Hospital chief executives who face having to find millions of pounds in extra savings have hit back at NHS Improvement’s claims they recruited too many staff.
One said the new regulator had made a mistake or that its methodology was “totally flawed”, while another said their trust would continue to recruit staff to help cope with a 16% increase in activity.
“They are financial castles built on sand”
Trust finance director
Sixty-three provider trusts were named as having over-recruited by NHS Improvement last week as part of its joint financial re-set with NHS England. It said all of the trusts had seen growth in their pay bill since 2014 which had exceeded inflation.
Karen James, chief executive of Tameside Hospital NHS Foundation Trust, which faces one of the largest penalties for its paybill growth at £14.4m told Nursing Times’ sister title Health Service Journal that she believed the regulator had failed to account for the new community services the trust had taken on.
She said: “I don’t see that this can be an accurate reflection of the situation because we are trying to recruit. I can imagine the methodology is totally flawed, we are not over-staffed whatsoever.
“We haven’t got the workforce to deliver what is required of us and therefore we are recruiting staff to meet the required standards that are set nationally,” she said. ”We are not deviating from any national requirements, we are trying to meet them.”
“Reducing staffing costs would be detrimental to the safety and quality of care”
If the trust was forced to save an additional £14m, she said it would have “huge implications”, warning: “The organisation would not be able to operate in its current form to deliver services that are required.”
Mid Cheshire NHS Foundation Trust is facing pressure to save an additional £5.1m. Chief executive Tracy Bullock said reducing staff would come at the cost of quality of care and said NHS Improvement appeared not to have considered the trust’s increase in activity or its historical understaffing.
“Reducing staffing costs would be detrimental to the safety and quality of care we are able to provide and, as such, would simply serve to increase agency usage to maintain that safe care,” she said.
“Much of the investment is as a result of CQC requirements, transfer of therapy staff to the trust, measures to address historic understaffing,” she said. “Our nurse staffing is now described as ‘adequate’ by the CQC but medical staffing is still below the correct number of doctors per bed.”
She added: “Over the two year period in question the trust has seen a 16 per cent increase in activity and has had to respond to that to meet the needs of patients.”
Ms Bullock said reducing staffing was not the right answer for the trust.
Another trust director said: “We looked at the revised total [NHS Improvement] wanted us to hit and it would involve losing somewhere between 10 and 15% of our staff. We can’t set a responsible budget like that.”
One finance director at an acute trust added: “There won’t be any workforce cuts here. We won’t be safe. I know some finance directors who signed up to control totals that they know they can’t meet. They are financial castles built on sand.”
“Recruiting and retaining sufficient numbers of clinical staff is crucial”
Alwen Williams, chief executive at Barts Health NHS Trust, which faces a £14.7m penalty for over recruitment and has been placed in financial special measures, said the trust would continue recruiting to permanent roles.
She added: “Providing quality healthcare is labour-intensive, and like all other NHS hospitals, the biggest single element of our finances is the wages and salaries of our doctors, nurses and support staff. This accounts for over 60% of our annual turnover of £1.4bn. Recruiting and retaining sufficient numbers of clinical staff is crucial to maintaining the quality of our services to patients.”
Norfolk and Norwich University Hospitals NHS Foundation Trust chief executive Mark Davies said the organisation had seen demand “rising relentlessly and we are treating more patients who require more complex care from a large geographical area”.
“Our staff are doing an amazing job but they are under significant daily pressure which is not sustainable,” he said.
In a statement, chief executive of Croydon Health Services NHS Trust said his organisation’s deficit had increased because the trust had invested in raising standards of care including recruitment of more than 100 nurses for positions currently covered by agency staff.
Asked what the trust would do to reduce spending he said: “Across the trust we have asked staff to flag where we can work smarter and cut costs – but we will not take a backwards step on quality.”