UK

Citation

(2003), "UK", International Journal of Health Care Quality Assurance, Vol. 16 No. 5. https://doi.org/10.1108/ijhcqa.2003.06216eab.005

UK

UK

Report on NHS Trusts & Primary Care Trusts Financial Information

Keywords: Primary care, Hospital’funding, NHS staff

The latest report from Laing and Buisson on NHS Trusts & Primary Care Trusts Financial Information 2003 provides information on income from private patients and the cost of employing agency staff in NHS hospitals.

Their report shows that the total private patient income of NHS Trusts in the UK was £359 million in 2001/2002, up from £334 million in 2000/2001, an annual growth of 7.6 per cent, which is double the rate of growth in 2000/2001, but, as an average proportion of Trusts' total core income from patient activities, private patient income remained unchanged at 0.9 per cent.

Private patient activity in England accounts for 95 per cent of the UK total. NHS Trusts in England generate 1.1 per cent of core revenues from private patients with the proportion being much lower in the rest of the UK (0.4 per cent in Wales, 0.1 per cent in Scotland and 0.3 per cent in Northern Ireland), but for a few Trusts this figure is considerably larger. Not unexpectedly, London NHS hospitals lead the way in private patient activity, accounting for eight of the top ten NHS Trust largest private earners, and the Royal Marsden Hospital NHS Trust earned the largest private revenues of all UK Trusts in 2001/2002, at £19.3 million. This equated to just under a quarter of its total core income from all patient activities.

However, the Government is to introduce a ceiling on private patient revenue growth in hospitals with foundation status. The Health and Social Care (Community Health and Standards) Bill stipulates that NHS foundation trusts will not be able to earn a higher proportion of total income from private patients than in its last financial year. For UK NHS Trusts this is almost certain to dampen overall private patient activity.

The cost of employing agency staff in NHS hospitals continues to increase strongly. The total agency staff cost of Trusts in the UK was £1.3 billion in 2001/2002, up from £980 million in 2000/2001. This was an annual growth of 31 per cent in 2001/2002, which followed growth of 26 per cent and 22 per cent in the previous two years. Agency costs increased to 4.6 per cent as a proportion of UK Trusts' total staff costs, from 4 per cent a year earlier. The proportion has doubled since 1997. The pattern of spending is heavily weighted towards England. Agency spending in England accounts for over 90 per cent of the UK total with NHS Trusts in England spending 5.1 per cent of total staffing expenditure on agency workers. The proportion remains lower in the rest of the UK (3 per cent in Scotland, 1.9 per cent in Wales and 1.6 per cent in Northern Ireland). Again London NHS hospitals head the league, accounting for seven of the top ten NHS Trust largest spenders (see Table 2). Guy' s & St Thomas' NHS Trust spent the most of all UK Trusts in 2001/2002, at £30 million. This equated to 12 per cent of its total staff costs.

Further information about the report and other Laing and Buisson reports can be found at: www.laingbuisson.co.uk/

NHS staff safety at workStaff shortages, Work’accidents

The NHS employs over one million people and its biggest constraint is staff shortages, yet three reports published in the Spring demonstrated that there are still considerable health and safety risks to staff.

In April, Sir John Bourn, Head of the National Audit Office (NAO), reported (A Safer Place to Work: Improving the Management of Health and Safety Risks to Staff in NHS Trusts) that, although there had been real improvements in the management of health and safety risks to staff in NHS trusts, progress overall was patchy. The number of reported accidents is increasing, the gap between the best and worst performing trusts is widening and more NHS trusts need to learn from and implement good practice. Moving and handling, needlestick injuries, slips, trips and falls and exposure to substances hazardous to health remained the main causes of accidents, but work/related stress had emerged as a serious issue with over two/thirds of trusts reporting an increase in the last three years.

The number of reported accidents in acute, mental health and ambulance NHS trusts increased by 24 per cent between the 2000/2001 base/line and the 2001/2002 target date set under the Department of Health 1999 Working Together initiative, with 135,172 accidents in 2001/2002. As a result, the Department' s national improvement target of a 20 per cent reduction by 2001/2002 has not been met with only just over a fifth of trusts meeting the 20 per cent reduction target.

The reasons for the increase are rather complex. Better awareness of the need for reporting and more robust incident/recording systems have contributed to it, and in some trusts the number of accidents has fallen through improved training and practices, while in others improved awareness and reporting have led to an increase in reported accidents. However, over a fifth of trusts identified staff shortages and increased workloads as leading to poor compliance with good practice and as a result an increase in accidents, and in all trusts there remains a significant problem of under/reporting.

