlers are being infected. Seven toddlers caught MRSA at Alder Hey in 2002-3; this rose to 28 in 2003-4 and 45 in the past year.
Last August three-year-old Kian Williams died after picking up MRSA at Alder Hey. He had suffered a “relatively trivial” injury while jumping off steps.
In February a two-day-old baby became the youngest victim to die in hospital from MRSA. Luke Day was born a healthy baby weighing 7lb 7oz but died 36 hours later at Ipswich hospital in Suffolk. Microbiologists say a doctor or nurse was the most likely source.
Professor Hugh Pennington of Aberdeen University, a microbiologist and expert in hospital-acquired infection, said: “This confirms that MRSA is now a problem that affects babies and young children and not just older people and patients who have had a lot of surgery. If we want to tackle MRSA it is a prerequisite that we have accurate information about the scale of the problem.”
This week the actress Leslie Ash, who almost died after becoming infected with a hospital superbug similar to MRSA, will speak about her ordeal at a Patients Association conference about the dangers of dirty hospitals.

Proof Bliar puts targets before patients

An investigation by The Telegraph today lays bare how the health of hospital patients up and down the country is put at risk by direct Downing Street interference in the NHS and Labour's obsession with targets.
Emails and internal NHS documents illustrate how Accident & Emergency patients are pushed aside and placed in danger so that hospitals can meet No 10's diktats on waiting times.
One doctor described this intervention as "dangerous and intolerable". She added: "It is only a matter of time before someone dies."
Another deplored the decision to move patients out of an emergency department because of a losing battle to treat patients within the Government's target time of four hours. "This constitutes a serious clinical risk," he said.
The investigation leads directly to Tony Blair's most senior advisers inside No 10. It shows how Michael Barber, the head of the Downing Street Delivery Unit, has taken charge of enforcing the four-hour waiting time target for casualty departments. At present hospitals must deal with 98 per cent of emergency patients within that time.
Hospitals struggling to meet the target, including the Epsom and St Helier NHS Trust, are forced to make lengthy and detailed "presentations" to Mr Barber and his Whitehall unit on what they are doing to achieve the goal. This was confirmed by documents obtained under the Freedom of Information Act.
Last night Michael Howard, the Conservative leader, called The Telegraph's findings "an absolutely disgraceful state of affairs" and said he would write to the Prime Minister to demand an explanation. "It is now clearer than ever that Mr Blair's government is putting targets before patient welfare.
"It's vital that doctors and nurses are left free to take decisions that are in the interests of patients and not help Mr Blair spin the statistics in his next press releases."
Chris Grayling, the Tory health spokesman, said: "The Government has, quite literally, created a climate of fear in many parts of the health service. I had one nurse come to see me to tell me that infection control guidelines were being ignored because of the pressure to meet targets. She was too scared, initially, even to give me her name."
An ICM opinion poll for The Sunday Telegraph today shows that 55 per cent of voters believe that Labour has broken its promises on the NHS, while only 39 per cent believe promises have been kept.
The NHS retains its position at the head of the list when respondents are asked which is the most important election issue. Labour has marginally increased its lead over the Conservatives since last week. It climbed one point to 38 per cent, four points ahead of the Tories, who are unchanged on 34 per cent. The Liberal Democrats are down one per cent on 20 per cent.
The most striking first-hand testimony in The Telegraph's investigation comes in an email from a young female registrar who has just completed a stint at an NHS hospital in the North West. Her identity is known but is not being disclosed.
She wrote: "I am increasingly dismayed and terrified by current political targets. . . I am worried because the four-hour A & E wait is used as a way to maintain and increase funding. This is affecting patient safety, especially in some trusts.
"I have just finished working in ********* Hospital and the situation there is dangerous and intolerable. A & E will not breach the four-hour targets under any circumstances - when a patient gets to three hours they must be moved to hit the target."
The email continued: "The wait for a bed is then often more than four hours. A & E remains empty. They cannot be cared for safely and it is only a matter of time before someone dies."
An email from Dr Rod Storring, a consultant physician at King George Hospital, in Goodmayes, in Essex, records that patients there were "at risk" because of the drive to meet targets. He was told "we would have to continue to do what we are doing until the election, regardless."
Last night Rosie Winterton, the health minister responsible for A & E treatment, said: "Far from putting lives at risk rapid access to high-quality treatment is saving lives."
A Downing Street spokesman said: "Our message was and is that we congratulate the NHS on the great improvement in the A & E service. It is a remarkable achievement."

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2005/04/10/nhs10.xml