04.08.15
FTs should scrap ‘non-essential’ jobs due to unprecedented financial crisis
Foundation trusts have been advised to “look again at their plans” to identify what more can be done to save money in light of a “simply unaffordable” financial crisis for 2015-16.
Monitor’s chief executive David Bennett sent a letter to all FTs in deficit saying that the NHS is “facing an almost unprecedented financial challenge this year”, adding that no stones must be left unturned in their “collective efforts to make the money we have go as far as possible”.
This includes reviewing staffing to make sure “only essential” vacancies are filled. Part of this will be certifying that safe staffing guidance is adopted “proportionately and appropriately” so that rosters can be “rigorously managed to deploy substantive staff” across shifts – including weekends and evenings.
However Louise Silverton, director of midwifery at the RCM, called this suggestion “nonsensical” and said: “The RCM believes all staff working within the NHS are ‘essential’ and trusts need to proceed with extreme caution when defining who is ‘essential’.
“What does adopting proportionately and appropriately mean? The whole point of this guidance is to end ambiguity by helping trusts understand exactly what is needed. [His] letter also suggests diverting ‘patients’ elsewhere when the reality is that for maternity services it is often the case that neighbouring units don’t have the capacity to take on referrals from other trusts.
“The government have pledged an extra £8bn of funding for the NHS by 2020. This is clearly money that is needed now, not in five years when it will be much too late.”
Janet Davies, chief executive and general secretary of the RCN, agreed that money cannot determine how staff is needed and that there can be “no compromise” on safe staffing levels.
She added: “Staffing levels are either safe or they are not, and this must be decided based on patient need. If staffing levels are decided by accountant rather than clinical staff, patient care will suffer. It is also unclear what constitutes a non-essential job in an NHS trust. If you get rid of support staff, their work does not disappear. Instead, it will mean frontline staff picking up extra paperwork and spending less time with patients. This is a false economy.”
Dr Tony O'Sullivan, consultant paediatrician and a member of campaign group Keep Our NHS Public, said that after over 10 years of efficiency savings "there are virtually no non-essential jobs left and an increasing bureaucracy to deal with the introduction of the market in the NHS, including tendering of services and the enforced competition between trusts".
Media officer at the same campaign group, Alan Taman, added that the move would "cost lives".
He said: "If the NHS was not bound by government dogma to follow the ideology of a ‘market place for health’, all of the NHS’s plans would be ‘affordable’. This is yet another step to downgrading our NHS and encouraging private health for those who can afford it, leaving those who cannot to struggle in an under-funded, under-resourced NHS."
In the letter, Bennett also said that reviews of the plans of the 46 trusts with the biggest deficits would not be enough to close the funding gap. He asked that those planning for a surplus this year also review their plans in an effort to “see what more can be done”.
If trusts have insufficient capacity to meet demands, they should work with commissioners to transfer activity to other providers that may have underused yet paid-for capacity.
Bennett reiterated that contracts with commissioners must “provide for adequate levels of activity” so as to not result in unnecessary risks for trusts.
Providers were encouraged to consider consulting with Monitor’s team, a process only mandatory for trusts in breach of their licence.
“They have already helped a number of trusts reduce their consulting costs significantly. We are also piloting our work on best practice in minimising agency costs, and the agency controls will be issued shortly,” he said in the letter.
This comes just a few days after an NHE FoI investigation revealed that nearly a fifth of trusts have spent more than a tenth of their total staff budget on agency.
Silverton and Davies, from the RCM and RCN respectively, added that agency costs are “primarily the consequence of staffing shortages” and that using agency staff would lead to lack of continuity of care and prove more costly in the long run.
Initiatives from providers would be met with guarantees from NHS England that CCGs would be issued a series of requirements to tackle the financial crisis.
Amongst these would be the order to suspend all fines and penalties relating to the admitted and non-admitted RTT standards backdated to the beginning of the financial year.
NHS England will be demanding transparency on revenue generated by other fines linked to provider non-delivery, in order to inform how commissioners should deploy them. They should also be clear about any “uncommitted reserves” so that potential upsides in commissioner budgets can be identified.
Lastly CCGs will endeavour to resolve contract disputes “as quickly as possible with binding arbitration to follow where this does not take place”.
Trusts should also make sure there is funding from CCGs for winter initiatives that have been agreed with SRGs (system resilience groups, the new name for urgent care working groups).
Bennett has guaranteed that Monitor will continue to play its part in initiatives such as Lord Carter’s work on the ‘model hospital’ and the central procurement, both of which will be available “in due course”.
The chief executive added that ministers have already seen these recommendations and will support providers to reduce their deficits manageably.
He asked that providers write back to him by 21 August with an estimate of the impact that actions taken to reduce deficit will have on their year-end bottom line.
In May, it was announced that NHS trusts in England had racked up a combined deficit of £822m in 2014-15 – more than seven times the £115m from the previous year.
At the time, Bennett said that it was clear the sector could “no longer afford to operate on a business-as-usual basis”.
“We all need to redouble our efforts to deliver substantial efficiency gains in order to ensure patients get the services they need. This will no doubt involve some significant changes to the way people work at some institutions,” he said.