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NHS hospital trusts in debt should be dissolved and replaced, says report Indebted NHS hospital trust should be dissolved and replaced, says report
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A heavily indebted NHS hospital trust should be dissolved, other healthcare organisations take over its services and ministers spend about £1.1bn subsiding radical changes to healthcare in an area containing a million patients, a troubleshooter's report to the health secretary has recommended.A heavily indebted NHS hospital trust should be dissolved, other healthcare organisations take over its services and ministers spend about £1.1bn subsiding radical changes to healthcare in an area containing a million patients, a troubleshooter's report to the health secretary has recommended.
A massive and unpopular overhaul of health services is necessary in south-east London because South London Healthcare NHS trust (SLHT) is so deeply in the red that it has no viable future in its current form, Matthew Kershaw, the trust's special administrator, has told health secretary Jeremy Hunt.A massive and unpopular overhaul of health services is necessary in south-east London because South London Healthcare NHS trust (SLHT) is so deeply in the red that it has no viable future in its current form, Matthew Kershaw, the trust's special administrator, has told health secretary Jeremy Hunt.
If implemented, his proposals would lead to a major reconfiguration of emergency, childbirth and planned care services in a large swath of the capital, including the closure of the A&E and maternity units at nearby Lewisham hospital, which is not part of the trust. That plan has sparked huge opposition from patients, hospital staff and the local MP, partly because it does not have any financial problems.If implemented, his proposals would lead to a major reconfiguration of emergency, childbirth and planned care services in a large swath of the capital, including the closure of the A&E and maternity units at nearby Lewisham hospital, which is not part of the trust. That plan has sparked huge opposition from patients, hospital staff and the local MP, partly because it does not have any financial problems.
Hunt has until 1 February to decide what to do. Health experts see the SLHT situation as a dry run for how the government will deal with a series of reconfiguration plans emerging across England, which all involve significant political implications and each of which has significant backing from doctors.Hunt has until 1 February to decide what to do. Health experts see the SLHT situation as a dry run for how the government will deal with a series of reconfiguration plans emerging across England, which all involve significant political implications and each of which has significant backing from doctors.
SLHT, which runs three hospitals, was the first NHS trust to be placed in administration by the Department of Health (DH) as an "unsustainable provider" of healthcare because it was losing about £1.3m a week. Its challenges, exacerbated by the high cost of hospital building developments under the private finance initiative (PFI), are so great that the trust is the NHS's "biggest financial problem", Kershaw said.SLHT, which runs three hospitals, was the first NHS trust to be placed in administration by the Department of Health (DH) as an "unsustainable provider" of healthcare because it was losing about £1.3m a week. Its challenges, exacerbated by the high cost of hospital building developments under the private finance initiative (PFI), are so great that the trust is the NHS's "biggest financial problem", Kershaw said.
Kershaw said nothing had emerged during a two-month consultation on his initial recommendations last October to change his thinking that only painful and complicated changes would solve SLH's problems, despite 8,224 patients, local people, health professionals and organisations submitting responses.Kershaw said nothing had emerged during a two-month consultation on his initial recommendations last October to change his thinking that only painful and complicated changes would solve SLH's problems, despite 8,224 patients, local people, health professionals and organisations submitting responses.
"Neither through the extensive consultation responses nor via all the work that has been done have any viable alternative solutions or proposals been put forward to solve the challenges faced by SLHT. I have said repeatedly that the status quo is not an option and I believe these final, refined recommendations are the right ones, although I appreciate that some people will find them difficult to accept," he said."Neither through the extensive consultation responses nor via all the work that has been done have any viable alternative solutions or proposals been put forward to solve the challenges faced by SLHT. I have said repeatedly that the status quo is not an option and I believe these final, refined recommendations are the right ones, although I appreciate that some people will find them difficult to accept," he said.
The proposals need to be implemented in full in order to ensure that people in south-east London could access "safe, high quality, affordable and sustainable" health services in the future, he added.The proposals need to be implemented in full in order to ensure that people in south-east London could access "safe, high quality, affordable and sustainable" health services in the future, he added.
