Just over a year ago, I went through Southern Health’s Annual Report and Accounts for 2015/16, looking mainly at what the figures told
us about what Southern Health was doing and where it was heading. My conclusion
at the time was that the figures showed Southern Health to be failing and
flailing: shrinking; shipping skilled professionals at a rate of knots and
replacing them with unskilled staff; paying executive directors more whilst
paying other staff less; and still forking out a fortune in dubious ‘training’
and ‘consultancy’ contracts. At the same time, the annual report was trying
desperately to fend off and ignore the pressing realities of their situation
and to pretend that everything would be fine if it wasn’t for those meddling
kids/#JusticeforLB/#JusticeforNico/other campaigners/the media/Monitor (sort
of)/CQC (sort of)…the list goes on.
The year 2016/17 has been somewhat, er, turbulent, for
Southern Health, with the Chief Executive, Katrina Percy, departing with a humungous
payout and an almost complete replacement of everyone (both Executive Director
and non Executive Director) on the Southern Health board. This blog looks at
the 2016/17 annual report figures to see if there are any signs of changes in
Southern Health’s direction as they moved into the post-KP era.
The money
Southern Health is continuing to shrink, for two main
reasons: 1) shuffling off their social care service, TQ21, to other
organisations (why were Southern Health running social care services in the
first place?); 2) continuing to offload learning disability services acquired
during the ‘absorption’ of Ridgeway/Oxfordshire Learning Disabilities NHS Trust
in 2012. By the end of 2017, when services in Oxfordshire will finally transfer
to the Oxford Health NHS Trust, I think this will mean that none of the
Ridgeway services acquired by Southern Health will remain in their hands,
although Southern Health will have pocketed over £8 million in reserves
transferred from Ridgeway and kept the proceeds from the sale of a number of
former Ridgeway properties. To my mind, it is no coincidence that both TQ21 and
the Ridgeway acquisition were driven by the venture capital mindset of Katrina
Percy and the Board at the time. People died
preventable deaths in these services.
Financially, this means that the income to Southern Health
continues to shrink, from £353.9 million in 2013/14 through £330.8 million in
2015/16 to £321.6 million in 2016/17 (a decrease of 9.1% in three years).
Overall expenditure has also dropped over this time period, from £348.5 million
in 2013/14 (when there was an operating surplus of £5.4 million) through £331.6
million in 2015/16 (with an operating loss of -£5.8 million) to £314.4 million
in 2016/17 (a decrease of 9.8% in three years). The income figure for 2016/17
includes a bung of £5.3 million from the Sustainability and Transformation
Fund, resulting in an operating surplus of £7.2 million. It is also worth
noting a final financial gift from Ridgeway in 2016/17 – the sale of the West
View/Home Farm site for £0.8 million.
How does Southern Health spend this income? Some specific
lines of expenditure suggest that Southern Health is still an organisation in
trouble. For example, ‘purchase of healthcare from non-NHS bodies’ (principally
buying inpatient mental health services from private companies such as Huntercombe)
rose from £5.0 million in 2015/16 to £9.1 million in 2016/17. Expenditure on
clinical negligence cases continues to increase rapidly; from £0.6 million in
2013/14 through £1.1 million in 2015/16 and £1.6 million in 2016/17.
As with all NHS Trusts, by far the biggest expenditure is on
staff. Reflecting the continuing shrinkage of Southern Health, spending on all
staff (excluding Directors) continued to drop; from £258.9 million in 2013/14
through £236.5 million in 2015/16 to £225.2 million in 2016/17 (a decrease of
13.0% in three years).
Continuing to buck this trend is expenditure on Executive
Directors. This has increased from £1.0 million in 2013/14 through £1.6 million
in 2015/16 to £1.9 million in 2016/17, a 90% increase in three years. Some of
this is undoubtedly due to changes in the Board throughout 2016/17, where there
are signs of attempts to regularise some of the more outrageous ways in which
Executive Directors (and a select few others) were paid in the Katrina Percy era.
Of course, this doesn’t mean that new Executive Directors are exactly donning
hairshirts and taking vows of poverty themselves.
First of all there is Katrina Percy herself. Including her
pay-off of a year’s salary and pension benefits, she ‘earned’ £295,000 -
£300,000 in 2016/17 (and she wasn’t even there for the whole financial year).