The report concludes that, despite Departmental initiatives to encourage trusts to introduce procedures for assessing the cost and impact of accidents, little progress has been made. The NAO' s analysis estimates that the direct costs are at least £173 million, but the true cost is substantially more once staff replacement costs, treatment costs and court compensations awards are taken into account, not to mention the substantial human costs of low productivity, staff turnover and their impact on delivering the NHS Plan. Trusts have made improvements in compliance with the statutory and operational responsibilities and in their overall approach to risk management and health and safety training but the types and quality of risk assessments vary and there is considerable scope for more trusts to learn from and implement good practice.

The report says that the NHS needs to develop a national health and safety strategy to co/ordinate existing and new initiatives, commission and disseminate evidence/based guidelines on health and safety interventions to help NHS trusts improve the management of risks and reduce the impact on stress, sickness absence and staff retention and work with the NHS Litigation Authority and Health and Safety Executive to support the development of a robust costing methodology for assessing the financial impacts/outcomes of accidents. It also needs to ensure that the new NHS Electronic Staff Records System is developed to capture information on reasons for work/related staff sickness absences and turnover.

In March another report from the NAO, A Safer Place to Work: Protecting NHS Hospital and Ambulance Staff from Violence and Aggression, said that good progress has been made to improve the protection from violence given to NHS staff but that more needs to be done particularly on risk assessment, staff training, follow/up after an incident has been reported, and the establishment of effective partnerships between the NHS and other public agencies such as the police.

In the last two years the level of reported incidents of violence and aggression against NHS staff working in acute, mental health and ambulance trusts has increased by 13 per cent. Around 95,500 incidents were reported in 2001/2002 and only a fifth of trusts met the Department' s national improvement target of a 20 per cent reduction by April 2002.

There are few or no data on the financial impact of violence and aggression but, based on their estimates of the cost of work/related accidents, the NAO estimate that the direct cost is likely to be at least £69 million a year. This excludes staff replacement costs and the human costs, such as stress, low morale, lost productivity and high staff turnover, which are known to be substantial.

The Department of Health, through its zero tolerance zone campaign, has been successful in raising awareness of the need for staff to report and in informing the public that violence against staff working in the NHS will not be tolerated but the NAO' s survey found that, while all NHS trusts have embraced the values set out in the NHS zero tolerance zone campaign, different definitions are used and there are wide variations in reporting standards and in the support provided to staff. These factors make it impossible to say conclusively how far the increase in reported violence reflects an actual increase in incidents, or measure how individual trusts are performing. Many Trusts have generally responded positively with better use of risk assessments, staff training, and improvements to the physical environment to make it both more patient/friendly and at the same time more secure for staff but further work is needed.

The NHS needs to do more to establish partnerships with the local police, the Crown Prosecution Service, social services and the media to ensure that there is a clear understanding of different organisations' roles, leading to a clear and consistent approach to dealing with violent individuals and incidents in NHS settings.

Third, in April a new King' s Fund report, London' s Mental Health Workforce, says that tackling safety in some of London' s mental health hospitals, as well as problems of excessive workloads and poor housing opportunities, are key to easing staff shortages that continue to be at crisis levels. Mental health nurses responding to a "reality check" survey spoke of safety worries caused by violence, harassment and drug dealing on acute mental health wards in the capital. Stress, overburdening workloads and a lack of affordable housing were also contributing to recruitment and retention difficulties.

The report' s author, Pippa Gough, said: "Acute mental health wards can be challenging, stressful and dangerous working environments. Nurses are increasingly vulnerable to violent and intimidating behaviour, and patients are also losing out when ward environments are unsafe."

The report highlights positive developments in tackling high turnover and vacancy rates and improving continuity of care, such as the nurse rotation scheme which aims to increase the average length of time that newly/qualified mental health nurses stay in trusts. It also calls for clearer policies about acceptable behaviour by patients and visitors on wards, together with the authority to take action where these are violated; clear drug and alcohol policies which are backed up with mechanisms to support staff when these policies are violated; and better training and education practices to prepare mental health workers for the challenging demands placed upon them.

