For years, millions of TV viewers have seen the best of Britain’s National Health Service on display in a documentary series featuring the work of the emergency department at King’s College Hospital in south London.
Engaging and committed medical and nursing staff pulled off seeming miracles in every episode — but now it is the hospital’s own health that is under the spotlight after its chairman, Bob Kerslake, resigned on Sunday and it was put in “special measures” on Monday because of a spiralling deficit.
As a former head of the civil service, Lord Kerslake’s resignation carried weight, though his recent appointment as an adviser to the Labour leader Jeremy Corbyn meant his parting broadside risked being seen as partisan.
But his decision to quit just a day before the health service financial regulator, NHS Improvement, announced his institution was being placed in special measures has prompted questions as to whether King’s problems could have been avoided — or simply represent, in microcosm, the fiscal travails currently afflicting every NHS institution. Under special measures, an improvement director will be appointed for KCH and the trust’s leadership will be reviewed.
Ian Dalton, NHSI’s chief executive, sought to paint KCH’s problems as going far beyond those with which the service as a whole was contending.
Mr Dalton said: “We understand that the wider NHS faces financial and operational challenges, and other trusts and foundation trusts have large deficits. However, none has shown the sheer scale and pace of the deterioration at King’s.”
NHSI said it had agreed with the King’s board earlier this year a budget deficit of £38m for 2017-18. In late October, the trust had “formally worsened” this prediction to £70m, and last week had forecast an end-of-year deficit of £92m. “As an organisation, King’s own prediction for its deficit has worsened by £54m, and more than doubled, within months,” the regulator complained.
But independent experts said that blaming the trust’s problems solely on internal mismanagement underplays the forces buffeting the whole of the NHS after years of sustained austerity.
By September this year, halfway through the NHS financial year, NHSI’s own figures showed that 83 per cent of acute hospital trusts were already in deficit.
While some planned to move out of deficit by the end of the year — partly due to receiving a share of a £1.8bn government bailout fund that took effect in 2016 — 65 per cent of all acute hospitals are still forecast to end the year in deficit.
Sally Gainsbury, senior analyst at the Nuffield Trust think-tank, said: “I don’t think this is a story about King’s. I think King’s is the canary down the coal mine.”
She said hospitals had been asked to cut their costs in real terms by 4 per cent annually since 2011, adding that this was “the equivalent of spending this year £750 in real terms on a patient that you would have spent £1000 on in 2010”.
King’s had cut costs by around 8 per cent in 2016-17, and was aiming for around 5.8 per cent in the current financial year. Meanwhile, per patient, hospitals are now receiving around 5 per cent less than the cost of treating them, she added.
Intensifying the pressures on trust budgets are so-called “delayed transfers of care”, in which patients who are medically fit to leave hospital must be kept in because there is no suitable care for them in the community.
Hospitals are expecting to spend a total of around £156m on such patients in the current financial year. But the figure fails to reflect the vastly higher opportunity cost of being unable to use those same beds for patients requiring non-emergency surgery: one of the few areas of activity on which hospitals can make a significant margin.
Hospital leaders, meanwhile, pointed out that providers had successfully stabilised their finances in recent years, beginning to reduce the sector’s deficit and realise efficiency gains of 1.7 per cent a year between 2012 and 2016.
But Chris Hopson, chief executive of NHS Providers, argued that asking trusts to deliver annual savings above 5 per cent, “year in year out, is impossible, risks the quality of patient care and places an intolerable burden on staff”.
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