Local NHS faces up to cash crisis

HEALTH services in York and North Yorkshire face a year of brutal belt-tightening.

The cash-strapped Selby and York Primary Care Trust will be expected not only to live within its £300 million budget in the 12 months beginning on April 1 - it will also have to make real inroads into paying back a debt of £23.7 million.

The effects of that belt-tightening will be felt by patients and health staff alike.

The primary care trust (PCT), which funds GPs and community nurses and pays for patients to be referred to hospital, has already put a freeze on new appointments in an attempt to "minimise redundancy implications".

But asked outright in an exclusive interview with the Evening Press whether health jobs may be lost, acting chief executive Penny Jones said: "Yes".

"The majority of money in the NHS is spent on staff," she said.

Patients, too, will notice the effects. As part of its "financial recovery plan", the primary care trust will be looking at ways of providing health care more cheaply and efficiently - without, Mrs Jones stresses, reducing the quality of care.

That could mean:

Fewer patients being sent to hospital if they can be treated at home instead

Freezing further attempts to cut waiting times

A drive to persuade patients not to get medicines on prescription that they don't use

GPs getting advice from consultants on patients by email.

The reasons for the primary care trust's financial problems are well documented (see panel).

Under Jeremy Clough, Mrs Jones' predecessor as trust chief executive, the primary care trust's debt spiralled from £6.6m to, at one point, a predicted year-end debt of up to £32 million.

Mr Clough blamed the ballooning overspend on the fact the trust had been referring people to hospital for operations more quickly in an attempt to meet tough government waiting times.

Mrs Jones refused today to point the finger of blame at the Government.

"I think they have put more money into the NHS than ever before," she said. "There has been significant growth in funding."

Mr Clough had been right to say the reason for the overspend was the trust's attempt to bring down waiting times by referring people for non-urgent operations more quickly, she said. "But we have to do that within the amount of money that we have been allocated," she said.

There are huge pressures on NHS budgets across the country. People are living longer, so they require more expensive treatment in old age. New, sophisticated treatments and medicines are continually being developed - such as new cancer drugs and techniques for doing operations such as hip replacements - all of which cost money. And people's expectations of the NHS are very high.

In the light of these pressures, Mrs Jones said it was a real achievement to have pegged the trust's deficit to below £24 million by the end of this financial year (March 31) when at one point it had looked as though it could reach £32 million.

Over the next 12 months, however, the trust is going to have to claw back a lot more. If it is to repay its debt in a single year as the government was originally insisting - it may now be given a little longer - almost ten per cent of its £300 million budget would be soaked up at a stroke.

So how does the trust make savings?

Several areas are being looked at in the financial recovery plan being put together by finance director Sheenagh Powell:

Job cuts. When Selby and York Primary Care Trust merges with North Yorkshire's three other primary care trusts (Craven and Harrogate; Hambleton; and Scarborough, Whitby and Ryedale), probably in October this year, £2.6 million will be saved in management costs. There will no longer be a need, for example, for four chief executives and four finance directors: instead they will be one of each.

On top of that, however, the NHS will be expected to make 2.5 per cent "efficiency" savings in the coming year. That will, Mrs Jones admitted, mean some jobs going - and not only administrative posts, but across the board. York Hospital would be affected as well as the primary care trust. And even GP practices - which are self-employed - would have to cut costs.

Freezing progress on waiting times. Emergency and urgent patients will remain a top priority, Mrs Jones said. Non-urgent patients waiting for operations such as hip and knee replacements will still be treated within the government's six-month waiting time. But attempts to reduce that waiting time still further may be frozen.

Providing health care more effectively - and not referring so many people to hospital. Very often, Mrs Jones says, elderly people do not want to go into hospital, but are sent there because GPs feel there is no alternative.

This is a very expensive way of looking after patients - it can cost up to £1,000 a night to keep a dependent elderly person in a hospital bed.

The trust is considering a number of initiatives that will enable more people to be cared for in their own homes. These include a new fast response team of health care staff who assess each patient's needs to see if, with more support, they could be looked after in their own homes.

