Ambulance services run up £6 million deficit for first quarter

Ambulance services in England have run up a £6 million deficit for the first 3 months of the 2015–16 financial year.

According to figures published by Monitor and the NHS Trust Development Authority, four NHS Ambulance Trusts and four NHS Ambulance Foundation Trusts are in deficit.

These figures form part of the wider combined deficit of £930 million for the 151 Foundation Trusts and 90 other NHS Trusts and in England, which is more than the entire full-year deficit for 2014–15 of £829 million.

Foundation Trusts ended the first quarter with a deficit of £445 million, which was £90 million worse than planned. NHS Trusts were revealed to be £485 million in deficit, which was £63 million worse than anticipated.

David Bennett, chief executive of Monitor, said:

‘Today figures reiterate the sector is under massive pressure and must change to counter it.’

He added: ‘The NHS simply can no longer afford operationally and financially to operate in the way it has been and must act now to deliver the substantial efficiency gains required.’

Richard Murray, Director of Policy at The King’s Fund, said:

‘These figures confirm that NHS providers are heading towards an unprecedented end of year deficit.

‘The reported overspend of £930 million at the end of the first quarter is more than the deficit for the whole of last year. This reflects a very sharp deterioration in financial performance among all types of providers, with 96% of acute trusts and more than half of mental health trusts now reporting deficits.

‘On this basis, warnings of a deficit of at least £2 billion by the end of the year are well-founded.’

He added: ‘Unless emergency funding is announced in the forthcoming Spending Review, a rapid and serious decline in patient care is inevitable.’

Taken from Journal of Paramedic Practice, published 22 October 2015.

Looking forward: the Five Year View

On 23 October, Simon Stevens outlined his Five Year Forward View for the NHS. Developed by the partner organisations that deliver and oversee health and care services, including NHS England, Public Health England, Monitor, Health Education England, the Care Quality Commission and the NHS Trust Development Authority, it offers a look at why change in the NHS is needed, what that change might look like and how we can achieve it (NHS England et al, 2014). This ‘upgrade’ to the public health system will take into account growing problems associated with obesity, smoking and the consumption of alcohol; greater control of patients’ own care through fully interoperable electronic health records that are accessible to the patient; and decisive steps to break down the barriers in how care is provided.

In line with the Urgent and Emergency Care Review (NHS England, 2013), the Five Year Forward View proposes an expanded role for ambulance services, highlighting the increasing need for out-of-hospital care to become a more notable part of the work the NHS undertakes. The plan highlights the need to dissolve traditional boundaries and integrate urgent and emergency care services between A&E departments, GP out-of-hours services, urgent care centres, NHS 111, and ambulance services. Through empowering ambulance service staff—including paramedics—with the ability to make make more decisions, treat more patients and make referrals in a more flexible way, it is hoped that pressure on other services can be alleviated and patients can receive the care they deserve. Highlighting the success of the introduction of major trauma centres, it emphasises the need for developing networks of linked hospitals that ensure patients with the most serious needs get to specialist emergency centres.

The Five Year Forward View also promotes the need to engage with communities in new ways by involving them directly in decisions about the future of health and care services (NHS England et al, 2014). Through the encouragement of community volunteering, it is hoped that a critical contribution to the provision of health and social care in England can be made. It is suggested that this could be done through further recruitment of community first responders, particulary in more rural areas, who are trained in basic life support. In addition, proposals for new roles include family and carer liaison, educating people in the management of long-term conditions and helping with vaccination programmes.

The Five Year Forward View is a welcome proposal of how the NHS can tackle changing demands in health care. By recognising how and why the health system needs to evolve, it is hoped the NHS will be able to provide better, higher quality, and more integrated care to its patients.

References

NHS England (2013) High Quality Care for All, Now and for Future Generations: Transforming Urgent and Emergency Care Services in England – Urgent and Emergency Care Review End of Phase 1 Report. NHS England, London

NHS England, Public Health England, Health Education England, Monitor, Care Quality Commission, NHS Trust Development Authority (2014) Five Year Forward View. http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf (accessed 1 December 2014)

Taken from Journal of Paramedic Practice, published 5 December 2014.

Hunt unveils plan to turn around NHS hospitals

Health Secretary Jeremy Hunt has set out the Government’s plans to help prevent future failures of care and safety at NHS Hospitals.

Following a review by NHS medical director Professor Sir Bruce Keogh, which investigated the quality of care and treatment provided by 14 hospital trusts that are persistent outliers on mortality indicators, Monitor and the NHS Trust Development Authority have already placed 11 of those Trusts into ‘special measures’.

According to the Health Secretary, ‘It is entirely possible, even likely, that other hospitals will have to go into special measures.’

The new inspection regime unveiled by the Health Secretary will identify more Trusts that need turning around.

Support given to the 11 Trusts already placed into special measures will come from NHS hospitals with the highest standards of patient care and safety.

Each of the 11 Trusts will be partnered with one of the best NHS Trusts in the country in innovative improvement contracts.

‘For too long, patients have had to put up with poor care because it was inconvenient to expose and tackle failure,’ said Hunt.

‘I am committing to total transparency on progress in these hospitals, and to leave no stone unturned in our mission to turn them round.’

Taken from Journal of Paramedic Practice, published 25 September 2013.

Number of A&Es failing to hit targets rises

The number of NHS Trusts in England failing to meet target A&E waiting times has more than doubled in the last year, according to the regulator Monitor.

Between April and June, 31 Trusts failed to meet their target of seeing patients within four hours of their arrival.

This is a considerable increase since last year, where just 13 Trusts missed their waiting times commitment over the same period.

The regulator’s report also uncovered record levels of debt among Foundation Trusts: 48 are in deficit compared with 36 last year.

Jason Dorsett, financial risk and reporting director at Monitor, said: ‘Our analysis shows patients are still waiting too long at A&Es in a number of Foundation Trusts.

‘The increased demand has also prevented Trusts from delivering their planned financial savings.

‘We expect to see Trusts planning now for how the increased demand will impact on their finances, so they are not storing up trouble for the future.’

The effect of increased waiting times at A&Es on ambulance services has not gone unnoticed, as patients have been forced to wait up to eight hours in ambulances outside.

This has left ambulance services with no crew to send to life-threatening calls, thus placing patients at serious risk.

Taken from Journal of Paramedic Practice, published 25 September 2013.