£12.8m deficit sparks call for a locum pay cap and reconfiguration of service to address issue

Teresa Molloy, Western Health and Social Care Trust Director of Performance and Service Improvement. DER0315MC093
Teresa Molloy, Western Health and Social Care Trust Director of Performance and Service Improvement. DER0315MC093

Western Trust bosses suggested locum pay rates should be capped as they reported a projected deficit of £12.8m at a meeting of Derry City and Strabane District Council’s Health and Community Committee on Thursday.

Teresa Molloy, Director of Performance and Service Improvement, and Lesley Mitchell, Director of Finance and Contracting, appeared before the committee to provide an update on the Trust’s Delivery Plan, but revealed they were not yet in a position to detail an approved document as negotiations with the Health and Social Care Board were still ongoing.

The health chiefs confirmed, however, that the increased costs of locums, services for ‘looked after children’ and unscheduled care at A&E, were all contributing to a deficit nearing £13m.

Mrs Mitchell revealed a £16m locum bill was a major contributor with recruitment still intractably difficult across all grades.

A Trust international recruitment drive also yielded only “modest success” in reducing our dependence on locums.

Meanwhile, an increase in the number of ‘looked after children’ - in April 2016 there were 523; it’s now close to 600 - was another significant overhead, with the Trust over-budget by £2.7m, affecting the overall deficit projection.

Sinn Féin Councillor Chris Jackson expressed concern that the straitened finances could lead to a reduction in service.

But Mrs Mitchell responded: “The Minister is very clear that we sustain the service we provide here.”

She noted that a budget deficit of £3.8m was covered last year; that an “authorised deficit” was approved in 2014/15; and that this year: “We envisage a similar solution.”

SDLP Councillor Martin Reilly said the Trust’s dependence on locums was a problem that Chief Executive Elaine Way had consistently raised.

However, he asked if there was frustration that it was an ongoing problem and if there were any fresh proposals to tackle it in light of Dr Rafael Bengoa’s report on the state of the health service across the North.

Mrs Molloy said she hoped Michelle O’Neill’s ‘Health and Wellbeing 2026: Delivering Together’ document, published in the wake of the Bengoa review, would take account of the locum issue.

“We don’t know yet how service reconfiguration will work. It has to be factor in service reconfiguration going forward,” she said.

She added: “An on/off switch would be a cap on locum rates. We’ve argued for this to avoid a market rate situation and various Trust’s bidding against one another.”

Mrs Mitchell confirmed that the Trust has submitted an unbalanced financial plan and will be seeking an authorised deficit that ideally would be covered by surpluses in budgets elsewhere within the health service.

Sinn Féin Councillor Elisha McCallion said: “The reality is we are hugely aware of the issues facing the Trust and the system as a whole. The Minister has said it’s almost at breaking point and we are going to have to deal with that in the long-term.”

She suggested the development of a new medical school at Magee could help resolve the locum issue.

“I’m delighted discussions are well underway with Ulster University about a medical school,” she said.

Councillor McCallion said the difficulties outlined by the Trust officers were unfortunately familiar.

She said: “It’s regrettable you are here telling us bad news but you are not telling us anything we don’t know. We know the challenges. It would be remiss of us not to thank the staff, our nurses and front line staff, who are angels in disguise.”