King's College Hospital in special measures: what does it mean, exactly?

[DulwichLondoner]

Lots of articles in the press about it, but I still fail to understand what it means.

Will services be cut? Will employees be fired?

Will the government step in somehow?

Will some creditors not be paid?

Does any one know?

https://www.ft.com/content/327f49c6-de80-11e7-a8a4-0a1e63a52f9c

https://news.sky.com/story/kings-college-hospitals-in-special-measures-11166678

http://www.bbc.co.uk/news/health-42304490

https://www.theguardian.com/commentisfree/2017/dec/10/quit-hospital-boss-nhs-chair-kings-college-hospital-london

[Penguin68]

The financial problem would appear to be significantly associated with the Princess Royal in Bromley - rather than Kings in Southwark. It would not surprise me to learn that PFI costs were contributory. The government has already stepped in by removing wholly independent decision making from the Trust (which is what special measures means, really). I doubt whether creditors will be impacted (this isn't a bankruptcy) - which is sad if it also excludes looking at PFI deals - nor would there necessarily be any impact on staff or services at Kings itself. Although there might be. Kings is part of the government response planning for major incidents etc. That will not be jeopardised, or at least not knowingly. This move appears to be all about financing and not about the way the hospitals were being run operationally - unlike some special measures moves.

[Peckhampam]

Penguin68 is right that the special measures are financial.

NHSI guidance says

Trusts previously put into financial special measures have received support across a range of areas including:

ensuring that their financial systems and controls operate effectively, so that money isn?t being spent without proper checks and controls - including, for example, in the authorisation of agency and locum spend

improving efficiency and productivity, including learning lessons from higher performing trusts

improving the way trusts manage their workforce and plan rotas to use their permanent staff most effectively - we have seen major reductions in temporary staff spend in this way

ensuring they get paid appropriately for the work they do

I am a Southwark Governor for KCH. As a Governor group we are worried as to what special measures might bring and as our lead governor said to the BBC we are "concerned at further cost pressure and the need to source further reductions after two years of major cuts".

As a public governor I need to represent the views of Southwark residents so please do post on this thread with your thoughts about what is happening to your local hospital.

Pam

[Penguin68]

Having read the attachments (thanks for the link, Peckhampam) I am assuming that the CQC is assuming that a fiscal deficit will necessarily lead to a reduction in patient care - since there is no evidence being presented at the moment (that I can see) that such a reduction is taking place (or has taken place). My own, very recent, experience in King's A&E - where I was seen by a doctor in under 90 minutes - suggests that the 4 hour targets - at least on a weekday morning - are being easily met, although waits to see consultants in some other areas (to my knowledge) are getting longer. I assume, as governors, that you are seeing where in the Trust the fiscal pressures are coming (overspends against budgets), and will know whether, as I have hypothesised above, there is a PFI element to this. Of the 4 main current account budget heads (Land & Buildings, Staff, Equipment, Consumables) there is always a concern that Staff costs are less easy to budget for, as with any given head-count requirement it makes a significant difference whether this is being met by contracted (employed) staff or by temporary staff - on an hourly basis normally more expensive for non-outsourced work areas. Again, unanticipated increases in the costs of, or demand for, consumables - such as drugs - must be an issue.

In a sane world (with a National Health System) you would need to match what is done against what needs/ should be done and cut anything which is done but shouldn't (didn't need) to be done - which would include 'nice to' rather than 'need to' items. But we know that prevention (with costs now) pays in over time against having to deal with preventable outcomes. But Budgets are annual, not generational. Which maybe means that you do need a government input to review the cost: operational: funding model. It is that model that Kings is failing against. Maybe the model needs changing.

[Peckhampam]

For clarification, the link I gave, which I have now removed, was for special measures. I'm sorry for the mistake as the Hospital has in fact been put under "financial special measures," which does not imply that there is a problem with patient care.

Many hospitals in England, including the majority in London are in financial deficit. There are many reasons for this, some individual to KCH, but it would certainly seem, as Penguin 68 says, that the financial model needs changing

[Zebedee Tring]

Had the Government funded King's and the rest of the NHS properly and not dumped the crisis hit Princess Royal Trust on King's, then King's wouldn't be in this predicament in the first place. Not to mention the PFI contracts, at least one of which lasts for a staggering 30 years, which are just as much the fault of Labour as the Tories.

It is reported that the new chair of regulator NHS Improvement, Dido Harding, spoke to Lord Kerslake, King's College Hospital Trust Chair, on Friday and asked him to "consider his position" in the light of consistently poor financial performance at the trust.

Would this by any chance be the same Dido Harding, ex Tory peer and chum of David Cameron, who in October 2015 was CEO of TalkTalk when experienced a "significant and sustained cyber-attack", during which personal and banking details of up to four million customers is thought to have been accessed? City A.M. described her responses as "naive", noting that early on when asked if the affected customer data was encrypted or not, she replied: "The awful truth is that I don?t know".

The moral is : don't do as I do, do as I say.

[apbremer]

And we are frittering away ?1BN per month on the fatuous foreign aid programme. just to show the world how virtuous and caring we are. What a bunch of idiots run this country.

[Penguin68]

And we are frittering away ?1BN per month on the fatuous foreign aid programme. just to show the world how virtuous and caring we are. What a bunch of idiots run this country.

Because, after all, if things are too difficult at home, they can always come over here and find a living. As they have done and will.

[Zebedee Tring]

For the avoidance of doubt, I am NOT advocating cutting the foreign aid budget. And I am not a Brexiteer and therefore not one of that group who was fooled into thinking that the NHS would get an extra ?350K a week when we left the EU. The amount that was frittered away on the so-called "reforms" perpetrated by Lansley, including the creation of NHS Improvement, was enormous.

