The news that Cambridge’s world famous Addenbrookes hospital has been put into ‘special measures’ by the regulator (the Care Quality Commission) hung heavily over the board meeting (September 22) of the Wiltshire Clinical Commissioning Group.
As the CCG’s Chairman, Dr Peter Jenkins, put it: “The problems they are facing are being faced across the country.” Within minutes the CCG’s own deteriorating financial position meant that an important investment in new treatment methods for the growing number of diabetes patients had to be ‘left on the shelf’ until funds became available.
After a pilot study for diabetes treatment at doctors’ surgeries rather than in hospitals and all the careful planning and costing of three schemes based on each of the three hospitals that serve Wiltshire, doctors on the board fought to save it. But the total annual cost of just over £100,000 was too much for Chief Financial Officer, Simon Truelove and he had to put his foot down.
“We are spending more than our budget. We have got to deliver a financial recovery plan. If we were sat here with our headroom intact, this would be an easy decision – absolutely the right thing to do.”
“I cannot support this – purely on a financial basis…we do not have the resources.”
There was an attempt to use other savings to pay for the diabetes scheme. But Chief Officer Deborah Fielding responded: “Any money salted away will have to go into our recovery plan.”
The CCG’s financial position has caused alarm at NHS England and at the first quarter assurance meeting NHS England demanded a financial recovery plan. From a planned ‘surplus’ of £5.5million the CCG is currently looking at a forecast surplus of £700,000. The surplus is returned the following year as part of the CCG’s funding.
There are a number – even a large number – of reasons for this. Prescription costs are up – especially in the high cost drugs category. Elective care costs (i.e. not emergency care) at the acute hospitals have soared. Planned savings are not coming through.
The government’s Better Care Fund (BCF) shares a large sum of NHS money with Wiltshire Council in a bid keep the frail and elderly out of expensive hospital beds. So far the expected BCF cost reductions are all showing red. (It should be noted that Birmingham’s CCG have taken out £4million of expected BCF savings from their annual cost reduction exercise.)
Simon Truelove also pointed to NHS 111 as creating a significant amount of demand for costly hospital services. Another factor that has a financial impact is that as the number of older people increases, when they do go into hospital they have more complex health problems, they stay in hospital longer and it takes longer to get them out when they are ready to leave.
Simon Truelove told the board: “The next debate needs to be on the level of intervention that we can afford.” And later he told the AGM: “It is very difficult to say to people we must restrict your access to services or drugs”.
“The NHS is free at the point of delivery. There needs to be a national debate – I don’t believe the NHS is sustainable with the current pressures.”
Part of the sustainability problem is that the CCG’s policy of providing more care locally ‘close to home’ and in the community – more care under the control of GPs – has initiated a battle to reduce the amount of work the acute hospitals do and consequently how much of the CCG’s budget they take. “We need,” Simon Truelove said, “our acute [hospital] sector to shrink…we need to change the behaviour of the acutes.”
Which brings us back to the plight of Addenbrookes.
Better news:
Having looked at the downside, the board was told that many of the CCG’s new schemes were beginning to bring rewards – not only in terms of better care but also in terms of some savings. Looking ahead, Deborah Fielding said that their three priorities were finance, workforce (and the difficulties of recruiting – one of Addenbrookes’ declared problems) and quality.
There was good news too in a presentation showing how the CCG is going to spend Wiltshire’s £850,000 share of the government’s extra money to improve mental health care for children and adolescents.
The extra money was widely welcomed in the face of – yet again – a ‘huge increase in demand’. Here the aim was to reduce the need (and cost) of specialist services through early intervention.