Royal Surrey’s 2016/17 budget

The Royal Surrey has set its budget for this financial year (2016/17).

It ended last year with a disastrous deficit of over £11 million resulting in an investigation by NHS Improvement (previously Monitor). The latter will report soon and I expect it to be justly highly critical of budget control and governance. The main cause of the overspending was the recruitment of 200 extra staff for which, in essence, there was no money.

The budget deficit for this year has been set at a staggering £17 million – vastly worse than last year!!! I had hoped to hear that it had set a budget aimed at least at reducing the deficit. The only slight glimmer of hope is that the hospital has set a ‘stretch target’ of saving an extra £7 million over and above the massively challenging savings already listed in the budget. If those extra savings are delivered the outturn will at least be no worse than last year. This will be the challenge for the new turn-around Director who is impressive but not a magician! Governors have asked for monthly reports on progress so as not to be caught out again. One problem will be that although projects to create savings are being urgently formulated they take time to bite and 16% of the financial year has already passed by.

Monitor is to investigate the Royal Surrey

I have just heard that Monitor (he body responsible for overseeing all Foundation Trusts) will be formally investigating the Royal Surrey for two reasons

• its sudden runaway financial deficit which it failed to control through proper governance arrangements re top executives and the board
• and its deterioration in performance against key targets and standards particularly A&E waits, the 62 day cancer standard and cancer 2 week (breast) standard

Governors have, during last year, expressed concerns that  doubling up of responsibilities at senior level when the CEO Nick Moberly left was unwise and would overload senior staff when there was the  added risk of eyes being off the ball with concentration on the merger. This is reflected in Monitor's concerns. Also I have several times expressed worries about serious breaches of the 62day cancer standard. Under processes concerned with formal Trust Quality Accounts, Governors are empowered to choose a standard for external audit. We chose the 62 day cancer standard.

Thus I certainly welcome the Monitor investigation.

The Trust has appointed a 'turnaround' Director who is now in post.

(Monitor has changed its a name very recently to 'NHS Improvement' - what a waste of money)

Royal Surrey shortlisted for awards

The Trust has been shortlisted for both the Patient Safety and the Quality Improvement prizes at the annual CHKS Top Hospitals Awards.  CHKS is a large company which provides data and information processing throughout the country and internationally.

The Patient Safety accolade is a national award for outstanding performance in providing a safe hospital environment for patients and is judged against a range of indicators, including hospital-acquired infections and mortality. It has been shortlisted with 4 other hospitals

St Luke’s Radiotherapy Service’s was shortlisted for the Quality Improvement category, which recognises developments in patient care and experience, as well as staff welfare, safety and morale. Royal Surrey has been shortlisted for this award alongside Hospital Magalhaes Lemos in Portugal and The New Victoria Hospital in Kingston-Upon-Thames, Surrey.

 

The winners of both prizes will be announced during a special ceremony at London’s Guildhall on May 10.

Merger pauses

In my last posting I mentioned that The Royal Surrey's financial position was 'dire' and 'unsustainable'. I have now been informed that the position has become so bad that the hospital has to concentrate all its efforts on swift and painful corrective action. They have therefore decided to 'pause' the merger.

Immediately the Trust will advertise for a new and permanent Chief Executive, a new Finance Director (the existing one announced a month ago that he had a new job - nothing to do with he financial meltdown) and a 'turn around' Director. All vacancies are frozen.

The causes of such a rapid deterioration are many and complex bur  revolve around failures to control departmental budgets and staff costs including agency staff and  ballooning drug costs. Governors are determined to know more and what steps are to be taken to guarantee a quick return to stability.

As for the merger the position, it will be reviewed in about 6 months but I cannot see it happening within 18 months at best if it happens at all.

Royal Surrey financial position

At the Board meeting today the Board Chair  described the financial position of the Royal Surrey as 'dire' and 'unsustainable'. The Royal Surrey is not of course alone in experiencing financial deficits. Whereas the proposed merger with Ashford and St Peters will result in financial savings these will not be evident for at least 18 months or more. Difficult decisions are in the offing albeit the Executive and Board are determined that. whatever is done. it will not compromise patient safety.

Merger latest schedule

The latest schedule is

• Monitor (the body which oversees Foundation Trusts) issues risk rating end July. If all OK
• Boards of both Royal Surrey and Ashford and St Peters approve merger late August
• Both sets of Governors vote on merger early Sept. If both in favour
• Merger formally takes place 1 October.

Ads for the new Chief Executive, the Chair and the new Non-Executive Directors have been placed.

Merger update

 

For about 12 months the Boards of the Royal Surrey and Ashford and St Peters have been active in developing the Business Case for the proposed merger. The governors’ Merger Working Group which I chair has also been very active in challenging the case wherever concerns have arisen. Governors have not always been successful in realising the changes they would have liked but can claim some credit.

 

Last week the Boards approved the final case and it has now been submitted to Monitor (the body that oversees Foundation Trusts). Monitor will crawl over it and in a few months revel its conclusions in the form of its view of the level of risk which the merger presents. A ‘Red’ rating will doubtless stop things in their track and cause a considerable rethink. ‘Amber’ will result in a reassessment in the areas causing concern and ‘Green’ will of course lead the Boards to proceed rapidly towards formal merger.

 

If the rating is Green then in about May/June both Boards will meet to formally approve a merger and immediately after that each Council of Governors will be asked to approve. A majority of Governors on both Councils have to approve for the Merger to proceed.