Problems that face the decision makers

An exclusive interview with the East of England Strategic Health Authority has revealed the extent of the problems facing Hinchingbrooke and some possible outcomes. IAN MacKELLAR reports.

HINCHINGBROOKE Hospital could lose its emergency surgery capability, but intensive care and other A&E functions look secure, The Hunts Post believes.

The East of England Strategic Health Authority will not allow the hospital's projected £30million debt to influence decisions on the future of secondary healthcare in the district, it promised.

The SHA's director of commissioning, Dr Paul Watson, insisted no decisions had been taken and promised that the public would be fully consulted when proposals for the future are published, probably early next year.

Hinchingbrooke is one of only two acute hospitals in the country to be rated "excellent" on all three measures assessed by the Healthcare Commission earlier this year. But patients in Huntingdonshire use hospital services more than any other district in England, Dr

Watson said.

It is convenient and popular with both GPs and patients, so the level of referrals is exceptionally high.

"It's an efficient hospital, providing good quality healthcare in an efficient way. The issue is that the primary care trust is receiving a fixed allocation, between £1,100 and £1,200 per head per year. But the local community is using the hospital at a higher level than anywhere else in the country.

"That creates problems because PCTs fund care on the basis of a standard tariff. But providing services at Hinchingbrooke is becoming more expensive, for example because we can no longer make junior doctors work 100 hours a week, as I did when I was working there. And it's now expected that consultants will be available for hands-on care.

"And there are new drugs that are effective but more expensive."

Dr Watson said the gap between net income and Hinchingbrooke's running costs was currently about £5million a year. When the "payment by results" tariff is fully implemented in two-and-a-half years' time - at the moment the Department of Health claws back around 20 per cent from Hinchingbrooke - running costs would be more or less in line. But the PCT will not get more money because of the extra treatment Hinchingbrooke provides.

"So for exactly the same level of care, the PCT will have to pay £10-11million a year more.

"The PCT has two choices. One is to take money from other things, such as mental health services, to keep up the level of hospital activity, but that would be contrary to the process in every other PCT. Or put more care into the community and reduce the level of hospital care to that of the rest of the country. But the effect that would have on Hinchingbrooke would be to push it back into deficit.

"If the PCT brought use of the hospital back to the national average, it would save £10-15million a year, though only about half of that would be saved in costs (at the hospital). So the cost per case goes up and up."

The dilemma is that, if Hinchingbrooke's income were sorted on the basis of the current caseload, the PCT would be bankrupted - in much the same way that Addenbrooke's (a foundation hospital that get paid in full for whatever it does) imposed huge debts on the former Cambridge City and South Cambridgeshire PCTs.

That is why the SHA is reviewing activity at the hospital. Teams are looking at three options, all of which involve reducing the amount of work Hinchingbrooke does.

One is to carry on much as now, but doing less work. This is clearly not feasible, but it will provide a reference point for the other two - streamline activities at Huntingdon or ship out much of the work to Cambridge and Peterborough.

The SHA is reviewing all 19 district general hospitals on its patch, where Hinchingbrooke has lowest catchment population of all on the basis the Department of Health uses to calculate it.