NHS Accountable Care Board quibbles about who controls extra winter funding while A&Es struggle to cope

Our NHS has been fragmented into 44 so-called Integrated Care Systems – formerly called Accountable Care Systems, but rebranded last year to avoid the connotations of USA healthcare

On 3rd December 2019 West Yorkshire and Harrogate Integrated Care System Board chose to overlook the crazy underfunding of our hospitals, while quibbling about which organisation should control the few extra peanuts NHS England flings their way to help with winter “pressures”.

This cannot go on. Please ask your MP candidates to sign the We Own It pledge . And on 12th December, please Vote NHS.

Extra NHS winter funding “won’t move the dial”

NHS England has recently given the six West Yorkshire and Harrogate acute hospitals an extra £2.394m to “mitigate winter pressures”. For example, the money will cover extra staffing that’s needed, when hospitals open more wards to care for the greater numbers of people who fall ill because of the cold.

Will this avoid the usual grim winter pattern? When hospitals with not enough beds to admit A&E patients are forced to turn away ambulances. Or have ambulances stuck outside A&E waiting to hand over patients, who are then eventually parked on trolleys in corridors.

At the West Yorkshire and Harrogate Integrated Care System Board meeting, Julian Hartley, Chief Exec of Leeds Teaching Hospitals, said that the extra money

“will not move the dial this winter.”

The extra winter payment comes on top of NHS and social care winter payments for 2019-20, already allocated in the November 2018 spending round.

Compared to other similar countries, the public is relatively sparing in our use of A&E

The Royal College of Emergency Medicine’s ‘Essential Facts Regarding A&E Services‘ points out that the UK has the 5th lowest A&E attendance rate of 11 comparable nations.

But the government and its minions blame the public for making too many “demands” on A&E.

This seems like a cover-up for successive governments’ decade-long underfunding of our NHS and social care services.

And its rubbish NHS workforce strategy – or rather lack of one – means there’s a shortage of A&E consultants and other key NHS clinical staff.

No one at the West Yorkshire and Harrogate Integrated Care System Board meeting on 3rd December raised these issues.

West Yorks and Harrogate Integrated Care System [aka Health and Care Partnership] Board, 3.12.19

Why can’t the government just fund our hospitals properly and be done with it?

The crazy thing is, while NHS England has given £2.394m extra winter funding to our 6 West Yorkshire and Harrogate District General Hospitals, this is almost exactly the amount that the Department of Health has just pocketed from a £2.39m interest repayment from Calderdale and Huddersfield hospitals trust.

This interest, paid in 2018-19, is on the yearly loan from the Department of Health that our massively underfunded Halifax and Huddersfield hospitals have had to rely on since 2015 to pay suppliers and wages.

The Government’s underfunding has created,

“significant doubt about the Trust’s ability to continue as a going concern”

CHFT Annual Report and Accounts 2018-19, p 207

The government should write off Calderdale and Huddersfield NHS Foundation Trust’s deficit and its debt to the Department

The Statement of Comprehensive Income in the CHFT Annual Accounts 2018-19 (p202) shows that the Continuing Operations deficit was £43m.

Its Statement of Financial Position (p 203) shows that the Trust’s total assets (aka Taxpayers’ Equity) were minus £59.45m

Our hospitals are so underfunded and so indebted to the government, that the Trust’s Annual Accounts 2018-19 warn (p 207) that,

“Given the ongoing deficit position, negative net assets and the challenge within the financial plans for 2019/20 further areas require consideration to be able to demonstrate that the Trust is a going concern.”

These areas include:

“The Trust is supported by loan funding from the Department of Health and Social Care with a balance totalling £144.9m at 31 March 2019.

” The Trust closed the year with £2.0m of cash but cannot sustain the planned deficit position within 2019/20 without the requirements of external cash support. Loan agreements are in place with the Department of Health and Social Care and draw down will take place on a rolling monthly basis…

In 2018/19 a cost improvement programme (CIP) [ie cuts] of £18m was delivered. …

Delivery of the 2019/20 planned deficit position requires an efficiency saving [cuts] of a further £11m.

The Trust is continuing to work upon a service transformation strategy working closely with local partners, aided by reconfiguration, to deliver a sustainable long term future. [This is the contentious hospital cuts scheme to centralise acute and emergency services in Halifax and planned operations in Huddersfield.] This strategy has been supported by regulators and the West Yorkshire and Harrogate Integrated Care System.”

