NHS Nursing - The brain drain

I was hoping that I could leave this topic behind given that the statistics provided by HSCIC are, I believe, unreliable as identified in my previous blogs here and here.  It goes against my all my training to analysis figures I have no confidence in but given Saturdays article in the Mirror and viewing several twitter conversations on the topic:

After seeing this I decided another article was necessary. The problem with the Mirror's figures is that they made the same mistakes as Shaun Lintern as described here, essentially they do not take year by year comparative figures, quoting May 2010 figures and comparing them to August 2014 figures distort the figures.  However the general premise of the Mirror article is correct.

First of all I want to look at the Acute, Elderly and General Nursing

I have removed 1st level nursing from this graph as its difficult to plot while allowing you to see the trends for the minority, but highly skilled nurses, as will be demonstrated later.

This graph shows that the total number of nurses in these categories have decreased.

Modern Matron 

August 2010 /11 = 35,418

August 2011/12 = 33,031 down 2,387

August 2012/13 = 31,320 down 1,711

August 2013/14 = 30,498 down 822

Ending August 2014 with a decrease of 4,920 from 2010

Managers

August 2010 /11 = 43,019

August 2011/12 = 30,031 down 12,988

August 2012/13 = 39,518 up 9,487

August 2013/14 = 42,248 up 2,730

Ending August 2014 with a decrease of 771 from 2010

Children's Nurse

August 2010/11 = 4,325

August 2011/12 = 7840 up 3,515

August 2012/13 = 3,335 down 4,505

August 2013/14 = 3,438 up 103

Ending August 2014 with a decrease of 887 from 2010

Other 2nd Level > Bands 6-8

August 2010/11 = 28,069

August 2011/12 = 24,408 down 3,661

August 2012/13 = 23,525 down 883

August 2013/14 = 19,851 down 3,674

Ending August 2014 with a decrease of 8,218 from 2010

Which gives a total decrease of senior nurses by 14,796 since 2010

Looking at Level 1 nurses - now we know from HSCIC that these also include bands below band 5 (qualified nurse) and therefore this is an area of contention for me as not all in this category are qualified nurses. However when I put these into the graph it is plain to see that the Mirror's article is highlighting the problems this creates as "senior nurses play a vital role in patients safety". Don't think many would disagree with Andy Burnham when he states “Nurse losses on this scale risk threatening standards of patient care. Half of nurses say their ward is dangerously understaffed as hospitals shed ­experienced nurses in a crude attempt to save money".

You can see quite clearly that the lower nursing grades overshadow the more qualified nursing grades. There is only 1 senior nurse (2nd Level) to every 78 junior nurses (1st Level).

In other disciplines we see a similar pattern with more staff losses:

Maternity

The total decrease of these categories from 2010-2014 is 3328

Paediatrics

The total decrease of these categories from 2010-2014 is 378

Other Psychiatry

The total decrease of these categories from 2010-2014 is 2982

Community Psychiatry lost a total of 690 nurses between 2010-2014

I have no idea where the Mirror got its figures from; "Britain’s total nursing staff plummeted alarmingly from 280,765 in June to 278,924 in August, according to the ­latest official figures"

According to the HSCIC there were 313,752 nurses in June compared with 311,670 in August so the total number of nurses lost in that period is 2,082. 

So the points made by the Mirror and Andy Burnham are valid.  Jeremy Hunt claims that the article is misleading and that the number of nurses falling is due to "seasonal variation" and that there is always a temporary dip in the summer months.  It appears that the "summer months" in England start in April.

Dont you just love politicians.

Hospital safe staffing levels

From April 1^st 2014 it became a national requirement for all hospitals to publish information about staffing levels on wards, including the percentage of shifts meeting their agreed staffing levels. This initiative is part of the NHS response to the Francis report which called for greater openness and transparency in the health service.  

NHS choices website has a feature that allows you to check how your hospital is performing here. Unfortunately it does not offer much in the way of detail:

So to get behind the headers one has to dig a little deeper.

If we look first at University Hospital of North Staffordshire (UHNS) found here

Selecting June’s statistics we can, if we look closely enough, see the departments that did not reach the minimum safe staffing levels. 

Difficult to see from this spreadsheet what is actually going on across the hospital but put into a 'traffic lights' system we can see more clearly how this hospital is performing in relation to their ward staffing:

Only 1 out of 41 wards had continuous levels of appropriate safe staffing over the month of June and worryingly the trend appears to be the majority of these wards are heavy reliant upon health care assistants. In one ward, 'critical care medicine', they only managed to reach an average day rate care of 52% of qualified staff - yikes !

