York Hospital boss warns of impact of NHS funding cuts

YORK Hospital’s chief executive Patrick Crowley is a man who usually measures his words carefully – in public, at least. So it was a little surprising when he stood up at a recent public meeting and launched into a passionate denunciation of the way NHS funding cuts were crippling the health service in North Yorkshire.

York Hospital had been forced to make £75 million of cuts over the last three years, he told City of York Council’s health scrutiny committee – and may have to cut a further £29 million over the next year.

That, combined with the huge £12 million debt left by the local primary care trust when it was abolished at the beginning of April, meant that health care in North Yorkshire was ‘on the brink of crisis’.

“I don’t know where it ends,” he told the meeting. “I personally believe the system is in denial about what is happening on the ground. At a time when quality of care has never been higher on the agenda, never has it been at greater risk.”

It was strong stuff. So what was it that suddenly prompted this normally reticent public servant to unleash such an indictment of NHS spending cuts?

It was very much off the cuff, he admits. He had been sitting in the audience when he was invited to speak. The discussion had been about the allocation of health funding to North Yorkshire, and the crippling levels of debt left by the primary care trust. And he just found himself speaking out.

Chatting to him a few days later in his office on the second floor of York Hospital, however, it is clear that the pressure had been building for some time.

For 18 months, the hospital’s accident and emergency department had been under sustained pressure, he says. “Normally there are seasonal variations, but that didn’t happen last year. So we were on red alert – which meant we had no free beds – a number of times last year.”

When that happens, the whole system starts to back up, he says. The hospital started to miss its four-hour waiting time targets in A&E, which meant ambulances couldn’t get away. And elective (non-urgent) operations had to be delayed because of the lack of beds.

The hospital was fire-fighting all the time – which is not the ideal way for a hospital to run, he admits.

“People are human beings, and in a caring environment they do need time to recharge their batteries,” he says. “We have to avoid expecting too much. Everybody needs a bit of headroom. We have to find a way to give people space to breathe and headroom to work more innovatively. We have to do that.”

But why is there so much pressure on the health service and the staff who work there?

It is a combination of things, he says.

An ageing population means that there are more older patients, with complex needs.

Nationally, the aim has been to try to reduce the need for such patients to come into hospital, by providing better home care and more support for patients in their own homes.

Because local authorities and other public services have been cut to the bone, however, this hasn’t been happening as much as it should have been.

That means elderly people being kept in hospital longer than they should be (delayed discharges are at their highest level since the mid-1990s) – often in less-than-ideal conditions. “A hospital is not a care home,” Mr Crowley says. The hospital’s beds are often full as a result – and have to be supplemented by extra beds squeezed onto cramped wards.

Then there is the question of funding in North Yorkshire. Under the formulas adopted when allocating budgets to the new commissioning groups of GPs that replaced primary care trusts last month (see panel), York is one of the lowest-funded areas in Yorkshire. It receives just £1,050 to spend on health care per person per year, compared to £1,234 in Scarborough.

Add to that the crippling, £12 million debt passed on by the primary care trust to the GP groups that replaced it and who now hold the NHS’s purse strings locally, and it is small wonder that health services in York are stretched.

On top of everything, the hospital – which has seen its budget cut in every one of the last three years – will have to make further cuts of up to £29 million in the year ahead.

Yes, Mr Crowley says, the Government is committed to maintaining overall levels of funding in the NHS. But because of the emphasis on non-hospital care, hospitals are being required to make ‘very aggressive’ efficiency savings – without reducing the quality of care they provide.

So how can he, as chief executive, make that work?

It’s not easy, he admits. Seventy per cent of the hospital’s spending is on staff: the doctors, nurses, cleaners, porters, clerical workers and administrators who keep the place going.

There are no plans to reduce staffing levels, he says – but that means savings have to be made in the 30 per cent of the hospital’s budget that isn’t staff-related.

That means reducing the cost of things the hospital buys – foods, supplies and so on – through negotiating hard, and collaborative purchasing with other hospitals to get the benefits of ‘bulk’ buying.

It also means providing more specialist hospital services that can generate income. In the last couple of years, Mr Crowley says, York has been quite successful at providing a wider range of cardiac services and cancer treatments. “That generates income.”

And what about bureaucracy and red tape? Health service bureaucracy is a favourite target of a certain kind of politician.

He sighs. A hospital is one of the most complex organisations there is in terms of management, he says, because of the huge range of services it provides, the complexity of the system it operates in, the need to liaise with so many patients, and so on. “I would say that the level of management found in our hospital and in hospitals in general is very low when compared with corporations.” How low? A “small few per cent” of the hospital’s budget goes on pure management, he says. He is not convinced that the constant tinkering and reshaping of the health service in recent years has succeeded in cutting levels of bureaucracy.

Scrapping primary care trusts – a whole tier of health service management – and replacing them with ‘clinical commissioning groups’ of GPs was intended both to put responsibility for health spending in the hands of doctors, and also to cut red tape. “But it doesn’t feel to me that the system is generally less bureaucratic.”

It annoys him when politicians such as health secretary Jeremy Hunt – who recently pledged to ‘name and shame’ failing hospitals and ban managers responsible for failures from working in the NHS – come up with ‘simple messages’ about how they are going to sort the health service out.

“If it was that bl**** easy, we would have done it!”

Hospital trust employs more than 8,000 on £400m budget

YORK Hospital merged with Scarborough Hospital last year to create a combined hospital trust which employs more than 8,000 people and has a budget of about £400 million a year.

The Scarborough hospital had been struggling to achieve the standards it needed to gain the foundation trust status held by York.

But there were benefits to both hospitals from the merger, Mr Crowley says. Patients who could have been treated in Scarborough were opting to come to York instead. By helping Scarborough improve the quality of care and so treat more patients, it has been possible to reduce the pressure on York.

The two hospitals are also able to share some essential administrative functions, such as human resources, so reducing costs.

York Teaching Hospital NHS Foundation Trust is now responsible for two big hospitals, smaller community hospitals in Bridlington, Malton, Selby and Easingwold, as well as district nurses and community services.

Of the nearly 8,500 staff, 29 per cent are nurses and midwives, 9 per cent medical or dental staff, 6.5 per cent ‘allied health professionals’, and 23 per cent scientists, clinicians or ‘additional clinical services’. Just over 20 per cent are ‘administrative and clerical’, and 12 per cent ‘estates and ancillary’.

There are 219 members of staff who earn £100,000 or more a year. Of these, 210 are medics or dentists, one is a ‘healthcare scientist’, and eight – including Mr Crowley – are managers.

‘I do worry about the future of the service in this time of austerity’

A WHOLE tier of health bureaucracy was abolished when primary care trusts (PCTs) were phased out at the end of March.

In this region, the local PCT – NHS North Yorkshire and York – was responsible for commissioning and funding health care across the county.

It was replaced by a series of smaller ‘clinical commissioning groups’ (CCGs) of local GPs.

The aim was to reduce bureaucracy, and place responsibility for local health spending decisions in the hands of family doctors.

But health care in North Yorkshire is still burdened by the £12 million debt left behind when the PCT was abolished.

That, combined with the comparatively low level of health funding per head in the York area, means that finances are still desperately stretched.

“I feel incredibly privileged working for the NHS,” Mr Crowley says.

“I grew up in North Yorkshire, and I care about it.

“The job is mostly enjoyable. But I do worry about the future of the service in this time of austerity.”