Senior cronies such as the Chief Operating Officer, Chris Gordon (now gently eased to a secondment to, er, NHS Improvement) still raked in as a Director £105,000
- £110,000 from Southern Health in 2016/17 – not to mention an additional
£70,000 - £75,000 in income from Southern Health for his work in ‘other roles’
for them. Whether appointed at the tail-end of KP’s reign or just afterwards,
other Executive Directors include Christopher Ash (Director of Strategy;
£180,000 - £185,000 including pension contributions), Gethin Hughes (Director
of Integrated Services; £185,000 - £190,000 including pension contributions),
Sara Courtney (Acting Director of Nursing and Allied Health Care Professionals;
£165,000 - £170,000 including pension contributions) and Paul Streat (Director
of Corporate Governance; £155,000 - £160,000 including pension contributions).
The new Interim Chief Executive Officer, Julie Dawes, took
home £150,000 - £155,000 in salary and a further £62,500 - £65,000 in pension
contributions in 2016/17. The Interim Chair Alan Yates, appointed by fiat by
NHS Improvement, isn’t doing badly either, taking home £100,000 - £105,000 in
total in 2016/17.
The Director of Operations for Mental Health, Learning
Disabilities and Social Care is Mark Morgan, who seemed to perform a similar
selling off role for Castlebeck after Winterbourne View. Under the KP era he was
being paid eye-watering amounts by Southern Health via his company. The annual
report for 2016/17 reports that he now takes a salary rather than being paid
through this company, although he still managed to rake in £265,000 - £270,000
from Southern Health in 2016/17. A number of other Directors were earning
substantial additional amounts for ‘other roles’ in Southern Health under the
KP era in 2015/16, but this seems to have stopped for four Directors in
2016/17.
For reasons which are not obvious to an outsider like me,
the great survivor of this turbulent period is the Medical Director, Lesley
Stevens, with a total £165,000 - £170,000 (including pension contributions)
from Southern Health in 2016/17.
One of the indicators that NHS Trusts have to report is the
ratio between the highest salary in the Trust and the median salary of all
staff in the Trust. In 2015/16 the median salary in Southern Health was £24,500
and the ratio was 7.6. In 2016/17 the median salary increased to £26,900
(largely because poorly paid workers in the social care TQ21 service no longer worked
for Southern Health). The 2016/17 annual report states that the ratio of
highest paid worker to median salary dropped dramatically to 5.7. It turns out
this is because the Trust decided that Katrina Percy’s income didn’t count
because of the payoff – the ratio would then have rocketed to around 11. The
Trust also decided that the next highest income, for Mark Morgan, didn’t count
either, because he was paid via his company for most of the time (or something
like that) – the ratio would then be approaching 10.
Through the nose
Last summer, Michael Buchanan of the BBC reported the hugeamounts of money being paid by Southern Health to two consultancy companies,
Talent Works and Consilium, both of which were led by people with connections
to Katrina Percy. Trusts have to report in their annual report and accounts total
spending to external agencies in three categories: legal fees; consultancy; and
training/courses/conferences. Much of the gargantuan spending to Talent Works
in particular was categorised as training rather than consultancy, particularly
for the infamous ‘Going Viral’ collection of happenings (I’m struggling to find
a neutral but descriptive term) inflicted across Southern Health.
In 2016/17 are there signs that Southern Health is curbing
its dangerous addiction to consultants, in whatever form?
First, Southern Health spending on legal fees is continuing
to increase: from £1.1 million in 2014/15 through £1.4 million in 2015/16 to
£1.7 million in 2016/17. How much of this legal spending is necessary to work
through the consequences of Katrina Percy’s actions (the annual report states
expenditure of £14,256 to the legal firm Capsticks specifically related to
Katrina Percy’s departure), and how much is engaged in aggressive and
unnecessary actions like the legal bullying involved in the @LBInquest, is
unclear.
Second, spending on training, which had shot up from 2014/15
(£1.0 million) to 2015/16 (£2.7 million), possibly involving recategorising
consultancy spending during that time, decreased slightly to 2016/17, but was
still running at £1.9 million.
Thirdly, spending on consultancy, which had ostensibly
dropped from 2014/15 (£1.5 million) to 2015/16 (£0.7 million), increased again
in 2016/17 to £1.3 million.
