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Committee raises concerns over Health Trusts' finances

The Public Accounts Committee has voiced serious concerns over the decline in the financial stability of the Health and Social Care (HSC) Trusts in a report published yesterday.

The Report, entitled General Health Report and Social Care Sector 2012-13 and 2013-14 found that despite only the Western Trust failing to break-even in 2014-15 (a deficit of £6.6 million), this masks an underlying funding gap of Trust pressures from 2014-15 which is reckoned to be over £131 million carried-forward to 2015-16.

The Chairperson of the Public Accounts Committee, Michaela Boyle MLA said: "Health and social care (HSC) bodies are facing an unprecedented financial squeeze. Although the HSC sector has been more generously funded than other areas of public spending over recent years, it faces an ever increasing demand for its services. This is partially as a result of an ageing population as well as increasing chronic conditions such as diabetes.

"Putting the HSC Trusts on a sustainable footing is a major challenge unless there is a significant change in funding or transformation of services. One significant problem that the HSC Trusts face is that they are unable to carry forward unused funds from one year to the next, impeding their ability to undertake longer-term financial planning.

The Committee believes strongly that it is crucial for the health service to redesign the way it provides services. If this does not take place, the Trusts will find it difficult to provide the health and social care services needed, within their budgets."

The report also found that using large numbers of locum doctors has contributed to the Trusts increasing expenditure, particularly within the Western HSC Trust where difficulties in recruiting and retaining permanent consultants continues to put pressure on budgets.

The decline in the financial stability of HSC Trusts is mirrored in widespread breaches of key waiting times for elective, emergency and outpatient care. In particular, key waiting times for cancer are not being met.

Ms Boyle said: "While delays in all types of appointments can cause pain and distress for patients and families, it is deeply worrying that no hospital was able to ensure that 95% of patients began their first treatment of cancer within the 62 day standard. We are concerned that the percentage of patients seen within 14 days of an urgent referral for breast cancer has fallen from 84% in 2013-14 to 81% in 2014-15. The Department for Health, Social Services and Public Safety needs to ensure that it can pinpoint why cancer waiting time targets are not being met and set out the action needed to meet these targets."

In conclusion, Ms Boyle said: "It is hard to see how the Department for Health, Social Services and Public Safety can sustain the current service model as efficiency savings start to dry up. Transforming Your Care has been heralded as the great transformational saviour for health and social care, but the pace of change has been at best mediocre. Without serious review and change, the Committee believes that the Trusts are likely to struggle to maintain their performance. We believe these issues must be dealt with urgently."

Notes to Editors:

The health and social care services face a growing challenge to deliver cost reductions without impacting on the quality of patient care. In its evidence session, the Committee explored the financial position of the HSC Trusts and their performance in the delivery of services.

The five regional HSC Trusts account for the bulk of HSC expenditure - £4 billion in 2014-15. During the last number of years they have depended on substantial additional financial support through in-year monitoring rounds to help them avoid incurring deficits.

Performance against the standard that 95% of cancer patients should start treatment within 62 days of being urgently referred by a GP is a crucial indicator of the readiness of the health and social care sector. Meeting this standard, however, has been challenging because the number of urgent GP referrals has increased in recent years.

Aside from financial and activity issues, the report also covered a range of other issues including:

That a "culture of fear" still exists in many parts of the HSC sector inhibiting whistle blowers from speaking out.

the mechanisms for managing how consultants' private work interfaces with their health service work may require tightening to ensure that health service patients always receive the most flexible and responsive treatment they can get.

In exceptional circumstances, health and social care bodies can use direct award contracts where they consider competitive procurement to be inappropriate. In the two years to March 2014, direct award contracts have reduced from just under £130 million to £48 million in 2014-15. However the Committee considers that the level of expenditure is not fully consistent with a supposedly narrow range of scenarios in which competition can be bypassed.


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