UNRELENTING pressure makes urgent medical care in the county a “critical” case with Wye Valley NHS Trust (WVT)  facing financial flat line.

WVT is already £1m over budget a month into the new financial year and dependent on £13m  of financial support available as  “permanent borrowing”.

This week, the WVT board was told that urgent care demand had already outstripped specific performance improvement schemes developed over the past year  and continued to rise.

Outgoing chief executive Derek Smith warned the board that getting  urgent care demand under control was “mission critical” if the Trust was to have a future.

A&E attendances at Hereford County Hospital show year on year increase, with activity over 2013-14 3.1% - or 1,467 - up against the previous year.

Attendances in April were 5.7% - or 234 - up against April 2013 - an additional eight patients a day.

West Midlands Ambulance Service has confirmed an increase of 161 patients arriving at A&E by ambulance between April-mid May compared to the same period last year.

A&E was designed  to handle a maximum 125 patients a day under the PFI deal that got the hospital built. The department’s daily average is now 145 with surges as high as 180.

Neil Doverty, WVT chief operating officer, told the board that attendances in May were forecast to be around 10% up on the same time last year.

The  “unrelenting” pressures of patient demand regularly saw A&E regularly failing the four hour national waiting time standard, he said.

Four hour failures amounted to £28k of the £35k in non performance fines WVT had incurred  up to April.

Urgent care pressure has an impact across all areas of the hospital, most immediately in bed availability and the scope for income generating elective surgery.

In April alone, there were 30 non-clinical operation cancellations on the scheduled surgery day and another 22 the day before.

But the impact on budget plans is the biggest concern.

WVT has set a deficit of £9m within its present financial plan. At the end of the first month that plan is already more than £1m over budget.

This, the board heard, was already “significantly at variance” with operational assumptions made in the plan, and, if such variance continues, WVT  would soon be reporting an equally significant variance situation across its overall finances with urgent care needing expensive agency staff,  elective surgery passed on to the private sector, and savings programmes failing.

The cash position of the Trust was, the board heard, dependent on £13m in financial support from the NHS available as permanent borrowing.

In January, WVT - facing a £15m deficit without financial support - secured £9m from the Trust Development Agency to forecast a break even position by the end of the 2013-14 financial year.

WVT has required increasing levels of support over recent years just to break even with another £9.8m needed over 2012-13.

In 2012 ,WVT was declared in “turnaround” to emphasise the urgency and scale of its financial challenges. The board subsequently rejected a range of options including a merger with another health trust  to fight for a future on its own terms.