Problems were already mounting for embattled trust - the background

The CQC was preparing inspections across the trust that, at the time, was already £1m over budget a month into the new financial year and dependent on £13m of financial support available as “permanent borrowing”.

Urgent care demand had already outstripped specific performance improvement schemes developed over the past year and continued to rise.

Mr Smith said getting urgent care demand under control was critical for the trust’s future.

At the time of the CQC inspection A&E attendances at the County were showing a year on year increase, with activity over 2013-14 3.1 per cent, or 1,467, up against the previous year.

Attendances in April this year, for instance, were 5.7 per cent, or 234, up against April 2013.

West Midlands Ambulance Service confirmed an increase of 161 patients arriving at A&E by ambulance between April-mid May compared to last year.

A&E was designed to handle a maximum of 125 patients a day under the PFI deal that got the hospital built.

By June the average was 145 with surges up to 180.

Demand regularly sees the A&E failing the four-hour national waiting time standard.

This amounted to £28,000 of the £35,000 in non-performance fines the trust had incurred up to April alone.

Urgent care pressure has an impact across all areas in the hospital, most immediately in bed availability and the scope for income-generating elective surgery.

Ahead of the CQC inspection available figures showed some 30 non-clinical operations had been cancelled on the scheduled surgery day and another 22 the day before.

But the impact on budget plans is the biggest concern going forward.

The trust has set a deficit of £9 million within its present financial plan.

By the end of the first month that plan was already more than £1 million over budget with the trust facing a need for expensive agency staff and savings programmes failing.

The cash position of the trust at the time of the inspection was dependent on £13m in financial support from the NHS available as permanent borrowing.

In January, the trust, facing a £15 million deficit without financial support secured £9m from the NHS Trust Development Agency to forecast a break even position by the end of the 2013-14 financial year.

The trust has required increasing levels of support over recent years just to break even with another £9.8m needed over 2012-13.

Then, the trust was declared as in “turnaround” to emphasise the urgency and scale of the financial challenges it faced.

In January this year it rejected a range of options explored over the previous year to secure its future.

The trust faced a merger, acquisition, break up, or even private sector management to cope with a funding crisis that meant it could not achieve foundation trust status by a government imposed deadline next year or any time in the foreseeable future.

....READ THE REPORT IN FULL...http://www.cqc.org.uk/provider/RLQ

What they've said...

DR ANDY Watts, chairman of Herefordshire Clinical Commissioning Group (CCG) urged patients not to be alarmed by the trust going into special measures.
“We have been working with the new management team at the trust to identify and address some of the areas highlighted as concerns in the CQC report,” he said.
“The CCG believes it is now important for the new measures to be put in place with a clear set of objectives – the majority of trusts which have been placed in special measures have seen improvements as a direct result.”
 

HEALTHWATCH Herefordshire chairman Paul Deneen says patients must be part of improvements planned for Wye Valley NHS Trust.
To this end, Mr Deneen welcomed the CQC’s salute to the work of trust staff as “committed dedicated and compassionate”.
“Both the new chief executive and the chairman of the trust board have given assurances that robust plans are in place to address the key issues raised in the report, and are leading on implementing changes and improvements,” said Mr Deneen.
Support

THE CHAIRMAN of the county’s health and wellbeing board says the CQC report raises issues for the whole health and social care system.
Councillor Graham Powell promised full support to the trust over the findings.
Herefordshire Council, said Cllr Powell, had “full confidence” that the trust’s new chief executive and board chairman can lead the improvements identified. 
“They will not have to do it alone,” he added.
More beds

NORTH Herefordshire MP Bill Wiggin said the CQC findings supported his case for more beds at Hereford County Hospital.
“This CQC report makes it quite plain that we do need to enlarge our hospital,” he said.
“Critical reports of our health care must be taken as a wakeup call and not a stick to beat staff.”
Solutions
HEREFORD and South Herefordshire MP Jesse Norman said special measures was the basis for sustained improvement of Wye Valley NHS Trust.
But the findings of the Care Quality Commission did little to add to the understanding of long-running issues faced by the trust, he said.
Instead, he added, the findings showed the NHS was finally engaging with sustainable solutions to those issues.
Challenges

THE NHS Trust Development Authority has said it is “committed” to supporting Wye Valley NHS Trust. Already, the TDA has confirmed a partnership between the trust and University Hospitals Birmingham (UHB) to work on improvements. Kathryn Singh, TDA portfolio director, said special measures was an “important opportunity” to address the significant challenges identified across the trust.

......READ THE REPORT IN FULL......http://www.cqc.org.uk/provider/RLQ