NHS plan could elbow out Hinchingbrooke privatisation
Exclusive A SCHEME to privatise the management of Hinchingbrooke Hospital looks likely to pushed aside after a credible alternative started to emerge. Although discussions are still at any early stage, The Hunts Post has discovered that a deal between t
A SCHEME to privatise the management of Hinchingbrooke Hospital looks likely to pushed aside after a credible alternative started to emerge.
Although discussions are still at any early stage, The Hunts Post has discovered that a deal between the current management of the Huntingdon hospital and Cambridgeshire Community Services (CCS), the "provider" arm of the county's primary care trust, could be the public sector "dream ticket".
Such an arrangement would have a number of advantages. Not only would it have the support of clinicians and trade unions, but because the hospital is bankrolled almost exclusively by PCT cash, the administrative synergies would deliver significant savings.
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Although the "preferred solution" of the East of England Strategic Health Authority is for a "management franchise" to the public or private sector, it would take two years to deliver, even after the Department of Health actually took a decision about whether it was prepared to try such an idea that would be ground-breaking for the NHS.
Such a decision is unlikely this side of a General Election, which is unlikely to be before May 2010.
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The beauty of the latest NHS idea is that it could be delivered in half that time, without legislation and without Hinchingbrooke losing key staff because of managers' and politicians' dithering about its future.
Hinchingbrooke chief executive Mark Millar told The Hunts Post: "I'm less concerned about the process. I'm more concerned about the speed, because the uncertainty is unhelpful to staff and undermines confidence in the hospital."
He added that, when asked in an internal consultation six months ago, integration with the primary care trust had been a favoured option for staff.
Orthopaedic consultant Tim Vaughan-Lane was more forthright. "That's the option clinicians would go along with. It gives a degree of independence, and it gives the PCT the option of deciding what services it wants to see Hinchingbrooke provide."
Hinchingbrooke has nearly £40million of historic debt. Some of this results from incompetence by previous managers, but most of it was caused by the way Hinchingbrooke was penalised by the Department of Health's accounting rules. The debt is not increasing. Nor is the debt interest-bearing, so cash for treatment is not being siphoned off to pay the interest.
Nonetheless, part of the problem that caused the debt was that Hinchingbrooke was too popular with GPs, who referred cases they could have dealt with themselves.
Part of the rescue plan agreed by the PCT - which now calls itself NHS Cambridgeshire - 15 months ago was to reduce activity at Hinchingbrooke by 20-25 per cent and transfer those minor procedures to outpatient clinics in doctors' surgeries and health centres, where they could be delivered at lower cost.
That has not yet happened. When it does, Hinchingbrooke will lose the critical mass that means it breaks even on a day-to-day basis, potentially plunging it once again into deficit.
But, if primary and secondary care were managed together - which many experts say is a "no-brainer" - the cost of care would fall, but the quality would not. Moreover, control would remain in Huntingdonshire, while the interests of patients from Fenland and South Cambridgeshire would be secured by the county-wide CCS involvement.
The other NHS option would be for Hinchingbrooke to be taken over by Addenbrooke's. But the Cambridge hospital has bigger fish to fry, particularly with expansion of the biomedical campus there and the move early in the next decade of Papworth Hospital.
However, Hinchingbrooke clinicians would resent such a move. "We would not welcome the dictates of another hospital that's trying to increase its empire," Mr Vaughan-Lane said.
There is also deep suspicion among the senior medics for a private sector operation. "I don't know anybody on the clinical side who wants anything to do with a company whose first duty is to shareholders," said consultant obstetrician Paddy Forbes. "That's anathema."
Any solution that involved the PCT would have to resolve the potential conflict of interest generated when the trust decided what money is spent on primary care, such as GPs and dentists, and what in hospitals, he added.
CCS was not prepared to commit to the plan. Matthew Winn, chief operating officer, said: "The Cambridgeshire Community Services board does not at this early stage have a view on the most appropriate solution to delivering a safe and sustainable future for Hinchingbrooke.
"We will consider the options as NHS East of England [the SHA] moves forward its engagement activities with the local community and will do what we can to support NHS East of England to find the best possible solution for Hinchingbrooke and the patients it serves."
The SHA was non-committal yesterday (Tuesday), but effectively confirmed that such an arrangement would fit with its preferred option for franchising.
"It's not for us to prescribe what the format is," a spokesman said. "We rule nothing out nor in," he added formulaically.
The debt could be the real stumbling block to any future arrangement and managers and clinicians believe the debt should be written off.
Yet it continues to drag the reputation of an efficient and publicly-popular hospital down. Last week the Audit Commission included Hinchingbrooke in a list of troubled hospitals, and each year the Healthcare Commission marks it down because of the historic debt - in spite of the fact that it is among the top five hospitals in popularity with patients. There was little reason not to remove the debt from the balance sheet last year when the Government issued public capital that effectively covered it for perpetuity - the equivalent of a rights issue for a quoted company, a device much copied recently by the banking sector.
nThe strategic health authority has advertised for someone to lead the "Next Steps" project for Hinchingbrooke's recovery, with a salary of up to £93,098 a year. While that may not necessarily be excessive for the scale of the task, it does seem premature if the current management can cope as expected and, as Mr Vaughan-Lane points out, project managers do not operate in a vacuum.
"Presumably, it's not just a project manager: there will be a team underneath. I wonder what the SHA intends to do. I find it incredible that all this money is being flung around."
"I find it somewhat obscene," Mr Forbes said. "It's the equivalent of two or three midwives or a brand-new scanner, so it's perhaps not the best use of resources."
Of course, there is a world of difference between advertising a post and appointing someone to fill it.