Battling to balance the books

IPSWICH Hospital is facing unprecedented pressures on beds and staff, and bosses are looking at a £4 million deficit at the end of this month.More operations are being cancelled and waiting list targets are being missed.

IPSWICH Hospital is facing unprecedented pressures on beds and staff, and bosses are looking at a £4 million deficit at the end of this month.

More operations are being cancelled and waiting list targets are being missed. The EADT asked Chris Dooley, the NHS trust's director of finance and performance, some crucial questions about the trust's future:

1) The trust is forecasting a deficit of £3.9million at the financial year's end. What are the main causes of this?

"We have had a 12% rise in emergency admissions and we are treating more and more people all the time. This means increased drugs bills, paying more for more tests, such as diagnostic imaging, and the costs of greater medical supplies. The pressure on beds has meant we have had to cancel operations because we can't bring the patients in, and have lost very expensive theatre time."

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2) What savings are being made by the trust to balance the books? What effect will this have on the service to patients?

"We are absolutely determined that patient care will not suffer. The savings will come with very good housekeeping - making sure every penny is spent wisely and we get best value for money. This can be done through careful procurement and getting the best deals, basically being very, very careful."

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3) Why are emergency admissions rising? What are the most common problems encountered?

"We have a growing population of older people and people with complex health problems. The PCTs are doing an enormous amount of work at looking how we can change the way we care for people with chronic disease, in particular the way care can be managed in the community. That includes preventative medicines and early intervention so people do not reach the crisis stage and helping them understand what they can do to stay healthy."

4) A "considerable amount of work has been undertaken to establish the reason for the overspend." What other factors have been found?

"There are no other factors - it's all down to the emergency admissions and their associated costs."

5) What are the consequences of a year-end overspend to the hospital trust?

"We have got to achieve financial balance and we have got to deliver our responsibilities - it is not an option. We are doing absolutely everything we can."

6) Pay budgets have overspent by more than £1m, "predominantly associated" with the use of locums and agency staff. Directors have spent £1.2m on agency nurses. Why does the trust need to use so many agency staff? Is it under-staffed?

"The sheer demand caused by emergency admissions means we have had to use many more agency staff. We have had to open more beds and each ward is staffed for the number of beds and the intensity of care needed. Without this demand, we would have reduced the cost of agency staff as we have had very successful recruitment campaigns."

7) What are sickness rates at the trust? What is staff morale like?

"Sickness rates are very low, about 4.6%, compared to the 5% benchmark set by the Community for Health Improvement. Staff have been absolutely marvellous. We understand many of them are tired because we've been so busy and it's been a long haul, but morale is good and they have pulled out all the stops."

8) How many times has the trust gone to red (when less than eight beds are available) or blue light alert (when only emergency cases are admitted) this year?

"We no longer have a red alert system, because it caused pressure in the organisation and wasn't very helpful for anything. Some times we were going into red alert two or three times a day, although some times for only about 30 minutes. We now have a personal notification system, meaning that everyone who needs to know is told.

"Since the New Year, we have gone to blue light about six times, but again it could be for just a short period of time. It is a huge decision to make, and is only done after weighing up all the risks."

9) There were 381 inpatients waiting more than nine months, compared to a plan of 0. The number of outpatients waiting more than 17 weeks also missed the target by more than 300. How concerning is it to miss the targets by such a margin? What causes this and what is being done to address it?

"Once again, the sheer number of emergency admissions have caused the problems. But the latest official figures are from the end of January and, with a fortnight to go until the end of the financial year, we really hope we are going to make these targets. It's a must-do directive."

10) What is the longest a patient has been left waiting?

"There have been no breaches of inpatients waiting more than 12 months to be seen or outpatients waiting more than 21 weeks."

11) There were 520 missed first appointments by patients in January 2004? What are the main causes of this and what can be done to address it?

"There was a lot of wintry weather in January which we think accounted for a lot of missed appointments. We try to encourage people to give us a call if they are going to miss their appointment and obviously 520 people could have been seen more quickly. We are working on a programme which will offer patients a choice of appointments and make the system work two ways."

12) In your opinion, what are the main problems being faced by the trust? Will the trust be able to cope if admissions keep rising as they have been?

"The main problems is that for many, many months we have had large admissions in emergency admissions. We are working together with the primary care trusts and clinicians to manage the demand. Our first role as a major hospital is to give care to those who need it the most, and we will never close our doors."

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