NHS South West Essex has announced a serious of desperate measures to address its overspending and get its finances back on track, in a drive to breakeven by the end of March 2011.
For some months the primary care trust has reported at its public Board meetings that it has been spending beyond its planned budget.
At a Board meeting on Wednesday the trust reiterated the scale of the demands on its finances and a clear way forward to overcome this challenge.
Andrew Pike, chief executive of NHS South West Essex, says: “The bottom line is that the primary care trust has been over-ambitious in the past, and demand for local healthcare had been rising well above regional averages which has led it to increasingly spending more than it can afford.
“We now have no choice other than to tackle this head on. We need to decisively reduce our spending and, regrettably, this will have a direct impact on some of our patients, staff and partners.”
NHS South West Essex has a budget of around £650m to spend on healthcare, health advice and health services for the residents of south west Essex in 2010/11. This works out at about £1,500 per person per year. Every month we are spending an average of over £3m more than our available resource. If the primary care trust continues at this rate, the local NHS will have spent around £43m more than it has available to spend by the end of this financial year.
Andrew Pike adds: “In all respects the local NHS has been living beyond its resources, in its use of hospitals, community and mental health services, in the investments the primary care trust made in new buildings, in public health initiatives and the amount the organisation grew in size.
“The Board of NHS South West Essex is quite clear – doing nothing is not an option. Our plan to redesign services, to improve quality and make efficiencies in the process, is a bold one which will lead to a better local NHS”
Many of the schemes outlined in the plan(summarised in notes to editors) will only make a full contribution to bringing the primary care trust into recurrent financial balance in the next financial year (2011/12). As a result the Board has agreed some temporary limitations to services.
The plans announced this morning agree specific ways of making savings of £43m to achieve breakeven. The total turnaround strategy is £52m which includes a contingency of £8m set aside to cover any projecs that do not make all of the anticipated savings.
A PCT Spokesperson outlined the details for the cuts.
“Firstly, we have found savings from running our buildings more efficiently.
Secondly we are reducing the number of staff at the primary care trust back to 2008 levels.
Thirdly, we have worked with our doctors, nurses and other clinicians to ensure we make the right decisions about prioritising spending money on areas that are clinically effective, things that work and improve the health of our residents.
We are limiting investment – cutting back, reducing the budget or stopping spending money – where:
* we did not get value for money in the past
* projects or procedures are not clinically effective
* we ran a ‘pilot’ project but decided it is not the way forward
* where we can get the same results (or better) by spending the money differently
* we have been spending on services closely linked to health (like education or social care) but these could be funded by other agencies for whom this is their number one priority
* we supported other organisations in the past when we had more money
* higher levels of spend have benefited organisations and institutions rather than the patient
* we had plans to expand a service, but have decided to stay with what we’ve got while our budget is under pressure
TAKING ACTION NOW: EXAMPLES
We will save £1.7m from stopping expenditure on private sector diagnostic procedures such as MRI scans or x-rays. Doctors will make decisions about when and where patients have tests, cutting out duplication and waste, but ensuring people who need these services get them.
In common with other primary care trusts we have decided to remove cataracts from one eye with a gap before removing a second cataract. Although this will incur a second visit later on there is evidence from patients that adjusting to the change following double surgery is a more difficult adjustment.
We spend around £56m of public money each year on medicine in south west Essex. We estimate that around 10% of medicine is wasted and around 43% is unused. We will continue to reduce medicines waste by extending a pilot to prescribe patients with enough medicine for a maximum of 28 days.
We will be stopping non-essential services such as baby massage or cookery classes. We have cancelled plans to mass-mail chlamydia self-test kits to all under 25s.
PLAN TO “REDESIGN” SERVICES
“We will be working with other healthcare partners, local authorities in particular, to reduce emergency hospital admissions through community nursing and social care collaborating to ensure patients who are elderly or have long term conditions remain well enough to be cared for outside of hospital.
When patients have had treatment we want to get them fitter faster so they can return home from hospital, reducing length of stay from up to 50 days to the national average of 21 days. As we start to improve patients’ lives and get them home faster we should be able to care for the same number of patients with a smaller number of beds. So we will also be looking at the number of community beds we have planned for the future and making a recommendation on what that should be by December.
We are setting up a referral management centre staffed by GPs which will ensure best practice in referral to hospital. We will also significantly reduce unnecessary follow up visits which are inconvenient for patients and take up an appointment that could be used by another patient. We want patients to have follow up treatment with their GP.
There are some surgical procedures which have limited evidence of benefit to patients – removing tonsils, for example. We will be sticking to national guidance and no longer offering these procedures.
We will be looking at best practice elsewhere in the country to offer patients the opportunity to have a minor surgical procedure as an outpatient rather than going into hospital for a day case procedure.
We will be bringing our spending on drugs for HIV/Aids in line with the spend which links to the number of people who have the condition by renegotiating the contract we have for this service.
While we understand that having difficulty conceiving a baby is distressing for people who want to have a family, it is not a life threatening condition. We are planning to temporarily suspend IVF services for some patient groups for the remainder of the financial year.
Other short term savings we are making will not prevent patients having treatment but will mean they have to wait a little longer for their surgery. These savings are for planned surgery for conditions which are not life threatening.