Its not the only one however, we can take a look at several other hospitals and perform the same analysis.

Nottingham University Hospitals Trust:

Only 4 out of 47 wards achieving expected levels of safe staffing.

West Hertfordshire Hospitals Trust:

Only 3 out of 33 wards managing to have a consistent safe level of staffing throughout June.

It was difficult to carry out a full analysis of all hospitals as some hospitals presented their data rather differently and, in my opinion, a little less transparent than they ought to be, Central Manchester here, North Bristol here ...hmmm

Not surprisingly however I did find a Trust that had a good record on safe staffing, not 100% perfect, but better than the rest that I had seen, ironic given that this Government is hell bent in ensuring its demise.

Over to Midstaffordshire Foundation Trust (MSFT) found here

and again using the 'traffic lights'

A much healthier picture with only Orthopaedics at Cannock Chase failing to continuously meet safe staffing requirements.

Stafford has 9 out of 17 wards having continuous safe staffing levels. 

Comparing MSFT to UHNS; it would be false to claim that the people of Stafford would be safer transferring to UHNS for treatment as Stafford outperforms UHNS in safe staffing percentages.

Looking overall at the the 'safe staffing' tables of NHS trusts I can find no evidence of the so called "Francis Effect" nor any evidence that would suggest that this Government has invested in extra nurses.  I have seen nursing staff ratios ranging from 1:8 right up to 1:13.  What is clear is that hospitals do not have enough nursing staff and that the majority of hospital wards rely too heavily on health care assistants to deliver care - this of course puts a considerable strain on the front line and something that the Francis report highlighted as one of the main issues at Midstaffs - something this Government continues to ignore!

NHS nurses workforce - what lies behind the statistics

Last week Jeremy Hunt quoted the number of NHS workforce statistics in a House Of Commons debate on Wednesday 16th July.  The Hansard report can be found here.

He states there are 6,200 more nurses on our wards

as the debate goes on it is reduced to 6000 more nurses

and then finally we have 4000 new nurses

So there we have it 2,200 nurses made redundant in the space of an hour.

Joking aside, there is much debate about the number of nurses and the politicians, press and so called 'health' journalists jump on them in order to spin these statistics into whatever shape suits their agenda.  So what is the true number of nurses?  its not an easy question to answer due to the way these statistics are collected and formulated.
To understand why its so difficult is down to a couple of things 1) the system the NHS use to collate these figures 2) the quality of data held within the system.

Lets look at the first point.  This NHS workforce statistics come from a NHS HR system called the ESR which stands for Electronic Staff Record, as previously blogged here , the ESR system does not link NHS staff pay bands with their occupation code, what this mean is that the only way to check the grade to see if that member of staff is a qualified nurse is for it to be done manually.
Now for point 2 - the quality of the data - the data in the system will include non-qualified staff and is open to abuse as HR can 'up' their nursing figures by including unqualified nurses, so HSCIC statistical header "qualified" nurses is a misnomer.  To be fair to HSCIC they do have caveats to the figures produced and have issued guidance that these figures are 'estimates' - something our politicians and press appear to ignore as they present them as fact!

So we are using stats that really should be taken with a huge pinch of salt and to be honest I don't think we will get a handle on these stats any time soon.  I have had some interesting email exchanges with HSCIC in order to get some background information on the stats as its naive to believe everything you read is true; now call me a cynic but where the Tories are involved I always suspect foul play - so delving a little further I asked HSCIC if there had been a change in the way the NHS workforce statistics are collected since 2010  and lo and behold there was:

So the figures prior to 2010, under a Labour government, were collected manually and therefore grades could be checked and proper statistics given, however under the Tories we have it all coming from a system that is not fit for statistical purposes, not manually checked for quality assurance and open to abuse.
So next time you hear a politician or journalist quote nursing statistics - send them my way :)


The big question here is what is the NHS England workforce? Does HSCIC statistics give the right type of information needed to manage and plan the workforce?
Compare HSCIC statistics to NHS Scotland's statistical information (sorry to rub salt in the wounds); I can break NHS workforce statistics down to nursing grades:

by age:

and even by gender/contract type

and also by region/health board and trends - but I won't bore you with that.  However you can see my point, HSCIC statistics just doesn't cut it. How NHS England, The NMC and the DH can know what is happening with nursing in England is beyond me, they simply do not have the tools to manage that aspect or any other aspect of the NHS workforce.

