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Wednesday, November 9, 2011

Analysis: How one NHS hospital is turning around a £13m deficit

 Heart monitor in the hospital's catheter laboratory How are the tough decisions the NHS is having to make across England affecting individual hospitals and services?

That's the question I've set out to answer, by looking at how the nationwide drive for efficiency savings is playing out in Leicester.

The trust which runs the city's three hospitals had chalked up an overspend of £8m in July.

Since then, the deficit has gone up to £13m. But managers believe they are now turning the corner.

Management consultants have been brought in to give advice - this will result in a bill of around £500,000.

The trust says the price is worth paying, because the consultants are helping with future plans, as well as the recent problems.

Like everywhere else in the NHS, staff are finding ways of doing their work more efficiently.

Closing theatres

There are 46 operating theatres in Leicester - but that number will reduce to 36 in the next three years. Eleven jobs have already gone.

The appropriately numbered Theatre Zero was the first to close last month.

Community pharmacists want to continue carrying out health checks

Equipment is still in the room, so it could be pressed into action if needed, but currently the only activity is the drone of the ventilation system.

Incredibly, closing the theatre has not resulted in fewer operations being performed. That's because surgery now starts on time.

The nursing leader behind the project, Elaine Ryan, explained: "Everybody used to have a different view on what the start time should be.

"Now we send for all the patients at 8am for the first list at 8.30am, and we send for the afternoon patients at 1pm for a 1.30pm start."

Another innovation has been DOSA - the Day Of Surgery Admissions area.

This is a peaceful room with individual bays, where patients are brought in a good time before surgery.

Again, valuable operating time has been made more efficient - because of cutting delays in waiting for porters to fetch patients.

Leicester's cardiology services are based at Glenfield Hospital, in a leafy area on the edge of the city.

Dr Doug Skehan said: "We have discovered that we have to do better in the way we code our activity. It's as simple as knowing that we send out the right bills.

"Many of our staff - including doctors and nurses - have not understood the true cost of healthcare as well as they might."

Delayed bid

Leicester's application for foundation trust status, which gives hospitals more financial freedom, is being delayed by up to a year.

Continue reading the main story
Let's devise a system and stick with it, because we know we can save tons of money.”

End Quote Mukesh Lad Community pharmacist The trust's chief executive, Malcolm Lowe-Lauri, is cautiously optimistic that the finances will balance by next April.

He said: "This is going to bite hard. It's a challenging period.

"But this is where you earn your corn - by delivering on behalf of the patient and the staff, but ultimately also the taxpayer who is forking out for the health service every year."

Big decisions are being made in primary care too, as structures reorganise and GPs prepare to take on more responsibility for commissioning decisions.

In inner city Rushey Mead, Mukesh Lad - a pharmacist who owns several stores - is unhappy that NHS work he started doing three years ago has been decommissioned.

The cholesterol checks on middle-aged customers, assessing their risk of heart attack or stroke, are being transferred to GPs.


NHS managers say they are preparing to invest £750,000 in a more ambitious programme, with targets that will encourage family doctors to screen greater numbers of patients.

But Mr Lad believes pharmacists are in a better position to do this work.

He said: "The average 45-year-old is very busy, running around in their day job.

"But we can catch them when they pop into the pharmacy. It takes 20-30 minutes and then they're away.

"Stopping this service is short-minded. Let's just devise a system and stick with it, because we know we can save tons of money."

NHS Leicestershire believes the new system will be better, because the results will be captured directly on to patients' records held by GPs.

But Nick Hunter, from the Local Pharmaceutical Committee, sees the decision as an example of decommissioning which is happening in other parts of England.

He said: "The Health Check programme in pharmacies had superb outcomes.

"We're also disappointed as businesses that we have lost out on a commercial opportunity.

"We're hearing similar stories from colleagues around the country - particularly in services connected with the prevention agenda."

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