In 2009 NHS chief executive David Nicholson claimed the NHS would have to save £15bn to £20bn by 2014.

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The time-scale has been pushed back to 2015 and beyond, but the £20bn “Nicholson Challenge” remains no less demanding.

Rising demand, a growing elderly population and ever more expensive equipment and drugs means that just to continue providing services, the NHS would need to make the efficiency savings.

While the NHS, unlike other areas of public spending, has seen its budget ring-fenced rather than slashed, those in the health economy argue that many factors means this actually feels like a funding cut.

And now the funding problems are really beginning to bite, and the latest NHS trust to unveil its plan to tackle this issue is the Norfolk and Suffolk NHS Foundation Trust.

The mental health trust is proposing to shed 502 front-line jobs over the next four years through a radical redesign which it says is being led by clinicians.

The trust is hopeful it will not have to make any compulsory redundancies and says inpatient beds will only be axed when there is evidence they are no longer needed.

Beds are also proposed to be reduced, from 225 to 172 in Norfolk and Waveney and from 150 to 117 in Suffolk.

However, some of the remaining beds will be changed from inpatient beds on wards to what are called “alternative admission” beds. These are beds in houses or bungalows in the community that are staffed 24 hours a day and which the trust says are preferable for many patients as they offer the support needed in a more natural setting without the need to be admitted to a psychiatric ward.

Former Waveney MP Bob Blizzard said he campaigned hard when he was in office to get the number of inpatient mental health beds in the area increased, which is why he was so concerned that they were facing a hefty cut - from 40 adult acute beds to 20 in Great Yarmouth and Waveney, with alternative admission beds rising from six to 11 and two substance misuse beds being moved to the west of Norfolk.

He said: “In-patient beds are already over subscribed. Staff have given me examples of patients sent to out of area beds, of patients accommodated in expensive private beds at £500 plus per day, of the existence of a waiting list for in-patient beds, of cases where new patients have been accommodated in the beds of patients out on leave (who may need to return urgently) - contrary to clinical advice. It’s hard to see how we can make do with fewer in-patient beds, when we already have a shortage.”

He added that community mental health teams had been cut in Waveney, so it was hard to see how more care could be provided in the community.

Mental health trust chief executive Aidan Thomas admitted that patients are having to be sent out of Norfolk and Suffolk on occasions, but said clinicians were confident they could reduce pressure on beds by following practices already being used by other trusts.

Monitoring arrangements are also being put in place to check on the quality and safety of services throughout the process, for example questionnaires for patients, ensuring that staff case loads do not fall to unsafe levels and keeping a close check on any incidents or increase in incidents.

Mr Thomas said many of the 250 clinicians who had helped to shape the radical redesign were keen on looking at how preventative measures could be put in place to stop patients from becoming very ill or getting to a point of crisis, as well as using treatments which give patients more choice and control over their life.

He said too many patients were being admitted to wards when in fact they could have been treated in the community, which is often what they would prefer and which would be better for them.

Mr Thomas said: “One way we could save more is by centralising our inpatient beds but we are not doing that. We are making sure that every locality - West Norfolk, Central Norfolk, Yarmouth and Waveney, East Suffolk and West Suffolk - has inpatient services for all ages of adult.”

The service redesign also comes at a time when instead of receiving block payments, the trust will in future receive payments for individual patients and the results or outcomes achieved.

But not all areas of mental health will be subject to this funding change, which is why certain departments at the trust are not part of this radical redesign and proposed job and bed cuts.

The trust has around 4,100 whole-time equivalent staff, of which 3,333 are involved in providing direct care services and another 807 work in corporate and support service.

However, the cuts are planned to come from a pool of just 2,130 staff.

Those departments which are not included are its wellbeing services, secure (forensic) services such as Norwich’s Norvic Clinic, drug and alcohol service and continuing care.

They will, however, be subject to cost improvement targets and to further plans for change in the coming months.

Corporate services underwent cuts and redundancies when the previous Norfolk and Waveney and Suffolk mental health trusts merged at the start of this year.

However, concerned staff said they were worried the number of consultant psychiatrist posts were being reduced from 99.7 to 66.70, a reduction of 33pc, while SAS grade medics, for example staff grade doctors, are being reduced from 9.5 to 3.8, a reduction of 60pc.

They also point out that band six staff, which could include senior nurses, are being reduced from 589 to 384.7, a reduction of almost 35pc.

And they say the 20pc increase in band three staff, for example health care assistants, from 364.9 to 439.5, is symptomatic of what is happening across the NHS as many highly-qualified roles are replaced with lower paid and lower skilled positions.

