‘Major concern’: Homerton Hospital facing ‘unexpected’ multimillion-pound overspend

Homerton Hospital

A “major concern” over Homerton Hospital’s projected year-end financial position has sparked calls for action from top medical professionals in Hackney and the City of London.

Non-GP referrals and day cases, in which patients make planned admissions for procedures requiring a bed for a single day, have unexpectedly increased at the Homerton – potentially costing as much as £4 million by the end of the year.

Workstream director Siobhan Harper presented the findings to an 11 October session of the City & Hackney integrated commissioning board, chaired by the borough’s deputy mayor Cllr Feryal Demirci (Lab, Hoxton East & Shoreditch).

Harper, who is director of the planned care workstream for City & Hackney clinical commissioning group (CCG), said: “We’ve got a concern at the moment around acute activity at Homerton Hospital in particular, where we are overperforming considerably against our current operating plan.

“It’s unexpected activity with day cases and referrals that are not made by GPs.

“The straight-line forecast outturn for the end of the year could be a considerable problem for the CCG, so that is a major concern.”

The CCG is responsible for predicting demand across Hackney, as well as the City of London.

Harper added that the CCG will be agreeing a plan of action with the Homerton “to get underneath what’s driving some of the activity”.

Whilst no in-depth analysis has yet been carried out on the cause of the increase, Harper pointed to a recently implemented electronic referral system.

Ian Williams, Hackney’s group director for finance and corporate resources, requested an update on the situation and how it was being tackled as soon as possible, saying: “On the overperformance, it would be helpful to know when we might get that information.

“The sooner we get it the better, so we can all understand what is overspending, or overperforming is the terminology.

“We’re keen to make sure the review work happens quickly, so what I’ve suggested is a meeting with NHS England.

“We do need to bring a conclusion to this, and make sure we’re clear that the money is going to be incorporated into our budgets.”

At the suggestion of CCG chair Dr Mark Rickets, a letter calling for a “recovery plan” will be sent to Hackney’s transformation board, a joint forum for all main local health and care organisations on improving services.

Dr Rickets suggested the letter should “outline the nature of the concerns that we have around particularly the overactivity and the impact this might have on system working in terms of money moving around in uncontrolled ways”.

He added: “If that goes to the transformation board, where we’ll all sit and have difficult, open conversations, I think it would be very helpful for us to stipulate that slightly more formally.”

A CCG spokesperson said: “City & Hackney CCG has an annual contract with the [Homerton Hospital] Trust which is based on previous plans and performance.

“So far this year across certain areas including day case procedures and non-GP referrals, the activity in these areas is higher than we expected.

“This means that the Trust is ‘overperforming’ against the contract.

“This is not necessarily due to higher levels of demand in the borough and it could be the result of how activity is recorded.

“The CCG has plans in place to manage the potential financial impact and is working on a joint action plan with the Trust to look into this further.”