What you asked recently, and our answers

If SHAs are to be phased out and new NHS National Management Boards established, what impact, if any, will this have on the Hinchingbrooke Next Steps (HNS) Project? 

The proposed date for the introduction of the new NHS National Management Boards is April 2012. The HNS Project Board is aiming to appoint a preferred franchisee in late autumn 2010, with a service commencement date of May 2011, well before SHAs are to be wound down. The HNS process will not be affected by the change.  Hinchingbrooke will continue to be subject to the same performance management monitoring and evaluation as any other NHS hospital. The performance of the franchisee will be monitored by the Trust board and NHS Cambridgeshire.

Question answered 3 June 10
 

Please can you explain how Hinchingbrooke’s debt occurred?

Hinchingbrooke is currently designated a financially challenged Trust with a historical debt of £38.4m, on an annual turnover in the region of £90m. 

The debt first emerged as a problem in spring 2006 and NHS East of England and the Trust Board acted immediately. A review was commissioned by KPMG. 

In March 2008 the Trust’s Auditors issued a Public Interest Report (PIR) highlighting Hinchingbrooke’s poor financial position. The PIR is a requirement under the Audit Commission Act 1998, and the Statutory Auditor has to issue this report in the public interest where they consider that a matter is sufficiently important to be reported on, in order for it to be considered by the body concerned, or brought to the public’s attention.

The PIR noted that although Hinchingbrooke’s Board was working towards achieving in-year financial breakeven in 2008/09, the view of the auditor was that it would not be able, without external support, to achieve its statutory duty to breakeven on a cumulative basis by March 2009 because:

• the extent of the projected accumulated deficit at 31 March 2008,
• the absence of a financial recovery plan to deliver this outcome.

A referral was also made to the Secretary of State.

An interim management team was appointed to stabilise the position, and Mark Millar was seconded from NHS East of England to become the new Chief Executive.  He was appointed with the task of leading the organisation, on an interim basis, while a solution to the debt was found.

There are a number of reasons why Hinchingbrooke accumulated such a large debt. During the Payment by Results (PbR) transition period of 2006-2008, Hinchingbrooke was not paid at the agreed tariff rate for all of the services it delivered to patients, partially due to internal mistakes.  Roughly 66% of this historic deficit (£25.6m) relates to a combination of the capped PbR transitional funding adjustments, and management errors.

The PbR transition process ended on 31 March 2008 and Hinchingbrooke hospital now receives income for the work it does, on a payment by results (price and volume) basis.

Another significant factor underlying the figures is that additional activity originally promised by Primary Care Trusts (PCTs) for the Diagnostic and Treatment Centre (which opened in October 2005) did not occur. Increased activity was to be generated by a shift in referrals to the Trust, but this had not been the case as local PCTs changed their commissioning intentions away from hospitals and into the community, in line with Department of Health guidance. This lower than predicted activity resulted in a deficit of £7.8m in 2005/6.

These factors, including management error, resulted in a loss totalling £38.4m.  Since the Summer of 2007 options have been considered for repaying the historic debt while ensuring the continued provision of the same range of services throughout the Hinchingbrooke site. The hospital has worked hard and now ‘balances its books’ each year but has not been in the position to contribute towards the repayment of its debt. Moreover, its sustainability longer term continues to be challenged, particularly in light of the economic climate. The procurement contract will be compliant with the option agreed in the 2007 public consultation.

NHS Cambridgeshire faces a recurrent funding gap of around £100m by 2013/14 so, with such financially difficult times ahead, it is important that every attempt is made to run Hinchingbrooke hospital in a way which ensures its future, while contributing towards its debt.

Question updated 6 July 2010

Why is Hinchingbrooke not sustainable, longer term, in its current form?

The funds that NHS Cambridgeshire will be receiving to provide services such as those at Hinchingbrooke will be decreasing, in real terms, over the next five to seven years. The effect of this will be fewer funds available to all NHS organisations, and greater efficiency will be required. Hinchingbrooke is not of a sufficient size to make these efficiencies on its own, in its current form. 
Question answered 12 March 10

Can you explain more about the purpose of the Trust comparator?

Staff at Hinchingbrooke are compiling a Trust comparator.  The role of the comparator is to provide a realistic financial baseline that reflects how the Trust would deliver the service requirements, as set out in the Invitation to Participate in Dialogue documents and later in the final Invitation to Tender.  It is being independently evaluated, against the bidders’ ITPD submissions. 

While the comparator will be a useful 'bar' against which to meausre the bids received, it will not be providing the long term answer for Hinchingbrooke's ongoing sustainability; it will not be a blueprint for the future.
Question answered 12 March 10, answer updated 17 May 10
 

Will you be holding public meetings in St Neots and St Ives?

Involving and engaging the public has been at the heart of the Hinchingbrooke Next Steps project from the very outset and meetings, open to the public, are a key part of that. We have the stakeholder panel meetings in Huntingdon, which are open to the public, and we also have three public meetings, in Cambourne, March and Huntingdon. People are also welcome to ask someone from NHS East of England’s Strategic Projects Team (SPT) to come and make presentations or answer questions at their own meetings. In March and April 2010, for example, SPT staff are attending meetings in Kimbolton, Doddington and St Ives. We are very happy to include St Neots and others in that offer.
Question answered 12 March 10
 

Some of the bidders lack experience of running an acute hospital.  How will they pass the evaluation?

All five bidders have substantial experience of providing urgent and planned care services, although not necessarily within the UK. It is expected that bidders will draw on their international and UK experience and will need to demonstrate strong and compelling evidence of their experience and ability to manage a UK acute hospital. Bidders are being asked to demonstrate this capability as part of the ITPD process (invitation to participate in dialogue).

All bidders are already providing NHS care, free at the point of delivery. Some bidders are working with NHS partners to ensure their plans and procedures meet the standard required to provide highly effective, safe and efficient health services.  Such partnerships are commercial and in confidence at this stage of the tender process.
Question answered 12 March 10
 

Are any services going to be cut, and what might they be?

A consultation was held in 2007, led by NHS Cambridgeshire, into possible options for the future of Hinchingbrooke hospital. The result of the consultation was a preference that services should continue at the hospital and, as a consequence, potential partners are being asked to bid to provide existing services, ‘as is’.

The funds that NHS Cambridgeshire will be receiving to provide services such as those at Hinchingbrooke will be decreasing, in real terms, over the next five to seven years. The effect of this will be fewer funds available to all NHS organisations, and greater efficiency will be required.

The Hinchingbrooke Next Steps project is committed to securing the full range of services currently provided. Any organisation which wins the franchise to operate Hinchingbrooke hospital will be required to provide the range of services agreed with NHS Cambridgeshire. If there were to be any substantial change in the services offered then it would be necessary to conduct a full public consultation. This is the same as if the hospital continued to be operated by its current management. 
Question answered 12 March 10
 

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