Wednesday, February 13, 2013
THERE are rumblings from Peterborough and Westminster that Hinchingbrooke Hospital’s franchise deal should never have happened.
Read between the lines of a report published last week and the conclusion is that the franchise deal was wrong. Not ideologically wrong for the NHS, but financially wrong.
Despite it being the deal that kept maternity and A&E services in Huntingdonshire, the report suggests it should not have happened while Peterborough built a new £289milllion hospital. Without the franchise deal, Hinchingbrooke would have had its facilities downgraded. It may have even closed.
The suggestion seems to be that one hospital to serve Huntingdonshire and its neighbouring city would have avoided Peterborough City Hospital becoming effectively bankrupt. The new hospital is too large for its current levels of work and is running at a loss of about £1m a week.
The city’s Conservative MP Stewart Jackson is the man leading the attack on health care provision in the area as part of his role on the Commons Public Accounts Committee (PAC). Last week’s report from that committee attacked the Department of Health for building the new hospital in Peterborough, using a private finance initiative (PFI), while keeping Hinchingbrooke open using a franchise model involving the private firm, Circle.
Unsurprisingly for a committee that deals with finances, the issue of patient welfare and the needs of the people of Huntingdonshire have only been mentioned in passing.
The report claims there was a “complete lack” of strategic oversight when both deals were being organised and says Peterborough’s and Hinchingbrooke’s finances and future are in doubt – despite Circle’s promise it can make Hinchingbrooke’s finances work.
Mr Jackson said: “It is extraordinary that these decisions were taken separately, despite the fact that the two hospitals are only 24 miles apart. This is in an area where the NHS has long acknowledged that healthcare provision is running ahead of local needs.”
He added: “Neither trust is financially sustainable in its current form and both will have to make unprecedented levels of savings to become viable. Events at both trusts reflect poor financial management and the failure of the strategic health authority to exercise strategic control over local healthcare provision and capacity planning.”
THE report comes back again and again to ask why both deals were allowed by the then East of England Strategic Health Authority (SHA).
It adds: “We asked the SHA why, given the fragile state of both trusts’ finances, they had allowed both projects to proceed.
“The strategic health authority told us that its role in respect of the Peterborough PFI scheme was to attest whether the commissioners’ activity forecasts looked reasonable and whether there was an argument for a new hospital in Peterborough because of the circumstances of the city and its needs.
The SHA had felt that the activity forecasts ‘were reasonable’ and it had been ‘persuaded and convinced that there was a necessity for a hospital in Peterborough.’
“The SHA also believed that there was a case, and continued to be a case, for ‘the continuation of a vibrant hospital in Huntingdon and that the two were ‘not inconsistent.’”
The SHA case for Hinchingbrooke was based on a huge consultation that involved the public, NHS staff, GPs and clinicians, Andrew MacPherson, the director of customer service strategy and the strategic projects team at NHS Midlands and East (formerly the East of England Strategic Health Authority), told The Hunts Post this week.
It was more than just numbers. But even if it were just about numbers, they wouldn’t stack up in favour of closing Hinchingbrooke and having one hospital in Peterborough.
Closing Huntingdonshire’s hospital would not solve Peterborough City Hospital’s capacity and financial problems – there was no guarantee that Hinchingbrooke’s patients would obediently travel north to Peterborough for treatment and give the hospital its critical mass. Addenbrooke’s Hospital in Cambridge would be tempting to many.
Another important issue not explored in the report is the requirements of the health commissioners of Huntingdonshire.
The people who commission services on behalf of the people of the district, the officials who are charged with doing what’s best for us in terms of healthcare provision, wanted to use Hinchingbrooke.
Peterborough’s financial mess is of its own making. As a foundation trust it made its own decisions and was given warnings about its PFI deal.
The report adds: “Monitor, the foundation trust regulator, expressed concerns at the time about the affordability of the Peterborough PFI deal but it did not follow these through. Monitor explained that its regulatory role had been ‘light-touch’, its powers to intervene had been limited to cases where failure was imminent and that was why it had not been able to stop the decision to proceed with the PFI deal.”
Hinchingbrooke’s financial mess is also not good reading.
“The unprecedented scale of savings required to remove the deficit from Hinchingbrooke was not risk assessed properly.
“During the final bidding process both bidders made a full and final offer that promised much more than their previous bids. Circle increased the projected savings by over 25 per cent to £311m over 10 years, which is an unprecedented amount within the NHS,” the report says.
CIRCLE has promised to sort the finances. It will be looking at breaking even in the next financial year, but whether it can make an impact on the debt will have to be seen.
What it has done already is improve services. Again, there was no room in the report to look at the quality of healthcare at either Hinchingbrooke or Peterborough City hospitals. The patient experience has no monetary value.
However, no matter what Westminster may think or suggest, Mr MacPherson believes the deal is not only good for healthcare in Huntingdonshire, but it is a robust deal that has survived extremely high levels of scrutiny to provide the best possible outcome for this district – an acute services hospital where there is a renewed emphasis on quality.
The process of getting the franchise was a long one, and it took into account Huntingdonshire’s needs rather than Peterborough’s PFI arrangements.
“People wanted improved services in Peterborough, the buildings were over multiple sites, and so a new facility was wanted by the patients,” Mr MacPherson said. “The people of Huntingdonshire wanted services in Huntingdonshire and not in Peterborough and we did what we could to enable that situation.”
The option of closing Hinchingbrooke was put forward when its debts started to mount – the debt is about £40million – but a consultation found huge support for Hinchingbrooke – especially among the health commissioners.
“The public wanted the services [including maternity and A&E] to continue and didn’t want to travel to have those services.
“The commissioners wanted Hinchingbrooke to supply the care,” said Mr MacPherson. “That gave us a challenge.”
What happened over the next months and years was a huge consultation process involving many groups of people – from GPs and patient groups to trade unions – many public meetings to scrutinise and evaluate the franchise bids from both the public and private sector (including a bid from Peterborough Hospital in partnership with Serco).
“It was a very detailed process and involved a huge consultation. It wasn’t just window dressing,” said Mr MacPherson.
“The Hinchingbrooke deal was a unique and innovative piece of work and it can be hard for people to fully understand it.
“But no matter how complex or unique, what we knew was that a large number of clinicians and NHS staff were part of the process and the outcome.”
DESPITE Hinchingbrooke becoming a political football, the franchise deal is not something the NHS has been asked to unravel in the hope that Hinchingbrooke could be closed and patients forced to traipse to Peterborough or Cambridge.
Mr MacPherson added: “The idea that [if Hinchingbrooke closed] everybody would go to Peterborough is highly unlikely as some patients would want to go to Addenbrooke’s.
“Theoretically sending patients to Peterborough would have helped but it would not have solved all of its problems.”
There is also a robust contract between the NHS and Circle with a little less than nine years remaining.
“There is no suggestion that anyone wants to dismantle what we have done,” Mr MacPherson said. “To do so would be at a significant cost to the public purse and there would be political implications.”
Hinchingbrooke, it seems, is safe for now. And with a growing population in Huntingdonshire the need for acute services in the district is only going to increase.
The NHS financial spotlight will hopefully soon turn on other areas of the country – especially if Circle starts delivering on its financial promises.
“Looking around the country, the East of England SHA was asking some questions three or four years ago that the rest of the country is just getting round to asking,” Mr MacPherson added.
Hopefully, the final whistle is about to blow in this game of political football.