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Locum costs create budget shortfall – but chairman has faith in financial future

NHS Highland chairman David Alston, alongside chief executive Elaine Mead.
NHS Highland chairman David Alston, alongside chief executive Elaine Mead.

NHS Highland has overspent its budget by more than £4million in the past three months – mainly because of the need to hire locum doctors.

The biggest overspend is £2.7million in the Inner Moray Firth area which includes Raigmore Hospital, a £1million overspend in the north and west Highland and £0.5million in Argyll.

A further overspend of £100,000 was identified for disposable surgical equipment which is needed to meet waiting time targets.

But board chairman David Alston said yesterday that the board is “heading in the right direction” in terms of making practical changes to the model of care to deliver more effective financial management.

He stressed that “locums is a major area where we can make in-roads”, suggesting that maximising the skills of professionals such as advanced nurse practitioners, can relieve pressure on doctors in some departments and reduce the need for locums.

Mr Alston added: “Sometimes that can be difficult for the public because they have traditional views about who you would see if you are ill. But there is something to be said for using these skills maximums and working with the public so that people can have a better understanding of it.

“It’s a challenging situation but there’s nothing unusual about this in the Scottish context at the moment”.

Mr Alston said another possible solution is to improve communication between hospitals and patients to avoid, for example, wasting time and money through cancelled operations resulting from last minute cancellations or failure to meet strict fasting requirements.

He added: “It’s about eliminating waste from the system, not because people are being wasteful but because our systems are not set up in a way to tell people to deliver in the most effective way.

“We also need to be growing our own, and news today that that nurse training will be transferred from the University of Stirling to the University of the Highlands and Islands is particularly important”.

During yesterday’s meeting finance director Nick Kenton confirmed that the board has overspent its revenue budget by £4.3million in the first quarter since April.

He also revealed that the board also risks missing its target of breaking even at the end of the year by £16.4million, if the current trends continues.

An additional £6.1million of further financial risks may crystallise during the rest of the financial year.

Mr Kenton added: “The position is very challenging. The key thing is that we are at month three, and have most of the year to go to do something about it”.

Vice chairwoman Sarah Wedgwood said: “This organisation takes hit after hit after hit and there’s only so much water you can wring out of the dishcloth. Are we at a point where we can not do it anymore?”