October 2003

Financial problems

North Bristol NHS Trust is 44.3 million pounds overdrawn. An independent report on the subject has been published. The Trust runs services in 5 hospitals and has an income of about £350 million. A number of qualitative factors were discovered by the enquiry including the major organisational changes that were forced upon Health Authorities last year, and a shortage of beds resulting in a decision to spend money on private health services such as hiring theatres and scanners. Other expenses were generated in attempting to meet waiting list targets.

The report showed that denial, fear and misunderstanding kept everyone in the dark about the rising debt. The report stated – "There were serious governance and performance issues in the running of the Trust but no evidence of fraud or deliberate concealment of information. Risk areas were insufficiently flagged and monthly budget reports were over-optimistic". The Trust’s Executive Team was described as being "dysfunctional, lacking in consistency and the management culture particularly under the last Chief Executive, as not conducive to effective team-working at executive level." The review team found that there was a failure to present an accurate picture of the financial position although some members of the finance team were concerned about this.

Ms Mills, the new Chief Executive, has promised that no cuts in services will be made but is, at the same time, adamant that feasible changes should be made to try to reduce the spending as far as possible. This may involve selling some real estate. Mr George Scaife, Chief Executive of the Strategic Health Authority, said that "the Government is taking a keen interest in the way things are being sorted out here and answers must be satisfactory…" "It will take some time to put right but now that job falls on us all."

The Department of Health’s Director of Finance, Richard Douglas, told MPs that the independent investigation into the "scandal" has blamed neither the Department of Health nor Avon and Gloucestershire Strategic Health Authority for failing to spot the Trust’s financial problems until it was too late. It went on – "We have never had any organisation which has gone out of control in this way in the history of the NHS… and it is unacceptable to us. How did it happen? It was basically that the Board wasn’t fully focused on the financial issues".

The former Chief Executive of the North Bristol NHS Trust received £71 thousand "in compensation for loss of office". It was later noted that he had taken up a post as Chief of Operations Synergy Health Care whose subsidiary Health Tex provides contract laundry services for hospitals in the Bristol area.

Kingswood people are being asked for their views on hospital services in their area. North Bristol NHS Trust is considering a range of options including shutting down one hospital. The first stage of the consultation exercise will begin in the late autumn and will run into the spring. The second phase will run until the summer and will present the public with a series of detailed options.

Hospitals

Southmead Hospital has been rated as one of the safest in the country for childbirth. It received high marks after it was assessed by the NHS Clinical Negligence Scheme for Trusts (CNST) – a national body that looks at the quality of care, safety of patients, and how well staff are prepared to handle potential risks. Southmead Maternity Unit has been awarded a Level 2 accreditation – the first unit in the country to achieve this rating. This means that the insurance premiums for the Trust will be reduced by more than £400,000. The CNST also re-awarded Level 1 status to North Bristol NHS Trust overall.

North Bristol NHS Trust is said to be planning close part of Blackberry Hill Hospital next summer. The 6 wards under consideration contain about 100 beds for elderly patients – many of whom are waiting to receive care in the community. Managers of the Trust have received assurances that they will be able to place at least 50 of the patients in homes. The other 50 will be placed on wards at Frenchay and Southmead hospitals. It is hoped that the move will raise £2.5 million through a combination of the sale of the wards and savings on the running of the service. The Chairwoman of the Community Health Council said that they had not been informed of the proposed changes and would be contacting the Health Scrutiny Commission.

Dr Judith Langfield, a Bristol general practitioner, said that she was puzzled by claims made by the managers of Blackberry Hill Hospital. She said – "I find this decision incomprehensible when the number of sick elderly are rising". The decision means finding beds in nursing homes or finding the staff to cope with people in their own home.

Bristol Royal Infirmary has published a report which is said to show that the hospital is now one of the top centres for children’s heart surgery in the country. The latest audit report shows that out of 355 heart operations performed on 308 patients between the ages of a few days and 18 months – 4 children did not survive. This is a rate of 1.2% - less than ¼ of the national rate for children’s heart surgery of 5.1% and less than half the hospital death rate of 2.5% for the previous year. The vast majority of operations were planned with 6% being classified as emergencies. (This matter is covered in the Dr. Foster review—recently published by The Times).

