East Sussex Healthcare Trust (ESHT) provides hospital and some community care to 525,000 people across East Sussex. It is right for us to know what is happening to the organisations that are there to protect us and our families at times of illness or injury. There are many figures given on their website which chart the changes within the trust although it is a complex discussion. The services our trust provides have changed over the years, our population’s needs have changed, the size of our population has changed and investment has been made in terms of new wards and new equipment. But the stark reality is that in 2011/12 ESHT returned a surplus of £87,000 and by 2015/16 they ended the year with a deficit of £48m.
The population served by East Sussex Healthcare Trust has a higher than average number of elderly and very elderly people. There are also pockets of increasingly high deprivation in the coastal towns. Both of these demographics will place a higher burden on the trust than it would otherwise have. The trust was serving a polulation of 525,000 in 2015/16 compared to 500,000 in 211/12.
The trust explains the frighteningly high deficit of 2015/16 by the need to use agency staff. Agency staff are indeed far more expensive to employ than their own staff. But, as 40% of staff in 2015-16 report having suffered work-related stress in the last 12 months then it would make sense for our trust to aim to bring that figure down. All hospital trusts have struggled with staff recruitment over recent years. We are working our hospital staff harder and harder all the time. Doctors and nurses have been blogging, speaking at rallies, protesting and trying to get their message heard for years. They are worn out with trying to give the best hospital care, with diminishing resources in an increasingly fragmented system and now feel unable to give the care they would like to give. It is time we listened to them and long past the time for our Government to listen.
Social Care cuts have also placed an added burden on our trust. The percentage of beds occupied by delayed transfer of care patients has risen from 2.44% in 2011/12 to 9.4% in 2015/16. That amounts to 67 people left in hospital across East Sussex who could otherwise have been discharged if social care was available. It also means 67 fewer beds for patients who need hospital care.
On the whole, the ESHT website reports a lot of success. A lot of people are being treated successfully and leaving hospital satisfied with the care they received. Our trust has clearly made efforts to improve in many areas such as reducing falls, diagnosing sepsis, controlling the spread of hospital acquired infections, improving end-of-life care and improving the care of those with limited capacity.
But something is going wrong in terms of the ecsalating deficit of the trust, and statistics that indicate for some people care is deteriorating. For example, the number of patients treated in A&E in under 4hrs has droped from 95.91% to 88%, and the number of patients who are treated within 62 days of an urgent GP cancer referral has droped from 85.5% to 82.5%.
Despite having spent many hours this week sifting through the ESHT website and trying to compare figures for 2011/12 to 2015/16 there has been little on the website to explain why the trust deficit has grown so rapidly or why some indicators of the quality of care have shown a demise. But with 72% of staff reporting they are working extra hours in 2015/16 it seems unlikely it is the fault of hospital staff not trying hard enougth.
Inflation for the NHS runs at roughly 4%/ year, which would account for rising population and the constantly rising number of more expensive treatments available, From an income of £3,445,000 in 2011/12 an increase of 4%/year would give the trust £4,030,162 in 2015/16. But we know that our Government has given the NHS approximately 1% increase per year since 2010. That would give our trust a total of £3,584,880 by 2015/16. The difference in these two figures would be £445,282, obviously this is a long way from explaining the £48m deficit. Agency staff costs in 2015/16 of £23m explain a lot of the sudden deficit but still there is a lot to understand. Unfortunately I could not find out anywhere how much income the trust did receive in 2015/16.
Since the HSCA of 2012 more and more NHS services have been put out to tender with bids accepted from ‘any qualified provider’. This fragmentation of the NHS has caused the service as a whole to become far less efficient. Could this discrepancy be explained by increasing ineffeciency and the costly process of putting services out to tender and assessing the bids that are submitted?
This is OUR NHS that is there to protect OUR lives and the lives of those we care about. We pay for this service and we live in a democratic country. The reason why our hospital trust has gone into the financial situation it now has and the reason why there is some indication that care has deteriorated should be explained to the people. The huge amount of information on the trust’s website does not give any explanation. It is also not an easy task to sift through what they do give to try and draw out conclusions. We have a right to know and the right to have a say in the future of our NHS care including hospital care.
ESHT was placed in financial special measures in September 2015. Its CQC rating improved recently from inadeqate to needing improvement.