The Western Trust has embarked on a “recovery plan” to address a significant financial deficit, the Derry News can reveal today.
The Trust confirmed that a recovery plan is a special measure imposed by the Department of Health.
Ms Teresa Molloy, Director of Performance and Service Improvement, and Mr Neil Guckian, Director of Finance & Contracting, appeared before members of Derry City & Strabane District Council’s Health and Community committee on February 13.
They delivered a presentation on the Western Trust’s financial and recovery framework otherwise referred to as ‘Working Together…Delivering Together’.
The committee heard that the Trust has struggled to deliver within budget. On April 1, 2019, the Western Trust entered a three year “recovery plan” under instruction from the Department of Health with a target of saving £39m in that time.
Mr Guckian said that could also be likened to “special measures”.
Defining special measures, NHS UK says: “In serious cases where hospitals are not providing good and safe care to patients, and the management cannot fix the problems by themselves, action is taken to improve the hospitals.”
The £39m deficit was reduced to £20m, he explained, but due to further cuts it is now sitting around the £30m mark. A £19m financial and efficiency recovery plan has been agreed for 2020/21.
The Trust representatives said it faces “unique challenges” having five of the top ten most deprived areas in the country.
Ten years of austerity has also taken its toll. Other challenges which are felt more acutely in the Western Trust area are workforce shortages - including junior doctors, medical staff, nursing and services with long term “hard to recruit/retain” posts.
Other demands cited were rurality, increasing crisis demand and capacity not keeping pace - such as the Emergency Department which is “too small”. Independent sector provider challenges and reforming services while managing “business as usual” have also proven difficult.
SDLP Councillor Rory Farrell said the Health Minister Robin Swann revealed that he needs £660m to maintain existing services. Cllr Farrell has had constituents contacting him who’ve been waiting 4/5 years for a hip replacement.
He asked what additional money the Trust needs and whether waiting lists can be reduced.
Staffing is a very big issue, DUP Alderman Maurice Devenney said, and he asked if the skills base and nurses were available in this area. The Emergency Department is also under “severe pressure”, he noted.
The Western Trust spent £27m on locum staff in 2017/18, which amounts to £2m per month, and included admin staff. Cllr Devenney wondered why there wouldn’t be enough admin staff in the local area and said the issue could take a decade to resolve.
UUP Alderman Andrew McKane described as “astronomical” the locum costs and a problem that needs to be addressed. He added that there are no domiciliary care packages in place in the southern section of the Trust and workers aren’t even being paid for mileage.
In response, Mr Guckian said there is a difficulty recruiting and retaining staff and if they don’t fill the rota “we are in trouble”. He said it is not just senior doctors, but the money spent on junior doctors would “scare you too” as they are paid by the hour to work weekends.
The clerical issue is an anomaly and shouldn’t be happening, he added, and the Trust is a “real outlier” when it comes to difficulties faced when recruiting medical staff.
A business case for the Emergency Department is “rapidly developing” and a “better strategy” is needed to address waiting lists, he said.
Ms Molloy added that an unscheduled care village, incorporating the ED crisis intervention services for alcohol and drugs is some years away and will cost approximately £100m.
The current ED is “incredibly small” for the number of people coming through and “not sufficient”.
Alliance Cllr Rachael Ferguson revealed that her mother has been waiting four years for a knee replacement and has now been left needing two knee replacements and a hip replacement.
Independent Cllr Gary Donnelly asked about Child and Adolescent Mental Health Service (CAHMS) saying there is a high rate of self-harm and suicide amongst young people. He said some parents are concerned about gaps in the service which are allowing “children to slip through the cracks”.
The need for occupational therapists is another issue, he explained, with constituents dying before getting the required adaptations to their homes.
Pointing to ten years of Tory austerity and a Boris Johnson run government, Sinn Féin Cllr Ruairi McHugh said he wouldn’t envy the task in front of the Trust. He asked when recommendations from the Bengoa report would be implemented.
Both Western Trust representatives explained that a lot of work is bring undertaken to recruit staff in key areas, including CAHMS where children most at risk are being identified.
They accepted there are “significant and serious issues” and they assured councillors that more detailed briefings would be prepared for a future meeting.
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