Healthcare reform loses out to legal payments bill

By Niall McCracken

Plans for fundamental change to how healthcare is delivered here have suffered a massive funding blow because of the need for the Department of Health to compensate for millions of pounds paid out in clinical negligence cases this year.

Transforming Your Care (TYC) is the Department of Health’s plan to shift the focus of healthcare from hospitals to the community.

However, a multi-million pound funding shortfall in TYC has not been given priority in the department’s latest bid for Stormont’s pot of unspent money because of the “inescapability” of the high losses it has incurred in clinical negligence cases.

The department confirmed that as of November 2013 it had already paid out £10m more in clinical negligence costs than it had during the last full financial year. It said there was a significant increase in the number of cases that have been settled in excess of half a million pounds.

Speaking to The Detail, Sinn Fein chair of Stormont’s health committee Maeve McLaughlin says she is concerned that the gap in funding will mean that “parts of the TYC agenda will go to the wall”.

The Detail can also reveal that the latest progress report by the Health and Social Care Board (HSCB) outlines that senior officials believe that funding for TYC is “not in line with plan”.

One of the key goals under TYC is for elderly people to live as independently as possible. This policy hit the headlines earlier this year for its plans to close half of the trust-run residential care homes for the elderly over the next three to five years.

As part of our investigation we have also examined the geographical breakdown of the controversial plans that could impact on over 400 permanent and temporary elderly residents in 20 residential care homes across Northern Ireland.

TRANSFORMING YOUR CARE AT A COST

The latest crisis facing TYC stems from the failure to secure planned “transitional funding” from the Northern Ireland Executive.

A TYC document published in December 2011 outlined a proposed re-investment of £83m from current hospital spend into primary, community and social care services over a five year period.

To support this change it was identified that there was a need for an extra £70m transitional funding over the first three years to allow the new model of services to be implemented.

To date the department had raised finance for TYC transitional funding through Stormont’s monitoring rounds.

This is when the Department of Finance shares out unspent money between Stormont departments who have pitched for additional finances.

Monitoring rounds take place three times during the financial year, in January, June and October.

The TYC Independent Review Panel identified a three year plan to secure £70m of transitional funding for the period up to 2014/15:

However, during the 2012/13 financial year the department only obtained £19m of transitional funding- £6m short of the projected target for the first year.

Speaking during a ministerial briefing on TYC in front of the health committee in March 2013, the chief executive of the Health and Social Care Board, John Compton, said that he anticipated a further £28m would be obtained in transitional funding for the 2013-14 year.

In the June 2013 monitoring round, the department was only able to secure £9.4m of its £28m bid.

A further failure to secure any funding during this year’s October monitoring round means that in order to meet the original target by the end of year two, the department would have to have a bid of over £20m approved in the January 2014 monitoring round.

The department has confirmed to The Detail that it is only submitting a bid of £7m for TYC transitional funding in the January monitoring round.

A spokesperson for the department said: "This reflects the scale of resource that could be spent in the remainder of this financial year and is in addition to the £9.4m received in June 2013 and £19m in 2012/13.

Speaking during a health committee meeting last Wednesday (December 11), representatives for the department said that a bid of £20m for clinical negligence costs would be taking priority in the January monitoring round.

The committee heard that £36m had been paid out in clinical negligence costs already during this financial year, compared with the full year out-turn of £26m in 2012-13.

Health officials told members that if they were unsuccessful in securing money to counter the increase in negligence costs this would mean having to find money for it in other parts of the budget.

Responding to questions from MLAs about why this would take priority over TYC funding , an official from the Department of Heath said a number of difficult decisions had to be taken.

She said: “It’s very, very difficult. All of these bids are high priority from that point of view. They’ve been ranked because of the inescapable nature of them, hence why at the top we have the bids that are being incurred where the spend is already hitting the budget.

“Of course we would want the TYC transitional funding to be made available but the reality of the position is that we can scale back the funding and expenditure to live within the resources that we have available.

“The clinical negligence settlements are happening and cannot be scaled back. So they are all high priority bids as far as we are concerned but the ranking represents the inescapability of the bids. But TYC is still a significant priority. ”

Speaking to The Detail, Sinn Fein’s Maeve McLaughlin said there needed to be more clarity on how the funding shortfall will affect TYC.

She said: "We keep hearing that TYC is going to be the biggest shift in how we deliver healthcare here and throughout this process we have raised the issue of transitional funding missing targets.

“So I have to ask why the issue of transitional funding is so far down the agenda in the January Monitoring round, with a £20m bid of extra clinical negligence costs taking the top bid. That to me seem at odds as to what the focus should be.

“Obviously if the money is not there to help with implementation, then there is a risk that parts of the TYC agenda will go to the wall. We keep hearing about the tough decisions being made, but it begs the question exactly how will this affect implementation of TYC in the long term?”

DIFFICULT POSITION

The latest January monitoring round announcement comes just months after the Health Minister, Edwin Poots, faced questions from the health committee about what would happen if TYC targets were missed.

During the meeting in July this year the Minister said: “We will go back in October to look for more monies. We have made the decision that we will progress with the £9.4m at full speed.

“There has been a fairly significant reduction, I believe, in the overspend, and, consequently, we believe that monies will become available in later monitoring rounds.

“So there is an element of calculated risk that more funding will be available in monitoring rounds later in the year and that there will be greater levels of funding than there perhaps were last year.”

Speaking during the same meeting, John Compton, HSCB chief executive and TYC’s chief architect, warned that a shortfall in funding could lead to problems.

He said: “We are proceeding on the basis of the £9.5m and then it depends on what happens in the October monitoring round. We could probably be in a very difficult position in the late autumn when a difficult set of choices would have to be made.”

The latest HSCB progress report from December 2013 provided an update on TYC.

It stated that as funding had not been secured from the October monitoring bid there was a risk that the Executive may not provide the full funding required to implement TYC reforms in 2013/14 and 2014/15.

It summarised the overall status of the project as “amber”, which means things are “not in line with plan”.

The paper stated that the problem was “correctable with focus but has the potential for risk escalation”.

THE CHANGING PICTURE OF RESIDENTIAL CARE

View Northern Ireland’s Residential Care settings in a full screen map

The plans for residential care in Northern Ireland have been a key focus of TYC since plans were first announced.

Residential care homes across Northern Ireland consist of specific services in a number of categories including those with a learning disability.

Under current plans only trust-run (statutory) residential care homes that accommodate the frail and elderly face potential closure under TYC reforms.

Earlier this year these plans were the subject of criticism after it became clear that the proposed closure of 50% of statutory residential care homes in Northern Ireland were being swiftly implemented by a number of individual health trusts.

It emerged that a number of trusts planned to shut all of their statutory residential care homes for older people. This forced the Health Minister to intervene and withdraw the trusts’ power to make these decisions.

In November 2013 HSCB published a consultation document on the criteria that will be used by health trusts to decide whether or not their residential care homes should remain open.

According to the HSCB there are currently only 20 statutory residential care homes that fall into this category in Northern Ireland. They are identified by the red pins on the map compiled by The Detail above.

In a statement to The Detail the HSCB confirmed that, as of mid November 2013, there were over 400 residents living in the 20 care homes being considered for closure as part of the consultation.

Of these, 283 are permanent residents, while the remainder are either temporary, respite, intermediate care/step down residents. At present all of the trusts apart from the Western Trust have a ban on referrals to their statutory residential care homes.

A spokesperson for the board stressed that any major changes proposed following this consultation, including the proposed closure of any home, will require further local consultation.