9 comments

  • It is instructive that people in the Norfolk and Suffolk NHS Communications Team can comment on this newspaper website, when clinicians cannot, because of the new and onerous Behaviour Policy for staff, which makes it a disciplinary offence for clinicians to even to discuss the Trust in a conversation in a pub. A disgraceful situation for a publicly-funded organisation to be in.

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    Adrian

    Wednesday, October 24, 2012

  • I had hoped never to read headlines like these ever again but then again you have never been able to trust the NHS to the Tories-in this case with the LibDems as co-conspirators.The Trust's communications strategy in trying to pretend that these cuts will have no effect is bound to rebound on them.Some of us have experienced these "radical redesigns" before,other "new dawns" and" brave new worlds" are artificially created.Patient safety ought to always come first and until the Trust has released its systemic risk assessments to the public these cuts are thinly disguised attacks on patient safety.It is up to the Trust to prove to the community they are operating a safe service.The people will not be fooled by talk of radical redesign or any more of their management-speak.Safety first,and foremost.

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    Peter Watson

    Thursday, October 25, 2012

  • How did the Trust ever become so out of touch? Oh yes, just have a look at the Annual Report of the Trust in which the Director's pay has to published. Aidan Thomas' remuneration is more than a Cabinet Minister - between £135,000 and £140,000 per year. The Medical Director, Hadrian Ball is paid more than the Prime Minister - between £170,000 and £175,000 per year. The Director of Governance & Nursing, Roz Brooks - £95,000 to £100,000 per year. The Operational Director - Norfolk, Kathy Chapman - between £97,400 and £102,400 per year. Commercial Development Director, Leigh Fleming - between £95,400 and £100,400 per year. Deputy Chief Executive, Andrew Hopkins - between £117,400 and £122,400 per year. Director of Operations - Suffolk, Debbie White - probably the same as Norfolk - between £97,400 and £102,400 per year. Trust Chair, Maggie Wheeler, £40,000 to £45,000 per year. That's a total of at least £750,000 per year on EIGHT bureaucrats. Wonder why the Trust can't afford doctors, nurses and services?

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    Adrian

    Thursday, October 25, 2012

  • Thought for the day: Why does the Board and Governors of Norfolk & Suffolk NHS Foundation Trust believe it has even the slightest chance of winning bids in the 'any qualified provider' world after four years of cuts to the quality and quantity of front-line services to the public, with 2.9 bureaucrats in 'corporate and support services' per in-patient bed? Or 12.1 bureaucrats per consultant psychiatrist? Or considerably more than twice as many bureaucrats as grade six nurses? Strangely enough, local GPs, commissioners and tenders ask about services delivered by clinicians to patients, not the amount of time and money wasted by powerpoint presentations and endless meetings. Come on, patients, commissioners, MPs, councillors, governors and journalists, do your jobs and hold these people to account!

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    Adrian

    Thursday, October 25, 2012

  • If the Trust changes were really clinician-led, as is claimed to the public, the clinicians should be leading the Trust, and asking questions such as whether a Comms person on the EDP website (see last new story comments) is needed more than services to some of the most vulnerable people in society. Many of the paper-pushers at Hellesdon and Ipswich have enjoyed substantial pay rises and promotions while front-line services and jobs have been cut and salaries have been frozen. What has actually happened is that the bureaucrats have said to carefully-selected stooge clinicians "Here are the cuts, we're not being cut, you harm yourselves, your colleagues and the services provided to the public."

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    Adrian

    Wednesday, October 24, 2012

  • The merger lost some of the dead wood in the bureaucracy but there is a forest to chop. The real point of the Trust, services to those with mental illness, had the Cost Improvement Programme cuts, much of which was ill-thought out and poorly managed, at the same time as the merger, so it isn't as though the bureaucracy was hacked while services weren't. Bureaucracy is supposed to exist to support front-line services, not to serve itself. The Trust seems to have forgotten this.

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    Adrian

    Wednesday, October 24, 2012

  • How much do the other 799 bureaucrats in 'corporate and support services' cost?

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    Adrian

    Thursday, October 25, 2012

  • It is a ridiculous and disgraceful proposition that the bureaucracy will remain the same size during four years of cuts which will see the number of doctors and nurses cut by more than 33%. The proportion of the Trust's budget spent on administration, pointless-endless-meetings and paper-pushing, already far too high, will climb substantially higher still. The cuts of 35% in band six nurses, 33% in consultants and more than 50% in career grade doctors shows the true priorities of the Trust bureaucracy and where the 20% budget cuts are falling quite disproportionately.

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    Adrian

    Wednesday, October 24, 2012

  • Shorter version.To quote Ricky Tomlinson of the Shrewsbury pickets and The Royle family:radical redesign my a#se!

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    Peter Watson

    Thursday, October 25, 2012

The views expressed in the above comments do not necessarily reflect the views of this site

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