Charlotte Leslie Foodbanks

Charlotte Leslie MP for Bristol, currently being investigated for accepting cash donations and failing to declare them  has written a blog for 'Conservative Home' titled

"Why government needs to be more like foodbanks"

In this article she describes her visit to a foodbank, she states;

but according to the 'Bristol Northwest Foodbank' (the one Charlotte visited) they state in their winter newsletter  that "Benefit changes and Benefit delay are one of the major contributions to local people needing to use our foodbank".  She does a huge disservice to the staff and users of Bristol Northwest Foodbank by denying that this is the case.   

This main reason is also backed up by figures from the Trussell Trust with delays in receiving benefits accounting for 30.93% of people being referred and 16.97% due to Benefit Changes.

Benefit delays are obviously a huge problem that leaves the claimant without money until the Government process their claim, this results on them having to rely on foodbanks.  It is not only the unemployed that is affected, the disabled and sick are also affected and as this article by the BBC shows this Government's utter contempt for the sick and disabled - leaving them 6 months or more without much needed funds.

Charlotte then goes on to say ...

"cutting through the politicisation" ..she then goes on to shamefully do just that by trying to score political points over Labour in terms of the number of foodbank users when they were in power against that of her own government.

So lets look at the numbers when Labour were in power;

2005-6	2,814
2006-7	9,174
2007-8	13,849
2008-9	25,899
2009-10	40,898

and now under Coalition Government

2010-11	61,469
2011-12	128,697
2012-13	346,992
2013-14	913,138

Its distasteful for Miss Leslie to try and score political points over starving people but even worse when her government is responsible for the huge increase in foodbank users since foodbanks franchises started in 2004.

Interestingly she also states "since the government opened up foodbanks to job centre referrals the rise in numbers attending foodbanks has doubled".  Apart from the disingenuous statement regarding Labour; the DWP have repeatedly denied that JCP refer claimants to foodbanks

http://www.theguardian.com/society/2014/mar/11/food-bank-jobcentre-dwp-referrals-welfare

So thanks to Miss Leslie we now know that the DWP have been in fact referring claimants to foodbanks since 2011.

She then goes on to criticise her own government's model

I am sure Miss Leslie agreed to so this blog in order to deflect blame away from her government's role in the upsurge of food banks but manages not only to highlight the huge rise in foodbank use since the Coalition came to power but also highlights that the DWP were lying when they said they did not refer claimants to foodbanks and lastly criticises her Government's model which exacerbates the need for foodbanks.

So in essence is not that the "Government needs to be more like foodbanks", the Government should be ensuring that they is no need for foodbanks by protecting, not punishing, the most vulnerable in our society.

My advice to Miss Leslie is to keep on blogging, she's an asset to all her political opponents.

Shaun Lintern's analysis of NHS earnings

Its that time of month again whereby I am compelled to write yet another article on Shaun Lintern.  I must point out that when I first decided to write a blog my aim was to write about the misuse of statistics used by the media and politicians, little did I know that the majority of it would be concerning Shaun Lintern.
This is not a deliberate or personal attack on Shaun Lintern per se but to merely set the record straight regarding his misuse of statistics.  Today's blog is not about misuse of statistics but rather his claims to them and the personal smears which accompanied them.
I will always challenge dodgy statistics because I believe the public deserve to know the truth about what is happening in our NHS and we should have the right to question someone who misleads the public without being smeared at.

Today Shaun announced that he had carried out an "analysis" for HSJ.

When further questions where put to Shaun about these figures he could not answer

I did ask for his source and after much to-ing and fro-ing he eventually gave me the link to the spreadsheets from HSCIC.

http://t.co/oiC3VCh2X8

If you download the spreadsheet and turn to table 2b, you will see that in fact HSCIC has done the "analysis" - not Shaun but credit where credit's due Shaun did come up with a pretty picture - unless someone else came up with that as well.

Now Shaun knows I know what has happened i.e. he tried to pass off someone else's work as his own but instead of owing up he labels me a "troll" in order to deflect from the subject and to smear me.
His tweet tonight - which is frankly so embarrassing for him that I will not post it here; is another ploy to smear and play the victim with some actually falling for it, but as they say you can fool all of the people some of the time and some of the people all the time but you cannot fool all the people all of the time!

