Budget deficit at North Devon District Hospital

It's been trying to improve after CQC report

The Northern Devon Healthcare NHS Trust, which runs North Devon District Hospital, was rated as ‘Requiring Improvement’ by the Care Quality Commission which inspected the Trust back in October 2017.

The CQC report raised concerns in maternity services, end of life care, the emergency department and in outpatients, and health officials told Devon County Council’s Health and Adult Care Scrutiny Committee last Thursday that they had made progress to tackle the concerns.

But Suzanne Tracey, chief executive of Northern Devon Healthcare NHS Trust, said that the improvements have come at a cost and they cannot be achieved within a balanced budget.

She said that the board had already decided to set a deficit budget for the year of £12m, but the current forecast was that there would be a £17m overspend.

Councillors were told that a new leadership structure in the maternity department has been established with a new head of midwifery in post and that three obstetricians in the team have been appointed. She added that an organisational development specialist is working with the team to change the culture, a joint specialist is working across North Devon to help with the challenges in end of life care, increased cleanliness spot checks are taking places, and they have put in place a substantive leadership team in the outpatients department.

Cllr Sara Randall-Johnson, chairman of the committee, asked what was being done to make it more attractive to potential employees to come and work at the hospital.

Mrs Tracey added: “We are trying to ensure that once we recruit people, we can retain them. We have been able to make the posts more attractive if we combine them across North Devon and Exeter, and we are looking to enrich the jobs by providing more training and development.

“There is more we can do to sell Devon as more of a place to liv and there is lots that we are doing to recruit people, but we can’t do all of this and maintain a balanced financial budget.

“Our board already decided it would set a deficit budget this year of £12m. All things the things we are doing come with a price tag and we are looking at a deficit of £17m. We will need to get that back in balance, but we are taking account of how we can that back and it may take a few years to achieve.”

Cllr Philip Sanders said that he had heard a lot of words about how the maternity service was improving, but added: “I have not seen any evidence, so what have you done to test it? I am also nervous about the effect it is having on other services as there is a tendency that other services are affected when your focus on one thing.”

He added: “The key for me is safety. Are the patients safe, but also, do they think they are safe?”

Mrs Tracey said: “It is intangible and about a feel, but also about speaking to people on the ward and external scrutiny. We are keeping an eye to make sure we don’t see areas of challenge appear in other parts of the organisation.

“We are focusing on ensuring people are safe. We take seriously the issues raised by the CQC, there was never a question of the safety of outcomes that patients were receiving. Are people safe within the hospital? Absolutely.”

A report outlining the actions that the NDHT has taken to improve since the CQC report was provided to the committee.

It said that staff training had greatly improved in urgent and emergency services, and in maternity services, incident investigations had improved and the culture within the service was improving. There was improved oversight, audit and assessment of the end of life service, and in outpatients, the Trust had better oversight of waiting lists, the report said. But it added that there were areas in which further action needed to be taken.

A follow-up inspection in July after last October’s inspection showed that there had been some progress at the Trust, but Professor Ted Baker, chief inspector of England’s hospitals, said: “It is clear that further work needs to be completed.”