The NHS in Chester district is facing a huge financial crisis. In the next year, a massive £42m of savings have to be made by the Cheshire West and Ellesmere Port and Neston Primary Care Trusts, with more than £8m of that to come from the Countess of Chester Hospital in the new year alone. DAVID HOLMES looks at what it may mean for management, staff and patients.
ESSENTIAL patient services will be protected, says the woman who has the unenviable task of sorting out the financial crisis in the local NHS.
Jacqui Harvey, joint chief executive of Cheshire West and Ellesmere Port and Neston Primary Care Trusts, hopes the financial recovery plan to make savings of £42m will bring the deficit down to £3m by 2008-09.
Key to the PCTs' cost-cutting strategy is reducing the number of expensive admissions to acute hospitals like the Count-ess by helping more people to be cared for in the community and in their homes.
Mrs Harvey said 'We hope to avoid any impact on patient care but the size of our task means that we must consider all options. However, I can assure tients that essential services will not be affected.
'Some of the savings will be made by providing care differently. For example, we are looking to provide more care outside of hospital in line with the Government's recent White Paper.
'More people can be cared for in their own home or close to where they live without compromising standards of care. In fact, many patients benefit from this.'
The proposals have been issued for consultation, which will run for 12 weeks. Mrs Harvey said the recovery plan would evolve over coming months and the local patient watchdog and county council overview and scrutiny committee would be kept fully informed.
She said the task ahead was a significant challenge but called for a sense of perspective.
'We will do our utmost to ensure standards of care are not undermined,' she said. 'We have achieved a lot over the last few years, particularly to reduce waiting times for treatment, and we are determined to ensure that our patients continue to receive the best standards of care possible within the resources we have available.'
Mrs Harvey became head of West Cheshire as well as Ellesmere Port in 2005. The trusts have been operating as one since January.
CHESTER MP Christine Russell blames trust bosses for the sorry state of Cheshire West Primary Care Trust.
Her comments follow a damning Audit Commission report which said managers failed to take action to reduce spending and had not done sufficient work with its main provider, the Countess of Chester Hospital, to cut costs.
Ms Russell said: 'You have to accept that the majority of NHS organisations are living within their budget and at the same time providing patients with better services. That's certainly the case at the Countess.
'Something like half the deficits are the responsibility of 5% of the trusts.'
She highlighted the example of Cheshire West PCT using a £3m grant to build an intermediate care facility but then not having the money to operate it and said there had been a lack of joined-up working with partners like social services to provide more cost-effective care for the elderly and with GPs to prevent hospital admissions.
But Ms Russell said the annual winter beds crisis had been confined to history.
Chief is told to cut spend on patients
THE exasperated boss of the Countess of Chester Hospital is being asked to cut spending on patient care by almost 10%.
Chief executive Peter Herring could be forced to make cuts of up to £8.3m in the next financial year but says he will do his utmost to protect jobs and patient care.
As the largest local health care provider, his organisation must swallow a bitter pill because the local NHS funding bodies are in a state of financial crisis and must make total savings of £42m.
Mr Herring's only consolation is that he doubts whether the crisis-ridden Cheshire West and Ellesmere Port PCTs can achieve their aim of reducing emergency admissions and outpatient appointments.
Mr Herring, who is 'very disappointed' with the PCT's financial management, said: 'We will try and handle the implications as best we can and try to minimise the effect on staffing without any deterioration in the services to patients.
'But until I know what the implications are, I am not capable of giving any guarantees of anything.'
Changes at the neighbouring Ellesmere Port Community Hospital are designed to avoid admissions to the Countess so it is available for patients in greater need by providing intermediate care for direct referrals from the community.
But Mr Herring fears the return of 'bed-blocking' at the Countess if recovering patients who would normally be discharged for rehabilitation at Ellesmere Port have no where to go, although the Trust refutes this claim.
'Clearly because we discharge a lot of patients to the Ellesmere Port hospital, any further changes could have a potential impact with patients backing up in hospital,' said Mr Herring, who believes the redefined role of Ellesmere Port Hospital will also take income from the Countess.
He said: 'If it's better for the patient, you cannot fault it, but clearly we would be losing income on the back of it.'
Tax-payers will be puzzled as, earlier this year, the Countess opened an £8m wing. And last year a £10m mental health hospital and a £3m intermediate bed care unit were opened on the same park, yet there is insufficient money to run the facilities.
Mr Herring said: 'The decisions to construct these new developments were made two or three years ago. The PCTs didn't have a deficit of £42m three years ago.'
Past errors are blamed
CHESHIRE West PCT blames a combination of factors for its financial deficit.
These include Government initiatives which exceeded central funding, a new NHS pay structure and a payment system for foundation Trust hospitals like the Countess.
But the appointed auditor to the Trust issued a damning report in February on the PCT's financial position and found:
* The PCT overspent in 2004/05 despite receiving support from Cheshire & Merseyside Strategic Health Authority. The underlying deficit at the end of that year was £8.1m.
* The PCT will significantly over-spend in this financial year; without financial support the position is fore-cast to be £17.6m.
* The PCT has not taken adequate recovery action in the last two years. nThe cash position is so poor that the PCT may not be able to pay its creditors without support.
Appointed auditor Peter Chambers, from PricewaterhouseCoopers LLP, said: 'The financial trend is symptomatic of an organisation that has not taken steps to manage its business.'
Trust chairman resigns
CHESHIRE West Primary Care Trust chairman Bob Hodson has resigned with immediate effect 'citing personal reasons'.
In a statement the Trust said Mr Hodson always intended to step down when the outcome of the consultation for 'Commissioning a Patient-Led NHS' was known.
However, for personal reasons, he decided to resign now. As a result, Cheshire West PCT's deputy chairman, Rob Robertson, has assumed the role of acting chairman.
PCT chief executive Jacqui Harvey, said: 'The PCT wish to thank Mr Hodson for his contribution to the PCT from its inception and we send him good wishes for the future.'
Six targets prioritised
THE cash-strapped PCTs will concentrate on meeting six key Department of Health targets but other targets may fall by the wayside.
The six targets are:
* Reducing health inequalities - helping people stop smoking and providing access to sexual health services.
* For cancer patients - trusts are meeting the target of 31 days waiting time from diagnosis to treatment but failing to meet the 62-day waiting time target from referral to treatment.
* Meeting the 18-week maximum waiting time target from referral to treatment for non-urgent inpatient or day-case hospital treatment.
* Working in partnership with other NHS organisations to reduce MRSA levels, although it is accepted 2007 decontamination standards for medical instruments will create a 'financial pressure'.
* Fulfilling the requirements of the 'choose and book' system which means patients can select where to have their treatment out of four providers, including one private company. Funding is temporary.
*Ensuring patients have access within 48 hours to a sexual health clinic.