There are plenty of ways that the NHS could be better funded, depending on one's political priorities, but this is not the appropriate thread for this debate.

[rendelharris]

Zebedee Tring Wrote:

-------------------------------------------------------

> Had the Government funded King's and the rest of

> the NHS properly and not dumped the crisis hit

> Princess Royal Trust on King's, then King's

> wouldn't be in this predicament in the first

> place. Not to mention the PFI contracts, at least

> one of which lasts for a staggering 30 years,

> which are just as much the fault of Labour as the

> Tories.

The one on the Princess Royal runs for sixty years, I believe, and in return for an initial investment of ?118m for the new building the taxpayer will eventually pay ?1.2bn!

[DulwichLondoner]

The New York Times had an article on the hospital a few weeks ago, but it was more on the impact of Brexit on staffing and recruiting than on the hospital's financial difficulties.

https://www.nytimes.com/2017/11/21/world/europe/nhs-brexit-eu-migrants.html

[mikeb]

The total payments made by the trust under the PFI will probably be more for 30 years of facilities management (plus any other contracted services) than for the original capital expenditure. You can't compare the two numbers - one is for services over 30 years and the other for a building.

Also, PFI contracts often require that the building is maintained to a much higher standard than is usual for public sector buildings - it's pretty common for public authorities under budget pressure to skimp on maintenance and only do what is absolutely necessary. This isn't possible if you've already contracted to pay for it.

None of this means the PFI was good "value for money" - it probably wasn't but you need a lot more information to assess this. And even if the PFI contract were good "value for money", it also doesn't mean that the actual specification was appropriate: it may well have been a poor use of limited resources to commission the building and / or to sign up for a long term contract for services.

[JoeLeg]

apbremer Wrote:

-------------------------------------------------------

> And we are frittering away ?1BN per month on the

> fatuous foreign aid programme. just to show the

> world how virtuous and caring we are. What a bunch

> of idiots run this country.

I'm not sure you understand how the foreign aid programme actually works.

[uncleglen]

apbremer Wrote:

-------------------------------------------------------

> And we are frittering away ?1BN per month on the

> fatuous foreign aid programme. just to show the

> world how virtuous and caring we are. What a bunch

> of idiots run this country.

I probably read the same stuff as you- for example

?150.4 million to India p.a. for example. India which carries out nuclear testing, has its own space programme as does China which receives foreign aid-http://www.telegraph.co.uk/news/2017/02/07/british-taxpayers-money-spend-improving-social-care-elderly/ - when we have our own crisis in the UK

Not to mention the fact that much donated money is 'disappeared' by corrupt people...as is the case in Eastern Europe with EU money....

[Zebedee Tring]

What about the massive amount of tax that we fail to collect from people and corporations who squirrel their dosh away offshore, in complicated family trusts or in other supposedly legitimate ways? Or in the massive tax cuts given the Government in recent years? This could pay for a doubling of the NHS budget.

[DulwichLondoner]

How about bringing the discussion back on topic? :)

[Zebedee Tring]

The amount of money that the Government is failing to put into the NHS is surely relevant to King's current plight. This failure is in turn very relevant to us in ED who use King's services.

[dbboy]

I'd cut ALL foreign aid NOW and spend this money on the needs of the UK.

[mikeb]

In this enlightening discussion of DFID, let us not forget that its budget is 0.7% of the U.K. economy ie a rounding error. Let?s move on from this trope.

[DulwichLondoner]

But now we're going to get ?350 millions a week for the NHS. Ah, no, wait, it was a blatant lie yet lots of people bought it.

(Sorry, I couldn't resist!)

[natty01295]

They are Real Scum Anyway !!!

Hate that stupid hospital And the Stupid Staff

[rendelharris]

DulwichLondoner Wrote:

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> But now we're going to get ?350 millions a week

> for the NHS. Ah, no, wait, it was a blatant lie

> yet lots of people bought it.

> (Sorry, I couldn't resist!)

You see, we can agree! You speak truth there.

[JoeLeg]

dbboy Wrote:

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> I'd cut ALL foreign aid NOW and spend this money

> on the needs of the UK.

What was it Mattis told the Senate? Oh yes, "If you're not going to fund the state dept properly then I need to buy more ammunition"

Foreign aid is a remarkably complex beast. No doubt parts of it get lost and stolen, but it's nowhere near as cut and dried an issue as some here are making it out to be.

We desperately need to fund the NHS properly, but it requires a mental shift in people understanding how modern medecine works and how expensive it is.

[JoeLeg]

natty01295 Wrote:

-------------------------------------------------------

> They are Real Scum Anyway !!!

> Hate that stupid hospital And the Stupid Staff

I appreciate you have strong reasons for feeling that way.

From my experience they've saved my mums life twice and my wife's life once.

[Penguin68]

Can I remind forumites that Peckhampam appears to be a public governor of the Trust and has asked for any input specific to the trust from local people for whom Kings is their key hospital. Debates about foreign aid are no doubt interesting but perhaps not specific enough to our local circumstances. I personally have found their reorganisation of A&E to be effective, at least at times of relatively low demand (weekday mornings). However waiting times to see consultants/ specialists on non-life threatening issues (I cannot speak for life threatening issues) seems to be extending. And I have found that their clerical organisation and record keeping (and their own internal communications) - at least in one specific department - appear chaotic, generating more work for themselves by failing to provide the right information in a timely manner to patients.