On p 208 the conclusion is

“[T]he directors believe that it remains appropriate to prepare the accounts on a going concern basis. However, the matters referred to above represent a material uncertainty that may cast significant doubt on the Trust’s ability to continue as a going concern and, therefore, to continue realising its assets and discharging its liabilities in the normal course of business.”

Calder Valley MP doesn’t seem to care that the government’s running our hospitals into the ground

On 30th September, I emailed Calder Valley MP Craig Whittaker, asking him to tell the Health Secretary, Matt Hancock MP, to write off Calderdale and Huddersfield NHS Foundation Trust’s deficits and its debt to the Department of Health and Social Care. So far Craig Whittaker has not replied.

Here’s the email.

Accountable Care System Leader wants extra winter money to go to the System not the hospitals

Turning a blind eye to this sorry farrago, at the West Yorkshire and Harrogate NHS Integrated Care System Board meeting on 3rd Dec, the System Leader Rob Webster bemoaned the fact that he would have

“preferred the [extra] money to have come through the System”.

He urged the acute hospitals that they need to work with their local A&E Delivery Boards in deciding what to spend the extra £2.394m “winter pressures” money on.

This instruction seemed a little redundant. Each so-called “place” (local authority area) has a local A&E Delivery Board. As shown by online information about Bradford District and Craven A&E Delivery Board, they meet 6-weekly/monthly to plan for winter:

“This includes staffing plans, capacity plans (eg care homes, hospitals) and bad weather plans…When demand ramps up as winter bites, the A&EDB has daily conference calls to help manage capacity and keep patients flowing through the hospitals and back home or to their care/residential home as soon as they are fit to be discharged.”

Julian Hartley, Leeds Teaching Hospitals Chief Exec, soothingly agreed with Rob Webster:

“A system approach is needed.”

He confirmed that the West Yorkshire Association of Acute Trusts wanted to make sure that the individual acute hospitals stay in communication with all the [ICS] partners including social care. Each “place” would have conversations as needed, including issues relating to dementia and mental health.

Someone added that care homes and social care are crucial to reducing the pressure on A&E.

Rob Webster conceded,

“Of course we welcome the resources”.

He then basically warned against giving the impression of biting the hand that feeds them – only to reassert that,

“We need to win the argument about [ICS] control of planning and spending. Next year we need to pitch for winter money in the way we want it”.

Such weaselly games should not be part of funding the NHS

We urgently need to restore rational methods for funding, planning and providing health, social care and public health services.

This would entail:

Royal College of Emergency Medicine: essential facts to inform any responsible debate concerning A&E

None of the Integrated Care System Board members talked about problems that have kicked in since the ConDem coalition government started its reign of austerity and dismantling the NHS.

Many of these problems are listed in a Royal College of Emergency Medicine factsheet that,

“is intended to provide all interested and concerned parties with a summary of the key data that should inform any responsible debate concerning Emergency Departments (EDs).”

Such as:

  • In Quarter 1 of 2010-11 Four-Hour Standard performance at Type 1 Emergency Departments was 97.7%, in Quarter 4 of 2017-18 it was 76.8%.
  • From Quarter 1 2010-11 to Quarter 4 2017-18 the number of people waiting more than four hours from decision to admit to admission has increased by 211,367 (1468%).
  • From Quarter 1 2011-12 to Quarter 4 2017-18 the number of people waiting more than twelve hours from decision to admit to admission has increased by 2248 (11,831%).
  • Exit block occurs when patients cannot be moved in a timely manner to a ward because of a lack of available beds. Exit block causes harm to patients and avoidable mortality.
  • In Quarter 4 2017-18 there were 14,223 fewer overnight beds in the NHS in England than there were in Quarter 1 of 2010-11. This represents a 9.85% in the decline in the bed base of the English NHS.
  • In Quarter 1 2010 bed occupancy was 84.8%, in Quarter 4 2017-18 bed occupancy was 90.0%.
  • There is a clear link between four-hour standard performance and bed occupancy rates. The last quarter in which acute bed occupancy stood at 85% was also the last quarter in which four-hour standard performance reached 95% at Type 1 Emergency Departments.
  • Delayed Transfers of Care (DTOC) are a serious problem and a cause of Exit Block.
  • In Quarter 3 2010-11 DTOC accounted for 3.07% of bed occupancy. In Quarter 4 2017-18 the same figure was 4.23%.
  • The biggest single cause of DTOC is patients awaiting a care package in their own home.

(A Type 1 Emergency Department is defined as ‘a consultant led 24-hour service with full resuscitation facilities and designated accommodation for the reception of accident and emergency patients’.)

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