Since the team was introduced in December, nearly 40 patients who might otherwise have been sent to hospital have been looked after in their own homes.

The trust is also piloting a community matron scheme in the Selby area. Among other things, the matrons will be able to work with patients who have been repeatedly referred to hospital to see if more preventive health care or a change in their medication could improve their health and reduce the need for them to be hospitalised.

Another possibility lies in email referrals. In certain specialisms such as dermatology, GPs uncertain about whether a skin condition is serious have often referred patients to a hospital consultant to be on the safe side.

In future, they may email a photograph to a consultant instead and ask advice that way. It will be quicker and cheaper, Mrs Jones said.

The bottom line, however, remains that "people who need to be in hospital will go," said Mrs Jones.

Reducing waste on prescriptions. Every year, a substantial amount of money is wasted by prescribing medicines to patients who don't really need them, said Mrs Jones. These can include patients on repeat prescriptions, where the prescriptions continue long after the patient needs the medicine. Procedures will be tightened up to stop that, and there will also be a campaign to raise public awareness about the cost of medicines.

:: Countdown to health care meltdown...

July 2005

Selby and York primary care trust loses its coveted three-star status and is reduced to one star instead.

The main reason? Its cash problems. Chief executive Jeremy Clough admits the trust is on course to overspend by £24 million by the end of the financial year in April 2006.

The reason for the overspend, Mr Clough says, is that the trust has been referring more patients to hospital more quickly to meet government waiting times. It is being penalised, in other words for doing its job.

September 2005

Mr Clough quits as primary care trust chief executive as the predicted deficit rises to £28 million. Penny Jones, chief executive of neighbouring Craven, Harrogate and Rural District primary care trust, is brought in as acting boss of Selby and York, as well as continuing in her own job.

Mr Clough subsequently lands a job as project director for North and East Yorkshire and Northern Lincolnshire Strategic Health Authority.

District auditor Mark Kirkham says he has "serious concerns" about the trust's financial position

New acting chief executive Penny Jones reveals it is likely the trust could merge with three other primary care trusts in North Yorkshire to form a super-trust for York and North Yorkshire.

October 2005

An application for the four North Yorkshire trusts (Selby and York; Craven and Harrogate; Hambleton; and Scarborough, Whitby and Ryedale) to merge is submitted to the North and East Yorkshire and Northern Lincolnshire Strategic Health Authority

Health Minister Liam Byrne tells local MPs that patients in York and Selby will not suffer because of the trust's cash problems. The minister says in the House of Commons the trust will get an £80m investment over the next few years

December 2005

York Hospital bosses are told to stop cutting waiting times for patients because of the cash crisis. The hospital should not carry out non-urgent operations such as hip or knee replacements more quickly than the six-month wait. Hospital chief executive Jim Easton describes the ruling as "disappointing"

The government says it could parachute special teams of management and finance experts into trusts struggling with big debts, as the NHS nationally faces a £620m overspend. It is unclear whether Selby and York trust will be targeted in this way

The NHS walk-in clinic in Monkgate, York, is told to reduce its hours. York hospital bosses fear this could lead to extra pressure on A&E

January 2006

York hospital bosses are warned there could be more cuts ahead. Primary care trust chief executive Mrs Jones says: "We're trying to do things that stop people having to go into hospital."

Details of cuts are announced, including reducing emergency hospital admissions, dealing with some patients by email and cutting the number of beds at Selby hospital. GPs slammed the cuts as "absolutely scandalous"

It emerged some patients needing surgery were sent to West and East Yorkshire by taxi because of a "lack of capacity" at York Hospital

Selby and York trust is "named and shamed" by the Government as one of 18 across the country in need of "direct and urgent" intervention. Teams of Government experts will be drafted in to help the trust turn its finances around

February 2006

The Government reveals the trust will be fined £1.3 million for running into debt.

York Hospital says its bid for foundation status could be delayed because of the trust's financial problems

Updated: 09:52 Thursday, March 02, 2006