The Bath and North East Somerset NHS Primary Care Trust (BANES) have indicated that beds will be cut at Keynsham Hospital. The Trust is trying to save £550,000 from it budgets and has launched a restructuring programme. The proposals follow an overspend of £15 million by the Trust. More than 10,000 people have signed a petition against the cuts. The Trust’s Chairman said that although the consultation has primarily been about the need to reduce the amount of money we spend in the local health community… we are working towards a strategy that will demonstrate a strengthening of the role of local hospitals. The Chairman of the Executive Committee said "the current proposals would have the opportunity to transfer some services from the Royal United Hospital into the space released in the 3 community hospitals – for example stroke services/a specialist rehabilitation service, minor surgery with enhanced out-patient facilities and more out-patient clinics". (It was not stated how these services could be provided whilst at the same time achieving the requisite financial savings. Ed.)

The Royal Liver UK Financial Awareness Report has found that 38% of people in the region would go into the red and 24% would use up all or part of their savings, to pay for medical care rather than waiting for NHS treatment. This study comes in the wake of figures released by the Department of Health which showed that 2 NHS Trusts in the Bristol area were in the bottom 10 out of all hospital trusts in the country for in-patient waiting times. New figures on waiting lists in all Bristol hospitals are expected within the next month.

Bristol is to have a bed-blocking "supremo" to try to help patients who are stuck in hospital to receive the care they need in the community. From the start of next year councils will be £100 per night for every night a patient spends in hospital unnecessarily. Front line staff in Bristol hospitals could receive police-style training to help them cope with increasingly violent patients. A multi-million pound self-defence scheme is being put in place although it is unclear as to how much money Bristol will receive for this initiative.

UBHT reported that 600 cases of MRSA infection had occurred across their 9 hospitals between 2000 and 2001. During the last 12 months– the figure had dropped to 249 cases. However, the organism is said to be still traceable in many parts of the BRI.

General

Professor William Gillespie, Professor of Microbiology, died in August at the age of 91.( a much admired and loved man. See appreciation by Prof.David Speller.

An evaluation of NHS walk-in centres has been undertaken by staff at Bristol University. More than 3 million people a year visited walk-in centres across the UK. The Government is to spend an extra £40 million a year on new NHS walk-in centres over the next 3 years.

A survey of pharmacists reveals that many do not feel equipped to perform increased primary care roles planned for them by the Government. Tariq Muhammad, Managing Director of Pharmacy Plus, which has shops throughout Bristol and the South West says that the Government has been negotiating a new contract with pharmacists which aims to see them more involved with patient care. At the moment there was no obvious way in which pharmacists would be able to cope with the increased pressure. The study showed that 84% of pharmacists recognised their role is evolving and about 56% felt that their customers don’t know when they should seek advice from a pharmacist or when they should go to see their doctor.

Thornbury Nursing Agency has been practically cut out of the market for providing nurses after having been one of the most used providers of private nurses in the City. The organisation is said to be laying off staff. It is understood that Thornbury Nursing Agency was sold for about £55 million – making it one of the most profitable agencies in the country.

A 3-day film festival for deaf people has recently been held in Bristol. People from many other countries attended the festival.

Baroness Ashton will be visiting Early Learning Centres in Bristol this week. Ms Ashton is in charge of the Sure Start scheme – a Government programme aimed at delivering the best start in life for youngsters by bringing together early education, childcare health and family support. Each Children’s Centre will offer services to children which include antenatal, parental outreach and full day-care services from conception until they start at reception or at primary school. The move is part of a 6-year development which will run until 2010. The City Council has submitted proposals for a further 7 Children’s Centres to the Sure Start office.

The South Bristol Blood Donor Challenge has been launched. The idea is to find an extra 2000 new donors. Many blood taking sessions within South Bristol are currently under-attended. At the moment only 6% of those who are eligible to give blood actually do so.

About ¼ of family doctors state that they would advise a patient to stay obese rather than to go on to the Atkin’s Diet. However the proportion of GPs who would prescribe the diet was "still high".

More than £1 million is wasted on unused prescribed medicines in Bristol each year according to figures released by the local Primary Care Trusts. Across the West – the figure has been estimated at more than £20 million.

NHS hospitals are answerable to 36 separate regulators – forcing them to spend millions of pounds on even more administrators to navigate their way through the system. Labour has created 19 new regulators since coming to power in 1997 and has plans for a further 9. (Source – The Times 15th October 2003)

A recent Government report has shown that 1/10 General Practice posts in the region are empty. Thirteen percent of GP posts in the City cannot be filled. These figures are not confined to the West and the DOH figures show similar problems nationwide. North Somerset PCT is the hardest hit in the area with 17% of posts unfilled for more than 3 months.

A paper on the organisation of children’s services has just emerged. The key structural change is the creation of Children’s Trusts allied to the introduction of new local directors of Children’s Services. The Children’s Trust will be expected to develop common features aimed at ensuring that services are coordinated around the needs of users. The Trusts normally sit within the Local Authority and report to the newly-created Director. New money is not on offer.