Last week the interim chief executive of Hinchingbrooke Hospital faced councillors and the public about the hospital s debts. IAN MacKELLAR was in the audience HINCHINGBROOKE Hospital would break even if it were debt-free and were paid the full tariff fo
Last week the interim chief executive of Hinchingbrooke Hospital faced councillors and the public about the hospital's debts. IAN MacKELLAR was in the audience
HINCHINGBROOKE Hospital would break even if it were debt-free and were paid the full tariff for all the work it does.
But, interim chief executive Jane Herbert told Cambridgeshire County Council's health scrutiny committee, it is likely to have accumulated nearly £30million of debt by the end of March next year and the primary care trusts cannot afford to pay for all the consultations and operations referred to the hospital.
Nearly 90 people packed into Huntingdonshire District Council chamber last Wednesday to hear how Hinchingbrooke got into its financial mess and how it might make a start on getting out of it.
At the core of its money woes is the state-of-the-art diagnostic and treatment centre, which opened a year ago, Mrs Herbert and trust chairman Sue Smith admitted.
Not only does the Private Finance Initiative building cost £250,000 a month to run but the hospital took on extra medics so that it could offer patients a rapid reduction in the time they wait to be treated.
But it all went wrong from day one. Although patients are unanimous in their praise for the service, there are not enough of them to pay for salaries and running costs.
The business case for the development assumed that patients would be referred for treatment by doctors outside Huntingdonshire, particularly from the north of South Cambridgeshire, according to the East of England Strategic Health Authority's director of commissioning, Dr Paul Watson.
But doctors did not change their pattern of referrals "and we have no power to make them do so", he added.
With the treatment centre operating at only 70 per cent capacity, the debts started to mount.
Mrs Herbert admitted there had been no budget for marketing the centre to GPs outside Huntingdonshire. Hinchingbrooke has recently attracted work from Bedfordshire and Northamptonshire, for which it is paid in full, but that did not stop cash haemorrhaging from the coffers.
The business plan for the centre was crawled over not just by Hinchingbrooke's board, but by four primary care trusts, the then Norfolk, Suffolk and Cambridgeshire SHA, senior finance mandarins in the Department of Health and independent consultants.
All confirmed it as robust but, as we now know, all were wrong.
Mrs Herbert staunchly defended the Hinchingbrooke board that took the decision to go ahead with it. She reminded councillors, the public and medics in the audience that Hinchingbrooke had prospered as a district general hospital with one of the smallest patient catchments in the country only because the board had been highly imaginative and innovative.
However, she did concede that not only had Douglas Pattisson resigned as chief executive last month, but finance director Phil Richards had also gone.
"It should not be assumed that they left with large public cheques," she told the meeting.
One of the biggest problems faced by the hospital and PCT together is that referrals for hospital diagnosis and treatment are far higher than the national or regional average.
But the money available to fund them assumes average demand - and the money available per head in the east of England is lower than elsewhere in the county because we are assumed to be a healthier population.
Managing that demand downwards will be a key element of any recovery plan, with more treatment - and some minor surgery - being provided, as it used to be, in doctors' own surgeries.
The hospital has agreed with the SHA a framework of three possible options to stem the outflow of cash. All involve Hinchingbrooke doing less work than now.
The first involves it remaining much as now but with a caseload reduced by 20-30 per cent. But that would probably not produce adequate savings to satisfy the SHA.
The second - and this is the one strongly favoured by Mrs Herbert - implies a radical change to the way the hospital is structured. But it would keep most of its services on the hospital site, though still with the same reduced caseload.
The third would see much of its work shipped out to hospitals such as Addenbrooke's in Cambridge or to Peterborough District Hospital, reducing Hinchingbrooke to little more than a cottage hospital.
Working groups of consultants, GPs, managers and patient representatives will evaluate each of the options independently, with a view to the Hinchingbrooke report being published on November 15.
It will be followed by local briefing events, with formal public consultation beginning in mid-December or early January and ending in March, before Cambridgeshire PCT takes a decision in April.
Dr Watson was adamant that there was no pre-conceived "hit-list" of specialities and no pre-judgment of the outcome of the review.
"We have no pre-determined outcome at all," he told the committee. His audience seemed sceptical.
However, one seemingly in-tractable problem at Hinchingbrooke is maternity services.
For many expectant mums, even outside the district, Huntingdon is the chosen destination for converting their bumps into babies.
Yet, in spite of its enviable track record for operational efficiency, its maternity services is overspent by £2.2million a year. That appears to be an inescapable loss.
"It is one of the key issues for us," says Ms Herbert, "and one of the trickiest problems we have.
"There's no spare capacity at either Addenbrooke's or Peterborough.
"If we are required to provide maternity services, there should be an income stream sufficient to fund it.