Growing concern about trust’s cost-cutting moves

WHEN Bexley Care Trust revealed it was £7.7m in debt, everyone waited to see how it was going to resolve the situation.

But if people were expecting a Queen Mary's Hospital-style public debate on its plans to reconfigure services, break even at the end of this financial year and repay £1m of its debt, they were wrong.

Many people have felt excluded from the trust's cost-cutting processes.

There have already been protests about reducing speech therapy services for adults and for children in special schools, family planning services and district nursing.

Most people have no idea what the trust's proposals are, who is being consulted about them or how to get their own voices heard.

People can also search in vain for details of the trust's cost savings proposals, which do not feature anywhere on its website.

The trust says this is because the site needs revamping.

Chief executive Simon Leftley accepts there may have been failings in communications with the public.

He said: "Many of the proposals are about the way we deliver our services, which would affect only our staff and so we are not obliged to consult the public."

But Mr Leftley said he would welcome comments and ideas from the public and accepted the trust may not have made this as clear as it might have.

He claimed the trust had involved the public and pointed to proposals on speech and language therapy for both adults and children, where public disquiet about the trust's plans has led to changes or an extension of the consultations.

Only a month has been allowed for most consultations, although for service changes such as in district nursing, the trust has allowed three months.

Mr Leftley said the trust had not moved from the recovery plan it outlined at a public board meeting in May this year.

But unlike at Queen Mary's, the changes are not all being made at the same time.

He pointed out the trust has made its proposals public, through the Patients' Advice and Liaison Service, Bexley Council's health overview and scrutiny committee, special interest groups and published them on the trust's internal website.

• Many consultations have already closed, but if you have any comments or ideas on the trust's proposals, you can email contactus@bexley.nhs.uk or you can write to the chief executive at Bexley Care Trust, 221 Erith Road, Barnehurst DA7 6HZ.

LOOKING AT REFERRALS

AT THAMESMEAD'S Lakeside health centre, other aspects of Bexley Care Trust's financial savings plans are causing concern.

Doctors and patients at the centre are worried about the trust's decision to monitor the referral of patients by GPs to a specialist.

The trust says this will only be done for GP practices which have a higher number of referrals than usual in the borough.

David Sturgeon, for the care trust, assured a meeting of the Friends of Lakeside that no-one's treatment would be delayed because of the new process.

But patients were angry their trust in their GP could be undermined by someone calling into question their doctor's judgement.

The decisions of practices with an "unusual" pattern of referrals will be looked at by a panel of public health clinicians.

The decisions will then be passed to a practising GP for an opinion.

Mr Sturgeon explained some GPs may not realise there were now new alternatives to hospital treatment available.

But patients were concerned details of their health problems and treatment would be passed around the trust for others to read.

Another cause of concern among the public is the care trust's decision to stick to the 13-week target for non-urgent referrals until the end of next March.

This means even if a patient can be seen quicker by a hospital department, their appointment will be delayed.

Care trust chief executive Simon Leftley said people could not have appointments the trust could not pay for.

He added: "Everyone will be seen within the Government waiting time target."

Changes not just driven by money

BEXLEY Care Trust says changes to its services are to improve patient care and are not just driven by the need to save money.

Like this year, the trust has overspent its budget for the previous three years, and chief executive Simon Leftley claims much of this is down to historic patterns of care, where Bexley people have traditionally undergone higher levels of hospital treatment than the national average.

But he said the current NHS cash crisis had also forced trusts to look more closely at how they spend their money.

Mr Leftley said the concentration was now on trying to reduce hospital involvement and bring treatments out into the community and closer to the patients.

Examples include the minor injuries unit at Northumberland Heath and minor surgery now carried out in some GP practices.

He said many of the trust's services were being altered, but this was to modernise and improve them.

Consultations on a number of proposals have already closed and some changes have already been implemented.

These include cuts to family planning services, withdrawing primary school health advisors, changes to the podiatry service, cuts in the incontinence service, cuts in support for pharmacists and cuts in clerical support to services.

Following an outcry from parents and concern from Bexley Education Authority, the trust has held further talks on cuts to speech and language therapy provided in the borough's special schools and agreement has now been reached on how this service will be provided.

The trust says it is also holding further talks following a similar outcry about the speech and language team based at Queen Mary's Hospital, Sidcup, and the aphasia group, for people recovering from strokes and brain damage.

Public consultation is now under way on proposed changes to the district nursing service, which would see the day and twilight services merged to provide nursing care on rotating shifts, between 8am and 8pm with further proposals on how to deal with night time care.

The trust says, following surveys, its proposals would best serve the needs of patients, but they could also save up to £120,000 a year.

More plans to help balance the books

BEXLEY Care Trust says the efforts to save money to balance its books may still not be over.

Already £7.7m in debt this year, the trust has also had to hand over £7.3m of its £240m budget to a fund to help trusts across London in financial trouble just like itself.

Then it was asked for another £2.2m.

The trust has reached an agreement that, as well as breaking even by the end of March next year, it will only have to repay £1m of its debt.

Another pressure has been to find some of the cost of new GP contracts.

It has budgeted to save 10 per cent of its £2m administration costs, which it says are among the lowest in London.

It has used a vacancy freeze since May, redeployment to try and reduce staffing and has cut the equivalent of 50 full-time jobs.

But the jobs of 15 administration staff remain at risk of redundancy.

Chief executive Simon Leftley says the care trust is on course to meet its financial targets.

But he says people should remember under the latest Government inspections, Bexley was one of only six care trusts in London rated as good for its health outcomes.