Friday, 7 September 2012

Health board management failing to curb overspending

Just when you thought things couldn't get much worse for the health boards in Wales, there's news that they are all overspent in the first three months of this financial year. Again. 
 Last year they were bailed out by health minister Lesley Griffiths after failing to hit budget targets.
 Tina Donnelly, of the Royal College of Nursing in Wales, explains that the crisis is structural rather than temporary: "The difficulty is you cannot help being ill in Wales so the demand is there ... Let's be clear, when the Assembly returns we have to make it really a priority in Wales to say we've got unprecendented utilisation of acute care services, we have inadequate provision in the community. That has to be fixed otherwise I don't know how health boards are going to manage, I really don't".
 This financial crisis is coupled with a management failure, at least in Betsi Cadwaladr University Health Board, to recruit key personnel. Poor management has also debanded and deskilled some of their most experienced and committed nursing staff, leading to demoralisation in key areas, including the Special Care Baby Unit.
 This deskilling is set to increase under the proposed changes with intensive neonatal care being shipped across the border to Arrowe Park. This is wrong on so many grounds that the decision to even put it out to consultation seems perverse. It flies in the face of clinical recommendations - i.e. doctors said keep this service in North Wales, the management said no. The consultation document says currents SCBU don't meet national guidelines, omitting to say that neither does Arrowe Park!
 There has been no consultation with the Wales Ambulance Service about moving seriously ill new-born babies - an additional strain on a service already struggling to meet targets.
 North Wales has a growing population, rising birthrate and plans to ensure that 500 Welsh babies currently born in Chester each year are repatriated to save £2m. That's another 8% rise in births annually and consequently another 8% hike in SCBU and neonatal intensive care admissions. It's unclear whether Arrowe Park - which currently has six intensive care cots - can cope with the extra work. Glan Clwyd currently has six cots and Wrecsam has four.
 This lack of planning and proper management is apparent in other aspects of the poorly thought out consultation currently ongoing re community hospitals. Key to the changes are a centralisation of services in 10 hub hospitals and subsequent closure and downgrading of other facilities, including five community hospitals.
 The health board management also tries to claim that care in the community will make up for the loss. If this were the case, most people would be happy to accept the changes, but the experiences of most people in recent years with out-of-hours GP services is a reduction in care and poorer service.
 This, in turn, has seen A&E being swamped by relatively minor problems because the community care isn't there. There is a lack of honesty and clarity about the real options on the ground if these changes go ahead and it's becoming clear from the large public meetings taking place that the public don't trust the health board management to listen or engage in a genuine consultation. 
 The local NHS management has looked after its own interests consistently - whether it's cars, spin doctors or pay rises for the bosses. It's time they started looking at the wider community's interests.

How the Welsh Health Boards are overspent:

  • Cardiff and Vale(four months to July) £12m; savings target by end of year £72m
  • Betsi Cadwaladr (three months to June)£8.667m; savings target £64.6m
  • Abertawe Bro Morgannwg (four months to July)£7.468m; savings target £45m
  • Cwm Taf (two months to end of May) £2.5m; savings target £23.7m
  • Hywel Dda (three months to June) £3.997m; savings target £36m
  • Aneurin Bevan(three months to end of June)£3.9m; savings target £48m
  • Powys Health Board (four months to July)£3.8m; savings target £19m

1 comment:

Plaid Gwersyllt said...

Care in the community needs buy in from GP's all of whom are independent contractors. Have they ALL bought in to the community care? I don't think so. How can it work if GP's haven't agreed t it.