Across all three categories, spending increased from 2014/15
(£3.6 million) through 2015/16 (£4.8 million) to 2016/17 (£4.9 million).
Southern Health’s addiction continues under new management.
If you want to look in more detail at who Southern Health
have been paying, this Freedom of Information request has details of exactly
when Southern Health paid invoices to which organisations in 2016/17 under the
three categories of training, consultancy and legal/professional fees. I haven’t
gone through all of this myself (yet), but one thing did jump out at me: even
at the end of March 2017, after KP had departed, Southern Health were still
paying large sums to Talent Works Psychologists Ltd for ‘training’, over
£137,000 in March 2017 alone.
Staffing
As I mentioned earlier, Southern Health continued to shrink
in 2016/17, with expenditure on (non-Director) staff also decreasing. What have
the consequences been for the number of staff in different roles employed in
Southern Health? A year ago, it looked to me like the figures were suggesting a
deprofessionalisation of the Southern Health workforce, with from 2014/15 to
2015/16 big reductions in the number of doctors/dentists;
nurses/midwives/health visitors; and scientific/therapeutic/technical staff to
set alongside a big increase in healthcare assistants/other support staff.
What has happened from 2015/16 to 2016/17? As you would
expect from a shrinking organisation, the total Whole Time Equivalent (WTE)
staffing time available reduced again, from 7,282 WTE staff in 2014/15, through
6,468 WTE staff in 2015/16, to 6,028 WTE staff in 2016/17.
However, within these overall figures there are signs of at
least a stalling of the staffing plans of the late-KP era. For example, the WTE
number of healthcare assistants/other support staff, after increasing
drastically from 1,587 in 2014/15 to 2,033 in 2015/16, dropped dramatically in
2016/17 to 1,484.
Other groups of staff that had reduced from 2014/15 to
2015/16 showed signs of small reversals in 2016/17. The WTE number of
doctors/dentists, which had reduced from 238 in 2014/15 to 211 in 2015/16,
increased again to 230 in 2016/17. The WTE number of nurses/midwives/health
visitors, which had plummeted from 2,507 in 2014/15 to 1,748 in 2015/16, had stabilised
at 1,786 in 2016/17. Similarly, the number of scientific/therapeutic/technical
staff, which had dropped from 823 in 2014/15 to 529 in 2015/16, has stabilised
at 557 in 2016/17.
Southern Health is still quite highly reliant on agency
staff (227 WTE in 2016/17 compared to 211 in 2015/16 and 287 in 2014/15) and
Bank staff (350 WTE in 2016/17 compared to 365 in 2015/16 and 461 in 2014/15).
Staff sickness rates are high at 4.5% in 2016/17 compared to 4.8% in 2015/16,
with an average of 11 working days per full-time post lost due to sickness.
Who let this happen?
As Southern Health struggles to emerge from the disastrous
reign of Katrina Percy (and unlike when it is applied to football managers, the
word ‘reign’ feels appropriate here), there are so many unanswered questions.
Principally, how was the catastrophic direction Katrina Percy took Southern
Health not only allowed to happen, but actively encouraged? There are so many
people and organisations part of making this happen who have evaded any
scrutiny or accountability. The murky deal for Southern Health to ‘absorb’
Ridgeway brokered by the Primary Care Trust at the time (remember that the
other NHS Trust shortlisted to take it on was Calderstones). The replacement
health service commissioners (Clinical Commissioning Groups) who studiously looked
the other way while continuing to blandly hand over the cash. Oxfordshire
social services commissioners who were so busy protecting their own reputations
they neglected to do their jobs. The whole self-serving shiny panoply of the Health
Service Journal awards circuit. Where were Monitor/NHS Improvement? The CQC? NHS
England? The Department of Health? (who they?). Without #JusticeforLB and other
campaigners wanting accountability and justice at Southern Health, Katrina
Percy would still be in post now rather than advertising her wares as aStrategic Consultant on LinkedIn, and I shudder to think where Southern Health (and
the people using its services, and its staff) would be headed.
I’m not privy to the internal workings of these
organisations so I have no idea whether they have engaged in any real
reflection on their role in this disaster, and whether they have changed what
they do as a result. My question to them would be, not only could it happen
again, but is it happening somewhere on their watch right now, and does it look
to them like failure or success?
