Cash Crisis for Troubled Trust

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The NHS trust that runs Margate’s QEQM hospital along with five others in east Kent is on the brink of financial ruin, its new chief executive has admitted – and may now have to seek emergency funding just to keep hospitals running.

Losses have snowballed 455% from £8 million last year to an anticipated £36.4 million this year amid rampant spending on expensive agency staff — set to hit £30 million this year — amid a failure to recruit, train and retain key staff.

Chief executive Matthew Kershaw told the cash-strapped East Kent University Hospitals NHS Foundation Trust (EKHUFT)’s board of directors — who are selling off £5 million-worth of land to help pay the bills — this month:

The Trust has drawn down all its available cash balances… [and] now faces the prospect of having to seek distressed funding support to maintain its day to day requirements.

The Trust says national pressures on staffing and A&E performance “are impacting local costs for staffing to a level not covered by available funding.”

Translation? The government wants them to meet tough targets but isn’t paying for the staff, or training, to let them do so. The chief executive warned that the trust faces “critical decisions as to long term sustainability of clinical services.”

Cuts, in short, are pending.

Mr Kershaw spoke out as long-running deliberations on the future of services across east Kent edge closer to public consultation. More than three years have passed since discussions began about a shake-up of clinical strategy across east Kent.

And many in Thanet have been left wondering whether A&E services at the QEQM face the chop. This has long been rumoured, not least since the CQC in 2014 found it “inadequate”, desperately understaffed and with safety “not a sufficient priority”.

EKHUFT — put into special measures by regulator Monitor following the series of devastating inspections in 2014 — has seen some improvements, recent inspections show. But the most recent  still raised serious concerns, including:

  • Overstretched midwives working in a Maternity and Gynaecology  ward with just one obstetric operating theatre for both emergency and elective procedures.
  • A shortage of basic medical equipment from resuscitation equipment and fetal monitoring equipment to  cardiotocography devices.
  • Staffing shortages in A&E  compounded by “insufficient staff observation of patients in the waiting area” and the absence of a a rapid assessment intervention team for patients arriving by ambulance.

One of the toughest challenges for the Trust remains holding on to staff (The most recent inspection by the CQC highlighted a “45% nursing deficit”).

On 23 November 2015 regulator Monitor instructed NHS trusts to cap spending on agency nurses and doctors and report back on progress. A recent EKHUFT report shows the trust had breached the cap 432 times in just one week.

(The trend is nationwide. The NHS spent £3.3 billion on agency doctors and nurses in the last financial year. And the recruitment crisis is likely to be exacerbated after the chancellor axed grants for student nurses.)

It seems no coincidence that the estimated deficit for this year (£36m) is so close to the anticipated spending on expensive agency staff (£30m). The trust’s management have clearly failed get to grips with a massive recruitment crisis and the numbers suggest we should be very worried indeed about future cuts to services.

Nobody wants to go off half-cocked but the Trust needs to come clean soon on its restructuring plans so there can be a public debate on the options. (The best one, of course, would be the government making sure it was properly funded).

Trauma patients (seriously nasty accidents and emergencies) are already dealt with for east Kent only in William Harvey in Ashford, which is serving a population of 750,000 and seeing its team dealing with up to three incidents per day.

The ongoing risk is that Trust bosses decide Margate’s A&E isn’t a trauma unit anyway and therefore might as well be slashed back to a minor injuries unit like Canterbury’s, leaving Thanet a full hour or more in an ambulance away from serious help.

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