Standard Editor Ian Dipple takes a look at what might happen next following last week’s dramatic developments.
CAMPAIGNERS are urging Health Secretary Jeremy Hunt to act to resolve the crisis engulfing Worcestershire Acute Hospitals NHS Trust, but what exactly are his options?
Following the restructure of the health service it is not crystal clear what power the Health Secretary has or if it will be down to the Trust Development Authority or NHS England to intervene.
One option would be to order an urgent inspection by the Care Quality Commission. If this then found problems with the quality of care or there are issues the existing management cannot resolve on their own then the Trust could be put into special measures and a number of actions taken.
These include partnering the Trust with another high performing Trust to help improve standards, devising an action plan outlining what improvements are needed and then monitoring their implementation to ensure progress is being made and appointing an improvement director to ensure specific steps in the action plan are achieved.
But there is no guarantee the Trust would fail such an inspection as in terms of quality of care the statistics show it continues to perform well in the majority of areas, although staff have started to suggest privately they are being stretched to the point where they fear quality may be compromised.
However while the staff may be making every effort to ensure care remains high quality, if replacement A&E consultants cannot be found then the service at the Alex cannot safely be maintained and the Worcestershire Royal or UHB cannot cope with the thousands of additional patients they would have to deal with. Effectively it would stress the system to the point where patients would suffer.
Alternatively it could be decided the Trust is failing financially. WAHT is forecasting a deficit of £27.6million this year, posted a loss of £14.2million last year and has £18million of debt on its books from deficits run up in the early 2000s following the Trust’s formation.
It is also having to rely on borrowing to ensure it does not run out of cash to pay staff and suppliers, a situation which Trust bosses admit cannot be sustained forever.
The reconfiguration project and efforts to treat more patients in the community were supposed to resolve the Trust’s financial problems long-term.
But with the reconfiguration project now in doubt and commissioners acknowledging it is unrealistic to cut emergency admissions by 15 per cent, no one knows where the money is coming from to pay for the extra staffing and capacity the Trust will need as commissioners – who buy in health services – are struggling to balance their own books.
In this scenario the Trust Special Administrator could be used to take over the functions of the board and management, assess the situation and come up with recommendations of how to proceed into the future.
This could result in allowing another Trust to take over all Worcestershire’s acute hospitals or break it apart with a number of providers taking over each of the three sites.
However this is only used as a last resort and it is not clear if such a radical measure will be deemed necessary by NHS officials.
But whatever Mr Hunt and the NHS decide to do, they need to do it fast.