Needless to say the figures Shaun quoted are wrong - the HSCIC spreadsheet does carry a warning that they are estimates and "experimental".  I won't embarrass HSCIC by publishing their mistakes but I firmly believe that no professional journalist would take these stats and publish them without checking first their validity but then in order to check their validity one would need to have a degree of maths knowledge which Shaun Lintern clearly does not have.
So my advice is once again to treat any stats that Shaun Lintern produces with extreme caution and if in doubt ask Shaun to produce his math formulas, that should separate the wheat from the shaft!

Shaun Lintern - Nursing Statistics

There has been much debate on twitter over the last couple of days on nursing workforce.  I have written about this in the past, in fact the subject of my first attempt at writing a blog was about Shaun's use of statistics.
I now find myself having to cover this topic again due to Shaun Lintern's continual habit of quoting statistics that are at false and/or misleading.
On Tuesday 18th, Shaun Lintern co-hosted #Nurchat. During that chat Shaun tweeted

Now anyone looking at the graph would think that this graph related to band 5 and band 6 nurses with nearly 174,000 being employed. Whereas it is in fact the same graph Shaun Lintern produced in January, which encompasses all nurses irrespective of grade working in 'Acute, Elderly and General' and has nothing whatsoever to to with nursing bands 5 and 6.

The spreadsheet from which this information is taken from can be found here

You will see in this spreadsheet that there is no mention of 'bands' instead it only records levels in this format;

 Shaun was questioned over his stats and he claims they come from Individual Trust's ESRs

ESR (Electronic Staff Record) is a HR programme that records the following

You will see that it does not record nursing bands yet Shaun is adamant that the ESRs are collected by HSCIC.

Shaun failed to reply to my tweet, so I emailed HSCIC and asked for a copy of the figures from ESRs. Here's their reply:

Therefore Shaun is telling porkies- they are not on the HSCIC website, it is not published, there is no link between pay band and occupational code and therefore would be impossible for Shaun to produce any statistics and graph them!

I personally cannot fathom why a journalist would set out to deceive the public in this way and my advice to all is to treat any statistics that Shaun Lintern produces with extreme caution.

**UPDATE**

Exposing Shaun Lintern's misunderstanding/misuse of stats feels like a full-time job at times *sigh* - There is more to statistical analysis that just rhyming off a line in a spreadsheet and feel any journalist worth their salt would actually analyse the numbers, especially if they are, like Shaun, hell bent on quoting them at every opportunity in order to appear knowledgeable.

but here's another one; 

On the subject of nurses - again - Shaun tweets;

HSCIC in collaboration with the RCN (see above email) undertook a recent study into nursing bands, the datasheet they emailed me states that there are 308,776 "qualified nurses" working in the NHS, of which   245,255 were in bands 5/6.  In Acute, Elderly & General, nursing bands 5/6 amounted to 139,510; nothing near the 174,000 Shaun Lintern is reporting!

The data sheets published on the HSCIC website also includes "unknowns" into the figures. So therefore, the "nursing" figures specified do not mean "qualified nurses"!

As specified in my first blog, nursing levels peak every Autumn due to graduate intake and should level off in December.  I have asked HSCIC to clarify the definition of 'nurses' used in their data because I have a feeling some will include HCAs + HCA Student nurse pilot scheme.  I will update this blog when I receive their response.

*HSCIC state that the nursing stats (bands) are not for general publication - hence why I have not published them in full here but happy to email them to those who have an interest, excluding Shaun Lintern!

Many of you may not have seen the HoC debate yesterday on the Francis report 1 year on.  If your interested the transcript can be found here

I am still working through the transcript but I would like to pick up on something Jeremy Hunt stated:

Statistics from NHS England show that in fact, even with the 'relaxation' of the target to 5% in 2010 (Ahem); this government has presided over the worst increase in A&E patients waiting more than four hours since the 4 hour target was introduced. By Quarter 4 2012/13, the figures had risen to 9%; in Quarter 3 2013/14 the level was 6.5%.
When Andy Burnham was SOS, the number of patients who waited four hours or more was only 2% .

Mr Hunt should be called back to the House to correct the record.

Patient Complaints

Thankfully now people are starting to question the reasons and motives behind the decision to single out midstaffs for public scrutiny.

