East Sussex Healthcare Trust (ESHT) has been for sometime in special measures for both quality and finances. A recent inspection of the Trust by the CQC has revealed that improvements in quality have been made. Improvements that Trust CEO, Dr Adrian Bull, seemed very eager to talk about at a recent meeting of the County Council’s Health Overview and Scrutiny Committee. But the future looks far from rosy for East Sussex healthcare. With the demand for cost savings coming from East Sussex Better Together and the impact of Social Care cuts, being made by East Sussex County Council (ESCC), it would be negligent to not feel concerned.
The Sustainability and Transformation Proposals for our region, or footprint, cover such a large geographical area that they have been divided into three place-based plans. East Sussex Better Together is the team who will aim to implement changes in our area which will absorb the deficits of our CCGs, adult social care and hospital trust.
We ended last year with a total deficit across the system of £94.9m, while plans for 2018/19 show that we will end the year with a deficit of £80m. There will need to be a cost reduction of £47.7m to achieve this end figure. CCGs are forecasting a deficit of £32m.
NHS England have introduced something called a Commissioning Sustainabilty Funding. This is funding that is given only if the deficit of £32m is abosrbed entirely. In other words, funding becomes available when significant cuts are made and would serve only to reduce the scale of cost reductions needed. This will not be money spent on patient care. Any cuts made to mental health spending have to be re-invested in mental health.
The East Sussex Healthcare Trust was heading for a deficit of over £60m this year with a deficit of £54m last year. Our trust now has a target deficit of £45m for this year requiring a savings programme of £18m to achieve that.
The recent CQC inspection that Adrian Bull spoke at length about to the HOSC committee of our Council had inspected many areas where quality had been rated as requires improvement. Many of those areas had turned things around enough to achieve a rating of good and a few had achieved a rating of outstanding.
When questionned by a Councillor as to how the Trust can hope to achieve financial sustainability without compromising quality Dr Bull seemed remarkably confident. He admitted the Trust had been accused of “buying the improvement in quality” but claimed financial sustainabilty would be achived by reducing poor care. He quite correctly stated that: “Poor quality care costs money.” But could £18m be saved simply by giving good care? If it can, then our trust must be giving a lot of bad care right now. From the CQC inspection it would seem that is not the case.
As many are now aware the County Council has recently agreed to £10m worth of cost savings on social care to happen this year. Social Care is often what keeps people healthy and in their own homes. It can reduce the demand on mental health services, reduce the burden of unpaid carers, avoid people becoming ill and needing to access A&E, it can tackle homelessness and provide sanctuary for women who are suffering domestic violence. We need it as a population but our hospitals need us to have it to.
The effect of these cuts can only be to place a greater demand on our hospital trust which itself is facing the need to make significant cost savings.
We also need to consider carefully the effect on East Sussex Healthcare Trust of changes being made to services at hospitals in neighbouring districts. For example, in Kent, campaigners are fighting the closure of hyper-acute stroke services in some of their hospitals. It seems likely that if Kent hospitals lose these services then East Sussex will be needing to accept patients from the Kent area.
From an outsiders perspective watching the webcast videoes on the ESCC website of the Health Overview and Scrutiny Comittee meeting, the Cabinet meeting and the meeting of East Sussex Better Together I get the feeling that we have many officials desperately trying to cover-up the enormity of problems they now face. They come across as desperate to give the appearance that they are doing a good job, and desperate to able to manage the demand to make cuts, cost-savings or any other of the terms now used to imply spending less money.
Cuts, effciency savings, cost savings and financial improvements are going to be needed year after year until we have a government willing to properly finance an efficient system of healthcare for the nation. These cuts or savings will not deliver all they promise. More cuts will follow until one day when we have a healthcare system so deeply flawed that the public are desperate for change that the Government will feel able to present privatisation as a solution.
Its time now to fight for a different approach.