Lincolnshire Talks: How did the county’s hospitals trust sink into double special measures?

Financial black holes, damning CQC reports and severe staffing shortages have left United Lincolnshire Hospitals Trust (ULHT) in special measures… twice. For our weekly Lincolnshire Talks feature, we look into how the trust found itself in one of the most challenging positions in the NHS.

This week, ULHT joined Northern Lincolnshire and Goole Foundation Trust in falling into financial special measures, enforced by NHS Improvement, alongside separate special measures put in place previously by Care Quality Commission inspectors for performance failures.

The trust has admitted that if recovery plans are unable to turn the situation around, it could be looking at a deficit at the end of the financial year of £75 million. 

In April this year, Care Quality Commission inspectors gave the both Greater Lincolnshire Hospitals trusts overall ratings of ‘inadequate’ after discovering a catalogue of failings.

They were the first two trusts in the whole country to re-enter the failure regime for inadequate organisations.

For ULHT in particular, inspectors noted a deterioration in standards for safety and effectiveness. Standards of leadership at the trust had also fallen from ‘good’ to ‘inadequate’.

Financial special measures

The financial performance of ULHT has continued to worsen. NHS Improvement (NHSI) placed it under a financial special measures support scheme this month after the trust lodged a deficit for the year to date of £30.7 million.

This means the trust will be offered support from improvement teams. In order to leave special measures for financial reasons, providers need to demonstrate rapidly that they are returning to  discipline. This will include developing a robust recovery plan.

Historically, the bottom line at the trust has taken a dramatic tumble into the red over the last five years:

• 2012/13 – £124k surplus
• 2013/14 – £25.8 m deficit
• 2014/15 – £15.1m deficit
• 2015/16 – £56.9m deficit
• 2016/17 – 56.8m deficit
• 2017/18 – £30.7m to date with predicted £75m deficit by the year end if not turned around

ULHT, which runs hospitals in Lincoln, Boston and Grantham, has said that under-efficiency and reliance on agency staff is a significant factor in the challenges facing local hospitals.

Deputy Chief Executive Kevin Turner said previously: “We know that there are many factors which are causing the deficit, which include a lot of our services being less efficient than they could be, staffing gaps that are routinely filled with more expensive temporary (agency) staff, and the challenges of providing services over a large geographical area. Our recovery plans will need to address these factors and more.

“Patient safety remains our top priority and our intention is to ensure that this will be maintained or improved at the same time as reducing cost.”

How much is being spent on agency staff?

The trust has made headlines in the past for its significant reliance on agency staff. These are drafted in from private companies when the trust is unable to staff shifts with full or part time employees.

In response to the issue, the trust has hosted a number of targeted recruitment drives to attract qualified professionals to the county.

For the first quarter of this year alone, the trust has spent a total of £7.5 million on agency staffing to fill rotas, and £9.9 million during the financial year to date. 

Current vacancies are listed as follows:

• Registered Nurses is 241.38 whole time equivalent vacancies – 15.21%
• Unregistered nurses/healthcare support is at 41.69 whole time equivalent vacancies – 10.43%

The trust added that this is largely the route of agency spending.

Underfunding a “national disgrace”, says Lincoln MP

Lincoln’s newly elected Labour MP Karen Lee reacted to the news, stating that the challenges will “impact on hardworking staff right across the organisation.”

She also placed failures within the NHS firmly at the door of the current government, calling for the public service to receive better funding and for NHS workers to be “properly paid”.

Karen Lee said in a column published on The Lincolnite: “The people of Lincoln, who, in my experience as MP and as a nurse, value and appreciate the care they receive from our NHS, know how hard everyone within it works to deliver a good service in difficult times.

“The fact that our NHS is severely underfunded and understaffed is a national disgrace.

“The current government claim to have invested in the NHS but this is smoke and mirrors, they give with one hand and take with the other.

“The net result is that the NHS continues to be underfunded while they promise tax cuts for those on high incomes and give over £1 billion to the DUP to prop up their failing government. Their priorities are clear and the NHS does not appear to be one of them.”