General Report on the Health and Social Care Sector 2012

A Report published today by the Comptroller and Auditor General, Kieran Donnelly, examines audit issues arising in Health and Social Care sector in Northern Ireland in 2011-12. This is the fourth such report on the Health and Social Care sector. The sector spends more than £4.4 billion a year.

Mr Donnelly said “While 2011-12 was a year where the Health and Social Care sector recorded good financial results it was also a period when a range of important measures of health care performance, including Accident and Emergency waiting times, declined. The Department of Health, Social Services and Public Safety has noted some improvements in the early part of the current year. I will examine if this trend has been sustained in 2012-13.”

Main findings

Financial Performance

In 2011-12 all Health and Social Care (HSC) bodies achieved their financial target to “break even”. In the current economic climate the HSC sector needs to continue to have a sharp focus on managing  available resources effectively so that it can continue to live within its means and to provide quality services for the people of Northern Ireland.

Operational performance

At 31 March 2012, more than 5,900 outpatients waited for treatment for more than 21 weeks and 775 inpatients waited for treatment for more than 36 weeks. In both cases the target set was that no patients should wait for these periods of time for treatment.

Over the last two years the Health and Social Care sector did not reach the 95 per cent target for patients waiting four hours or less for Accident and Emergency (A&E) treatment. All Trusts experienced a decline in this performance in 2011-12.

A further target is that no patient should wait longer than 12 hours for A&E treatment. Despite a 1.6 per cent fall in numbers attending A&E Departments in 2011-12, the numbers waiting more than 12 hours for treatment increased by 2,832 to 10,211 (an increase of 38.4 per cent). Of the 10,211 patients waiting longer than 12 hours at A&E in 2011-12, 99.5 per cent were in the Belfast, Northern and South Eastern Trusts.

Other issues

Special measures were introduced for the Belfast Trust in April 2012 to give the Trust the opportunity to ensure an improvement in the quality of service it provides and restore Ministerial confidence in the effectiveness of its operational controls. In November 2012 the Minister decided that the special measures arrangements should be relaxed although the Department and the Health and Social Care Board would continue to monitor the Trust’s performance closely. We recommend that management in other Trusts take steps to ensure that any read across from the special measures process in the Belfast Trust is applied.

The Department provided the Trusts with £113.6 million for pay modernisation under the Agenda for Change (AfC) programme in 2011-12. We consider that an initiative of this importance and cost to the HSC must deliver, and demonstrate it has delivered, the intended benefits. It appears that to date, while the substantial costs of AfC have been incurred, few of the benefits of AfC are evident including the formal staff development, and resulting improvements in the delivery of services to patients.

The Health and Social Care Sector’s Counter Fraud and Probity Service (CFPS) received 104 fraud referrals (notifications of possible/suspected fraud) in 2011-12. CFPS recovered £113,000 in respect of payment claims made by Family Health Service practitioners and £30,098 from those who had fraudulently claimed exemption from health service charges. Given the huge size of the healthcare budget, and CFPS’s own estimate that for dental and ophthalmic charges alone fraud/error is estimated to be £2.8 million, we recommend consideration is given to ensuring CFPS have the appropriate level of resources.