First of all we had Professor Jarman and his infamous HSMR Stats, there has been much debate about these stats and I have no personal plans to revisit them as it has already been established that they are worthless.

However, with regards to Midstaffs and why it was selected; the HSMR was one of the reasons.  I would like to draw your attention to a piece written in Computer Weekly as it clearly shows how wrong those stats were and in fact; 

"Mid-Staffordshire NHS Foundation Trust maintained an average rate of patient death for 17 years, according to a rational look at the numbers behind the NHS controversy"

"Mid-Staffs admitted 13,780 seriously-ill patients in 2004. By 2007, such admissions had increased by 2,654 cases, to 16,434. Yet Mid-Staff's death-rate for these high-risk patients actually fell in that time, from 6.4 per cent to 5.8 per cent"

http://www.computerweekly.com/cgi-bin/mt-search.cgi?blog_id=102&tag=Mid-Staffordshire%20NHS%20Foundation%20Trust&limit=20


So bang goes the theory of Midstaffs being the "killing fields" as describe by Cure The NHS.

Since that article was posted on twitter, Cure and their allies have tried their best to counteract the argument that Midstaffs was a set-up and today Professor Jarman posts this:

So now we are onto complainants, every hospital has complainants and these complaints can be about a variety of things; appointment delays, waiting times, food etc.

So were Midstaffs complainant figures any worse than any other ?

Midstaffs complaints*

2005/06 = 447 Complaints     82.1% resolved in 21 days with 0 unresolved by the end of year
70 Trusts had higher rates ranging from 453 - 1264 complaints

2006/07 = 339 Complaints     71% resolved in 21 days with 2 unresolved by the end of year
104 Trusts had higher rates ranging from 340 - 1322 complaints

2007/08 = No complaints recorded by HSCIC, this could be because;

Information from 23 PCTs states they did not receive returns for some practices within their area and so have submitted incomplete data.

2008/09  = No complaints recorded by HSCIC, this could be because;
Information from 35 PCTs states they did not receive returns for some practices within their area and so have submitted incomplete data

2009/10 = 0 Complaints

2010/11 = 611 Complaints, no breakdown on number resolved
43 Trusts had higher rates ranging from 613 - 1533 complaints

2011/12 = 492 Complaints, no breakdown on number resolved
56 Trusts had higher rates ranging from 495 - 1062 complaints


So yes Prof Jarman is right there were other complainants but far less than those in other hospitals.
So that just leaves "Patient Pressures" i.e. Cure The NHS in his equation but I think there is another part that needs "exposing" and that is the role the Tories and their MPs had to play;

This is an extract from one of the Francis witness Statements, Mr Ken Lownds, who worked with CTNHS and was the first to initiate the support of local Tory MP Bill Cash, a "staunch supporter" of CTNHS.

Full statement here http://www.midstaffspublicinquiry.com/sites/default/files/evidence/Ken_Lownds_-_witness_statement_and_exhibits.pdf


So here's my equation;

Tories aim to privatise NHS + Vengeful Cure The NHS = Partnership to use Midstaffs as NHS propaganda to justify the privatisation of NHS and the closure/downsizing of Trusts.






* Source: http://www.hscic.gov.uk/

NHS In Financial Crisis

I'm sure we all remember the article in the Telegraph by David Prior, Chairman of CQC;

http://www.telegraph.co.uk/health/nhs/10612450/NHS-care-watchdog-warns-of-alarming-culture.html

There was much debate on twitter about it, with most calling into question the political motivation behind it. There is no doubt in my mind that David Prior overstepped the mark.

However, I was more concerned about the nuance of the article whereby David Prior states;

"The NHS will “go bust” without radical change to drive up standards and rid hospitals of a “toxic” bullying culture that damages patient care".

"Without “transformational change”, he says, including greater private-sector involvement, hospital mergers and an end to pointless targets, the health service risks going bust”.

Yet only one of his many statements relates to finances;

"almost half of NHS hospitals expect to end the financial year in debt"

That little nugget of information was almost hidden amongst all of the propaganda.  It was also stated in the article that there was a £330 million hole in trusts’ finances.

Call me cynical but I treat all figures from the right wing media with a great deal of scepticism. So is it £330m?

Figures from a FOI request to the Department of Health paints a different picture in that collectively, NHS trusts (2012/13) are in debt to the tune of £5.1bn.

