When fair’ is unfair

HINCHINGBROOKE Hospital in Huntingdon is weak in its use of resources and only fair in its quality of clinical services, according to the health watchdog, the Healthcare Commission. Yet the same body rates it as excellent on all three criteria on w

HINCHINGBROOKE Hospital in Huntingdon is "weak" in its use of resources and only "fair" in its quality of clinical services, according to the health watchdog, the Healthcare Commission.

Yet the same body rates it as "excellent" on all three criteria on which it assessed acute hospital trusts - a standard achieved by only one other acute hospital trust in the country.

By contrast, Addenbrooke's Hospital - to which emergency patients would be moved if Hinchingbrooke were downgraded - received just one "fair" and two "good" ratings on the acute criteria. Yet it was classed as "good" for quality of service and "excellent" for its use of resources.

The latter is easily explained. Addenbrooke's, in common with all foundation hospitals, is using somebody else's cheque book. So the hospital breaks even because the primary care trust is saddled with the bills.


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By contrast, Huntingdonshire PCT, which was disbanded at the end of last month, made a modest profit, while Hinchingbrooke was saddled with debts, partly for treatment it had carried out for which the PCT could not pay, and partly because it was penalised for being efficient by having to prop up inefficient hospitals.

So Hinchingbrooke is "weak" in its management of resources because it could never possibly have been anything else.

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It is in debt not because it manages its budget inefficiently - it's actually among the 10 per cent most efficient hospitals in the country - but because it doesn't get enough money to pay the bills.

If you are baffled already, that is understandable. But it gets worse. The rules about quality of service are even more Byzantine.

The starting point is that Hinchingbrooke is an excellent hospital on all three major criteria for acute trusts. On top of that, of the 12 national target indicators on which it was assessed, it achieved 10, under-achieved on delayed transfers of care (which is actually a PCT issue), and failed to see patients at chest pain clinics quickly enough.

But there's a new set of targets, too. Of the 11 relevant ones it met seven, under-achieved on three - MRSA (the figures are old and this year's much better), the proportion of data with useful ethnic group coding, and recording smoking status and reducing smoking.

It did, however, fail on one target: the percentage of patients getting access to genito-urinary medicine clinics within 48 hours of referral. Nearly half of the country's hospital also failed, but Hinchingbrooke will have to deal with it urgently. It is the only clinical criticism wholly within its control.

Hinchingbrooke's overall rating owes far more to its debt - which is in large measure not its fault - than to the way it treats and cures patients.

It may have fallen victim to a one-size-fits-all view of the best way to deliver healthcare.

* Hinchingbrooke's response

ALTHOUGH the Healthcare Commission's ratings came as little surprise to Hinchingbrooke Hospital, managers were disappointed that the dedication of staff was not reflected.

Failure to achieve the genito-urinary medicine target - in common with a huge proportion of other acute trusts - dragged the hospital from a "good" overall quality of service rating to just "fair".

Interim chief executive Jane Herbert said: "Patients should be assured that this is not a reflection of the standard of care provided by our staff and valued by the community.

"The ratings include three 'excellent' scores, which Hinchingbrooke received as part of the Acute Hospital Portfolio - an accomplishment matched by only one other acute trust in a review of more than 150 hospitals.

"We all know our staff provide excellent care and we value their contribution."

The hospital pointed out that the "weak" rating for use of resources was an automatic reflection of unbalanced books and an end-of-year deficit.

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