Hospital and ambulance service are handed fines of more than £3m for missing key patient targets
PUBLISHED: 09:48 17 May 2017 | UPDATED: 13:17 17 May 2017
Archant Norfolk Photographic © 2008
Norfolk’s largest hospital was fined more than £2.5m for missing key NHS patient targets.
The Norfolk and Norwich Hospital (NNUH) was hit with fines from the Norfolk and Waveney clinical commissioning groups (CCGs), who also handed a bill of more than £250,000 to the region’s ambulance service.
The fines were suspended for the 2016/17 financial year but the full extent of the burden placed on the trusts in the year before has been revealed through Freedom of Information requests put in by Cromer town councillor David Russell.
Mr Russell, who is also the council’s representative at North Norfolk CCG said he was keen to see the money ploughed back into local NHS services. But since last year, CCGs have been able to use the funds to balance their books.
“All this money is supposed to be used to improve services, but now the government have changed that,” Mr Russell said. “My town council is not happy about it, we recognise the problems the CCGs face to find savings, but it needs to be spent on patient care.”
But the CCGs insisted “positive investments” had been made.
In 2015/16, NNUH was fined £2,481,000 by CCGs in Norwich, west, north, and south Norfolk for failing to deal with 95pc of A&E patients within four hours. The hospital was fined a further £267,064 by Great Yarmouth and Waveney CCG, of which £108,295 was reinvested into NHS services.
That year, NNUH met the four-hour target 85.33pc of the time. In 2016/17 this rose to an average of 85.7pc.
A NNUH spokesman said their performance was improving all the time, and pointed to improvements to the emergency department and other changes.
He said: “Currently nine out of 10 patients visiting A&E are treated within the four-hour target. Attendances at A&E at the N&N rose from 108,831 in 2015/16 to 115,118 in 2016/17 and our performance in relation to four-hour targets improved over this time.”
East of England Ambulance Service (EEAST) was fined £267,870 by CCGs in Norwich, and north and south Norfolk when they missed their target of reaching at least 75pc of the most urgent calls within eight minutes. In 2015/16, 71.5pc of Red 1 calls (the most time critical) hit the target. In 2016/17 this dropped to 68.4pc.
For Red 2 calls (still serious, but less immediately time critical) this was 60.9pc in 2015/16, rising to 61.92pc in 2016/17.
An EEAST spokesman said: “Regional targets for ambulance trusts reflect the reality that the geography of many Trusts makes it very challenging to respond to some patients within eight minutes. However we are getting to more critically-ill patients quicker now than a year ago.
“Our staff and volunteers make essential individual contributions to patient outcomes every single day, and are the driving force behind our ambition to provide the best possible responses to our communities.”
NHS Providers, which represents hospital trusts, hit out at CCG fines last year when nationally the bill amounted to £600m. The group said it was nonsensical to fine hospital trusts, when 90pc were in deficit. NNUH ended 2015/16 with a deficit of £21.9m.
For 2016/17 it was estimated this would rise to £25m. At EEAST although a £158,000 surplus was posted in 2015/16, recent Board papers estimate a deficit of £7.8m for the 2016/17 financial year.
CCGs used to be able to waive the fines, but charging them became obligatory in April 2015. Similarly, fines used to be reinvested to help trusts.
But in January 2016 NHS England told them they could instead hold onto the monies and use them to improve their own balance sheets.
However, the message from all five of the CCGs was that “the issue of contractual penalties must be viewed in the wider context of the positive investments being made by all NHS and social care partners.”
A spokesman said the aim was to prevent avoidable emergency admissions to hospital and help to reduce pressures as much as possible. And pointed to services such as the urgent care centre at NNUH, and specialist epilepsy nurses who work with patients to reduce unnecessary admissions.
He added: “With regard to penalties, most NHS providers have key performance requirements in their contracts. It is a national requirement that in some cases financial sanctions should be applied if they are consistently missed. Performance requirements and potential sanctions are agreed with the providers. The aim is to improve performance and/or patient care.”
Focus on improvements
Both NNUH and EEAST highlighted the improvements their services had made since the 2015/16 financial year.
A spokesman for the NNUH said: “Our A&E performance is improving all the time. Currently 9 out of 10 patients visiting A&E are treated within the 4 hour target.
“There are a number of steps we have taken to improve performance and the most significant is the expansion of the Ambulatory Emergency Care (AEC) service. This service has enhanced patient experience and helped to reduce the number of patients requiring admission to hospital by around 5%.
“Ambulatory Emergency Care is offered to patients who require further investigations, procedures or treatment following a referral from their GP or from A&E. The service offers same-day emergency care and reduces unnecessary admissions into hospital.
“We have also created a day ward dedicated to medical patients who were likely to be admitted, but who could be treated on a day case basis.
“Recent projects to improve our Emergency Department performance have shown that many patients come to A&E needing diagnostics and advice from a consultant which enables them to go home safely rather than spending time as an inpatient in hospital.
“We launched a discharge HUB in May 2016 that acts as a central point of contact for all wards and staff to access support with discharge planning.
“A significant amount of work has been completed over the last 12 months in reducing the number of patients who have been in hospital for longer than 14 days, known as stranded patients. This number in April 2016 was around 350 patients, with an intense focus on this and persistent reviews we have successfully managed to reduce this number to around 200 patients.
“All of these improvements continue to have an impact, with performance currently sitting at 90% (& improving) alongside more patients being treated with planned, surgical treatments.
A spokesman for all five CCGs added also highlighted investments. He said: “For example we have invested in the urgent care centre at NNUH, a specialist epilepsy nurse working with patients to reduce unnecessary admissions, practice-based integrated care teams and integrated care co-ordinators to assist patients and their carers reaching crisis point resulting in a reduction in hospital admissions, a collaboration between NNUH, EEAST and Norfolk Community Health and Care NHS Trust for a falls prevention vehicle which has helped a number of patients, ‘virtual wards’ in three CCG areas which enable patients to be treated at home rather than need an emergency admission, ‘hear and treat’ service run by the ambulance service to reduce ambulance conveyances and a clinical hub at the 111 service to help patients remain safely at home rather than need to go to hospital.”