Issue - meetings

1.1.        The Committee considered a report on the recent Care Quality Commission (CQC) Inspection Report on East Sussex Healthcare NHS Trust (ESHT) and an update on the Trust’s work to improve End of Life Care (EOLC).

1.2.        Dr Adrian Bull, Chief Executive, ESHT, and Vikki Carruth, Director of Nursing, ESHT, introduced the report and answered the following questions from the Committee.

Making financial savings without compromising quality and safety performance

1.3.        Dr Bull said that the trust has had troubled finances for a number of years and had a deficit of £48m prior to his arrival in mid-2016. The underlying financial position was worse than that at the time, however, and was being enhanced by one or two one-off in-year contributions. A report by Dame Ruth Carnall in 2016 said that the finances were on a rapidly deteriorating trajectory and were heading towards a deficit of more than £60m. The Trust has arrested this deterioration and the deficit for 2017/18 was £54m, with plans for a deficit of £45m for 2018/19.

1.4.        Dr Adrian Bull said that the Trust’s aim is to maintain quality and safety improvements made over the last two years whilst reducing its financial deficit. He was clear that whilst ESHT would work to tackle financial issues, the trust would not do so by making short-term cost saving measures that would imperil quality and safety. He clarified that it was not the case that financial improvements were being ignored in order to improve quality and safety.

1.5.        Dr Bull explained that a range of initiatives have been undertaken to achieve this financial position, for example, significantly improving financial reporting, and allowing devolved responsibility for budgets to the service level, rather than top down corporate budget planning. Dr Bull explained that every financial initiative the trust develops goes through a formal quality improvement assessment process to ensure that the initiative will not have an adverse effect on clinical performance. Large areas of financial inefficiency that still need to be addressed include agency staff, drug costs and length of stay of patients.

1.6.        Dr Bull said that many of the trust’s initiatives to improve quality will also deliver financial savings because poor quality care costs money, for example, unnecessary lengths of stay, avoidable readmissions, and extra treatments for preventable infections.  He explained how two years ago the length of stay for emergency care was over 6 days but is now 4.6 days. This meant that despite the significant increase in admissions over the past two years, the total number of bed days has fallen and the trust has been able to reduce the number of beds it is running, thus saving money.

Exiting Financial Special Measures

1.7.        Dr Bull said that it is less clear how the trust can emerge from financial special measures compared to quality special measures. This is in part because the latter happens as the result of a CQC recommendation whereas there is no equivalent for financial special measures. He believed that the NHS Improvement  ...  view the full minutes text for item 5