Further information about A Safer Place to Work: Protecting NHS Hospital and Ambulance Staff from Violence and Aggression and A Safer Place to Work: Improving the Management of Health and Safety Risks to Staff in NHS Trusts can both be accessed from the NAO Web site at: http://www.nao.gov.uk/

The King' s Fund report, London' s Mental Health Workforce, can be accessed from the Fund' s Web site at: www.kingsfund.org.uk/

Changes to NHS complaints processesNHS complaints, Primary’care, Advisory service

Changes are underway for dealing with complaints about health care. Patient Advice and Liaison Services are now operational in most areas of the country and several Independent Complaints Support and Advocacy pilot studies are taking place. Early in the year, Health Minister David Lammy announced a £2 million extension to these. The extra funding will ensure the continued development of this new service, offering support to individuals who wish to make a complaint about their NHS care or treatment.

The Independent Complaints Advocacy Service (ICAS) is a new service with a statutory duty to provide independent support to NHS complainants under Section 12 of the Health and Social Care Act 2001. The Commission for Patient and Public Involvement in Health (CPPIH) sets the standards for and will monitor the provision of the ICAS. The pilots include a wide range of voluntary organisations such as MIND, CABs, Age Concern, Specialist Advocacy Groups, Carers Organisations, and Community Health Councils, covering about 70 per cent of the UK. The service will be rolled out nationally from 1 September 2003.

Additionally, a new Commission for Health/care Audit Improvement (CHAI) will take over responsibility from NHS Trusts and PCTs for independent reviews of complaints under plans outlined in NHS Complaints Reform - Making Things Right, published by the Department of Health. The latest figures show that NHS Trusts resolved 140,000 formal complaints from people about their local NHS services, but 2 per cent of people felt the need to take their complaint further and requested an independent review. Research has shown that complainants do not perceive this stage of the complaints procedure as being impartial, which is why the Department plans to introduce radical reforms. The reforms also include:

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  increasing support and information for people who make complaints through local Patient Advice and Liaison Services (PALS) and Independent Complaints and Advice Services (ICAS);

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  patient feedback and customer care training for NHS staff, including board members, to improve the way people are dealt with to help resolve complaints quickly; and

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  subject to legislation, placing responsibility for independent complaints reviews with CHAI.

Health Minister, David Lammy said: " Patients and staff alike have told us that they want a new complaints procedure that is more flexible, responsive, independent and, as a result of their concerns, leads to improved NHS services. Our radical plans will mean that individual patients will get full responses to their complaints and that the lessons learned from them will lead directly to service improvement.

" We are determined that the structure and operation of the complaints procedure will change as part of our commitment to put the voice of the patient at the heart of the NHS, providing a fair, effective, consistent and efficient complaints management system fit for the twenty/first century."

Peter Homa, Chief Executive - designate of CHAI, said: " CHAI will be the authoritative, independent judge of the quality and efficiency of both NHS and private health care in the UK and will be a driving force for its continuous improvement. That includes redress for individuals when something has gone wrong.

" We will play a key role in delivering an NHS complaints procedure that provides both resolution for the individual and a direct link to quality improvement processes."

CHAI is dependent on the passage of the Health and Social Care (Community Health and Standards) Bill, and it is not expected that it will be fully operational before April 2004.

For further information about any of the above, see: www.doh.gov.uk/complaints

New national standards for children' s hospital servicesNHS childcare, Children' s’health care, Laming’Inquiry

New national standards have been introduced to deliver more child/friendly services in hospitals, including dedicated children' s units in A&E Departments. They will be backed up by a £70 million investment in neo/natal intensive care facilities.

The new standards cover the design and delivery of hospital services for children, the safety and quality of care, and will help to ensure children are cared for in hospital settings that adequately reflect the needs of their own age group. They mean that NHS hospitals should consider introducing:

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  separate facilities for young children from those provided for adolescents;

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  designated play areas for young children and privacy for adolescents;

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  education support, so children do not fall behind in their schooling;

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  dedicated children' s units in A&E departments; in a typical year a half of babies under 12 months and one quarter of older children attend A&E;

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  menus that encourage children to enjoy their meals;

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  regular security reviews to ensure access to children' s wards is limited;

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  specialist training for staff dealing with children;

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  play specialists who help children cope with the distress of being in hospital; and

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  surveys of children and their parents to help inform inspections undertaken by the new Commission for Health/care Audit and Inspection.

Hospitals will now be expected to appoint a " children' s champion" at board level to ensure that the standards are met and, in line with recommendations by the Laming Inquiry, no child should be discharged from hospital without a care plan.

The new standards are the first part of Getting the Right Start: The National Service Framework for Children, Young People and Maternity Services. The remaining parts of the Children' s National Service Framework will be published during the coming year.