The DH states in the FOI:
"We have interpreted ‘debt’ to mean the total amount reported by each NHS Trust in their Balance Sheet in respect of bank overdrafts, current and long term loans, obligations under finance leases, Private Finance Initiative (PFI) and Local Improvement Finance Trust (LIFT) arrangements. These are the items most readily identified with the term ‘debt’ in accounting terminology.

Org code	Org Name	Total       Operating revenue	Total Debt
		£000's	£000's
RVN	Avon and Wiltshire Mental Health Partnership NHS Trust	194,649	(47,367)
RF4	Barking Havering and Redbridge Hospitals NHS Trust	439,072	(261,608)
RVL	Barnet and Chase Farm Hospitals NHS Trust	358,530	(40,911)
RRP	Barnet Enfield and Haringey Mental Health NHS Trust	190,575	0
R1H	Barts Health NHS Trust	1,324,546	(865,552)
RC1	Bedford Hospitals NHS Trust	223,069	(8,222)
RYW	Birmingham Community Healthcare NHS Trust	249,124	0
TAD	Bradford District Care NHS Trust	135,925	(4,306)
RY2	Ashton Leigh and Wigan Community Healthcare NHS Trust	175,326	0
RXH	Brighton and Sussex University Hospitals NHS Trust	606,159	(37,135)
RXQ	Buckinghamshire Healthcare NHS Trust	350,954	(66,761)
RYV	Cambridgeshire Community Services NHS Trust	162,804	0
RYX	Central London Community Healthcare NHS Trust	193,341	0
RYG	Coventry and Warwickshire Partnership NHS Trust	205,910	(30,437)
RJ6	Croydon Health Services NHS Trust	243,581	0
RN7	Dartford and Gravesham NHS Trust	177,219	(73,263)
RWV	Devon Partnership NHS Trust	140,932	0
RYK	Dudley and Walsall Mental Health Partnership NHS Trust	71,330	0
RC3	Ealing Hospital NHS Trust	234,113	(494)
RWH	East and North Hertfordshire NHS Trust	350,574	(8,116)
RJN	East Cheshire NHS Trust	185,752	0
RXR	East Lancashire Hospitals NHS Trust	405,107	(123,643)
RX9	East Midlands Ambulance Service NHS Trust	155,065	(50)
RYC	East of England Ambulance Services NHS Trust	235,594	0
RXC	East Sussex Hospitals NHS Trust	387,425	(1,224)
RVR	Epsom and St Helier University Hospitals NHS Trust	343,599	(229)
RLT	George Eliot Hospital NHS Trust	122,531	(1)
RX5	Great Western Ambulance Service NHS Trust	74,677	0
RY4	Hertfordshire Community NHS Trust	129,108	0
RQQ	Hinchingbrooke Health Care NHS Trust	110,581	(14,218)
RWA	Hull and East Yorkshire Hospitals NHS Trust	497,193	(61,717)
RYJ	Imperial College Healthcare NHS Trust	971,561	(4,373)
RGQ	Ipswich Hospital NHS Trust	236,761	(28,924)
R1F	Isle of Wight NHS Trust	168,776	0
RXY	Kent and Medway NHS and Social Care Partnership Trust	172,961	(17,335)
RYY	Eastern and Coastal Kent Community Health NHS Trust	213,850	0
RAX	Kingston Hospital NHS Trust	208,667	(28,622)
RR8	Leeds Teaching Hospitals NHS Trust	1,002,529	(211,458)
RT5	Leicestershire Partnership NHS Trust	281,926	(8,756)
RY1	Liverpool Community Health NHS Trust	146,710	0
RRU	London Ambulance Service NHS Trust	303,186	(950)
RWF	Maidstone and Tunbridge Wells NHS Trust	367,421	(222,113)
TAE	Manchester Mental Health and Social Care NHS Trust	106,335	0
RW4	Mersey Care NHS Trust	208,598	(5,056)
RQ8	Mid Essex Hospital Services NHS Trust	275,234	(158,483)
RXF	Mid Yorkshire Hospitals NHS Trust	460,870	(327,940)
RYH	NHS DIRECT NHS TRUST	139,265	0
RY3	Norfolk Community Health and Care NHS Trust	124,843	0
RVJ	North Bristol NHS Trust	529,984	(9,456)
RNL	North Cumbria Acute Hospitals NHS Trust	235,326	(52,816)
