It would be disingenuous of me to start anywhere else today than with the news that the Trust has been downgraded as part of the NHS Oversight Framework (NOF), dropping from level two to level four.
You may have seen this reported widely in the media over the last few days, often described as being placed in ‘special measures’ and, whilst this term isn’t formally part of the regulatory language used by the NHS, I appreciate it can be helpful for some in getting a handle on what it all means.
Certainly, I won’t shy away from the fact that NOF4 is the lowest segment within the NHS framework and the Trust will now join a national Recovery Support Programme designed to make immediate improvements.
This is, in the main, an ask around our financial position which I have referenced many times in recent weeks and months. The truth remains that, despite loads of hard to work from everyone and additional external expertise, we continue to overspend.
Let me give some assurances, equally, to colleagues, patients and their families and partners across our communities who will have concerns following this development.
The first is that we’re not alone in facing huge financial pressures and neither do we expect to fix it on our own either. ELHT has already received a great deal of support and scrutiny from national and regional colleagues and we’re one of four NHS organisations in Lancashire and South Cumbria dropping into NOF4 and onto a recovery programme which will provide further help to reduce costs.
The other organisations are our neighbours and colleagues at Lancashire Teaching Hospitals (LTH) and Blackpool Teaching Hospitals (BTH), as well as the Lancashire and South Cumbria Integrated Care Board (ICB), which commissions and funds services. It is a definite positive that we already work closely together and we will continue to share brain power, energy and good practice to make progress as a team.
The second assurance I want to give is that in being downgraded there has been a clear acknowledgement that ELHT also continues to do good things, every day, too.
This doesn’t negate the financial position, of course, but the Trust is committed to providing health care that really matters to local people and it’s positive that this is also recognised.
I want to remind people that the Trust continues to perform well in many areas, including providing fabulous maternity services, developing community teams who are leading the way for others and, as I mentioned last week, theatre utilisation programmes which are the best in England.
There are many, many other services I could reference but these are specific examples of how we are supporting families, caring for people in their own homes and making sure we prioritise life changing surgery. These are all important areas of healthcare that I am proud to say we’re doing well.
Recent analysis also confirmed that ELHT sees very high volumes of patients – more than our neighbouring Trusts – and delivers treatment on the whole in a cost-effective way.
To this point, it continues to be the case that we are seeing more and more people, primarily through our urgent and emergency care pathways, than ever before, often with additional complexities and acuity that is more advanced too.
Of course, this all costs us more as we require more people in A&E to care for patients, within emergency operating theatres to respond to trauma, on our wards where we often step up to admit more people and in follow up teams including outpatients and community services to support discharges that are critical to our flow.
We have spent money also on trying to reduce our waiting lists and have made progress on some of our longest waiters, recently seeing everyone who had been waiting for more than 65 weeks for treatment.
What is clear in amongst all of this, though, is that we can be guilty of providing services beyond those we’re funded for too.
Of course, we do this for all the right reasons, but it’s true we can’t always afford the gold standard provided if we’re actually funded for less – and sometimes we’re doing things that we don’t receive any budget for at all. These are loss making for the Trust and contribute to our creaking bottom line. This will be something we have to address in the coming weeks and months.
I know colleagues could not work any harder and are often taking on additional things and treating more people within contracts where, actually, we don’t get any extra money, no matter how many people we see. To face these issues openly and address them honestly will be part of our recovery, no doubt. It is difficult when you have joined an organisation, feel passionately about a profession and want to do your best for patients, irrespective of the cost.
Being in NOF4 will cause concern for our communities, but it’s important that those who need care feel confident in our services and able to come forward and access what they need.
This is extra important for East Lancashire where we know there are vast differences in communities, with large parts of the area below the poverty line and less GPs than in other parts of England. These issues, among others, already result in additional health problems for people, inequities in the quality and longevity of life for residents and undoubtedly contribute to some of our financial difficulties too.
Moving into NOF4 is a really difficult concept, for everyone at ELHT and in our communities, to comprehend when we are doing so much and working so hard.
It has impacted morale among our teams and colleagues are concerned that the quality of services and safety will be compromised by the level of cost reductions we have to make. But I want to impress on everyone that the Trust continues to be committed to safe, personal and effective care and the NHS as a whole always has these priorities at heart.
You will recognise some difficult decisions have already been made and implemented, including controversial ones such as stopping the shuttle bus between Royal Blackburn and Burnley General hospitals, saving us £780,000 a year.
Again, it would be disingenuous of me not to suggest there is much more to come as we reduce our costs and balance our books. Feedback, suggestions and ideas will always be welcome.
It is going to take sustained efforts of everyone equally, including colleagues, patients and partners, to make progress.
But as I have said before, when it’s tough and the chips are down, there is no where I would rather be than ELHT, supported by the great people around me, who I believe have got what it takes to sort this in absolute spades.
Thank you to everyone who has messaged me personally offering support and their personal commitments. It is much appreciated. As ever, I will keep you updated and informed as we make progress to correct our financial position and ultimately progress from NOF4.
Martin