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Concerns about finances of largest NHS trust

Warning: Dr Michael McBride, interim chief executive of the Belfast health trust
Seanín Graham

CONCERNS about the management of a health trust were raised last night after it emerged it is battling a multi-million pound deficit.

A leaked letter to the top ten directors of the Belfast health trust reveals the pressures they are facing to balance their books - with a warning from its chief executive to curb spending.

In correspondence seen by The Irish News, Dr Michael McBride orders his most senior managers to overhaul their use of costly locum doctors and agency staff to claw back part of its overspend.

Dr McBride, who is also Northern Ireland's Chief Medical Officer, also directs that they attend "one-to-one accountability meetings" in coming days to ensure they are "breaking even".

The Belfast trust, which has an annual budget of £1.3 billion, is the only one of the five health trusts which has failed to balance its books for 2015/16 and is facing a £13.5 million shortfall - on top of £30m in 'savings targets' it must make for this year.

The private correspondence reveals the deficit had £9.5m shaved off it through 'new investments' being axed – reducing it to £4m - but by June this had risen again to £3m, meaning they were overspending by £1m a month since the beginning of the financial year. A conservative £12m overspend was forecast for the year.

Cost-saving measures including recruitment freezes - a move known as 'vacancy controls' - have led to frontline pressures over the past three years, trade unions have warned.

Sources have also warned of threats to patient services with any future cuts and said there is "no more fat to trim".

But Dr McBride is seeking:

- workforce numbers to be reviewed

- overtime, bank and agency staff numbers to be controlled

- "strong" management of sick and absence leave

- "Absolute commitment" from all staff to refrain from spending unless funding has been secured

- Monitoring of staff who "veer off" budget targets

The health chief warns his directors that spending must be controlled and "immediate action" is needed but with "minimal impact on service delivery/performance".

However, health professionals last night said the financial crisis engulfing the trust – which is the north’s biggest and houses the regional medical specialties – raised questions about its management.

Dr George O’Neill, a GP who formerly headed up Belfast’s local commissioning group, said the deficit had become a "recurring issue" but that in previous years they had been "bailed out".

"The Belfast Trust has a legal obligation to balance the books and come in on budget. But yet again it hasn't - it shows the organisation is bankrupt and merely reflects the financial disaster of the entire service. It's a busted flush," he said.

"With an annual budget of £1.3 billion you would think they could manage to stay within their spending. The other big worry is by making further cuts and slicing £9.5m of this deficit, what new services have been lost?"

Dr McBride, who has been in post for eight months, singles out the multi-million pound bill for agency doctors as a major factor contributing to its overspend.

"Medical agency usage in particular seems to have risen this year with some indication that this is attributable to both increased usage and rates paid," he writes.

He goes further and criticises the overtime paid to the Trust's own doctors.

"Enhanced rates paid to Trust staff cover vacancies may also be contributing to the overspend."

Last month The Irish News reported that £200m had been spent on hiring private agency doctors and nurses over the past five years due to chronic staff shortages.

There was a £150m bill for locum doctors alone, with the biggest spend in the Belfast Trust at almost £48m.

Dr McBride's letter, dated July 29, gives his most senior managers - which includes the director of A&E, acute services, nursing, social services, human resources and surgery - an August 28 deadline to come back to him with breakeven plans.

He states: “I intend hold one to one accountability review meetings in early September. For this reason, I am now asking that you submit detailed plans for your directorates which will enable you to breakeven on your 2015/16 budgets by year end, or, if appropriate, maintain or increase directorate surpluses."

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