RAP	North Middlesex University Hospital NHS Trust	184,011	(134,529)
RLY	North Staffordshire Combined Healthcare NHS Trust	79,598	(14,098)
RX7	North West Ambulance Service NHS Trust	261,390	(80)
RV8	North West London Hospitals NHS Trust	380,272	(63,257)
RNS	Northampton General Hospital NHS Trust	271,319	(669)
RBZ	Northern Devon Healthcare NHS Trust	220,696	(17)
RX1	Nottingham University Hospitals NHS Trust	813,301	(21,149)
RHA	Nottinghamshire Healthcare NHS Trust	425,742	(16,957)
RHX	Oxford Learning Disability  NHS Trust	23,246	0
RTH	Oxford Radcliffe Hospital NHS Trust	821,894	(292,809)
RW6	Pennine Acute Hospitals NHS Trust	569,981	(71)
RK9	Plymouth Hospitals NHS Trust	405,853	0
RHU	Portsmouth Hospitals NHS Trust	451,946	(253,311)
RQW	Princess Alexandra Hospital NHS Trust	184,592	(1,433)
REF	Royal Cornwall Hospitals NHS Trust	323,372	(1,601)
RQ6	Royal Liverpool Broadgreen  Hospitals  NHS Trust	440,858	(11,080)
RD1	Royal United Hospital Bath NHS Trust	233,623	(375)
RL4	Royal Wolverhampton Hospital NHS Trust	385,001	(9,316)
RXK	Sandwell and West Birmingham Hospitals NHS Trust	433,153	(30,177)
RCC	Scarborough and North East Yorkshire Health Care NHS Trust	31,582	0
RXW	Shrewsbury and Telford Hospitals NHS Trust	309,382	0
R1D	Shropshire Community Health NHS Trust	79,694	0
RYQ	South London Healthcare NHS Trust	451,633	(183,264)
RQY	South West London and St Georges Mental Health NHS Trust	163,244	0
RVY	Southport and Ormskirk Hospital NHS Trust	181,123	(8,586)
RJ7	St Georges Healthcare NHS Trust	641,867	(54,337)
RBN	St Helens and Knowsley Hospitals NHS Trust	278,623	(277,953)
R1E	Staffordshire and Stoke On Trent Partnership NHS Trust	372,793	0
RTP	Surrey and Sussex Healthcare NHS Trust	226,042	(328)
RDR	Sussex Community NHS Trust	188,015	(501)
RY8	The Derbyshire Community Health Services NHS Trust	188,435	0
RY9	The Hounslow and Richmond Community Healthcare NHS Trust	59,353	0
RY6	The Leeds Community Healthcare NHS Trust	139,943	0
RJ2	The Lewisham Hospital NHS Trust	241,490	(50,381)
RY5	The Lincolnshire Community Health Services NHS Trust	108,802	0
RAN	The Royal National Orthopaedic Hospital NHS Trust	120,809	(141)
R1C	The Solent NHS Trust	192,177	0
RY7	The Wirral Community NHS Trust	66,506	0
R1G	Torbay and South Devon Health and Care NHS Trust	142,186	0
RWD	United Lincolnshire Hospitals NHS Trust	422,861	(627)
RJE	University Hospital of North Staffordshire NHS Trust	473,629	(348,054)
RKB	University Hospitals Coventry and Warwickshire NHS Trust	509,243	(285,947)
RWE	University Hospitals of Leicester NHS Trust	758,742	(13,633)
RBK	Walsall Hospitals NHS Trust	228,417	(147,312)
RWG	West Hertfordshire Hospitals NHS Trust	278,273	0
RKL	West London Mental Health NHS Trust	233,798	0
RFW	West Middlesex University NHS Trust	154,205	(39,806)
RYA	West Midlands Ambulance Service NHS Trust	152,633	0
RYR	Western Sussex Hospitals NHS Trust	367,805	(2,732)
RA3	Weston Area Health NHS Trust	96,800	0
RKE	Whittington Hospital NHS Trust	281,403	(36,463)
RWP	Worcestershire Acute Hospitals NHS Trust	348,811	(79,560)
R1A	Worcestershire Health and Care NHS Trust	170,870	(114)
RLQ	Hereford Hospitals NHS Trust	175,825	(60,038)
RX8	Yorkshire Ambulance Service NHS Trust	209,822	0

This clearly shows the NHS is in financial crisis, not due to "culture" but due to the lack of investment this Government has made over the years.