SLHT currently runs three hospitals in south-east London: Princess Royal University hospital in Orpington, Queen Elizabeth hospital in Woolwich, and Queen Mary's hospital in Sidcup.SLHT currently runs three hospitals in south-east London: Princess Royal University hospital in Orpington, Queen Elizabeth hospital in Woolwich, and Queen Mary's hospital in Sidcup.
Under Kershaw's "tranformation programme":Under Kershaw's "tranformation programme":
• SLHT "should be dissolved and other organisations should take over the management and delivery of the NHS services it currently provides".• SLHT "should be dissolved and other organisations should take over the management and delivery of the NHS services it currently provides".
• The three SLHT hospitals need to make £74.9m of efficiency savings over the next three years as part of moves to improve their "operational efficiency".• The three SLHT hospitals need to make £74.9m of efficiency savings over the next three years as part of moves to improve their "operational efficiency".
• The DH "should provide additional funds to the local NHS to cover the excess costs of the PFI buildings at Queen Elizabeth hospital and the Princess Royal University hospital" until those contracts end.• The DH "should provide additional funds to the local NHS to cover the excess costs of the PFI buildings at Queen Elizabeth hospital and the Princess Royal University hospital" until those contracts end.
• Queen Elizabeth hospital should merge with Lewisham hospital, though the latter would lose both its A&E and maternity units, even though it is a financially successful organisation.• Queen Elizabeth hospital should merge with Lewisham hospital, though the latter would lose both its A&E and maternity units, even though it is a financially successful organisation.
• King's College hospital in south-east London should take over the Princess Royal hospital.• King's College hospital in south-east London should take over the Princess Royal hospital.
• Emergency care should be provided at four hospitals – King's College hospital, St Thomas' hospital (central London), Queen Elizabeth and the Princess Royal – with University Hospital Lewisham, Guy's Hospital (central London) and Queen Mary's hospital providing "urgent care".• Emergency care should be provided at four hospitals – King's College hospital, St Thomas' hospital (central London), Queen Elizabeth and the Princess Royal – with University Hospital Lewisham, Guy's Hospital (central London) and Queen Mary's hospital providing "urgent care".
• Obstetrician-led maternity care should be available at King's College hospital, Princess Royal University hospital, Queen Elizabeth hospital and St Thomas', with each of those hospitals, and Lewisham hospital, also having a midwife-led birthing unit.• Obstetrician-led maternity care should be available at King's College hospital, Princess Royal University hospital, Queen Elizabeth hospital and St Thomas', with each of those hospitals, and Lewisham hospital, also having a midwife-led birthing unit.
• Queen Mary's hospital should be developed to become a "hub" for health and social care for people in the London borough of Bexley.• Queen Mary's hospital should be developed to become a "hub" for health and social care for people in the London borough of Bexley.
• Many more patients in south-east London and Kent should be treated at or near home as part of an expansion of community-based health services which will reduce hospital admissions.• Many more patients in south-east London and Kent should be treated at or near home as part of an expansion of community-based health services which will reduce hospital admissions.
• The Department of Health should write off the accumulated debt of the SLHT hospitals because "it is important that these new organisations are not saddled with the issues of the past" as they start a new era.• The Department of Health should write off the accumulated debt of the SLHT hospitals because "it is important that these new organisations are not saddled with the issues of the past" as they start a new era.
The cost of implementing all the recommendations would come to a total of £1.093bn, Kershaw's team confirmed.The cost of implementing all the recommendations would come to a total of £1.093bn, Kershaw's team confirmed.
Writing off the historic debt that has built up since the trust was created in 2009, purely in operating costs, would mean the DH did not get back any of the £207m it will have spent by the end of March this year to cover those costs. In addition it would have to spend another £313m to implement Kershaw's proposals, including £55.3m to meet the extra losses that will be incurred over the three-year transition period he envisages is needed to implement them in full, starting in 2013-14.Writing off the historic debt that has built up since the trust was created in 2009, purely in operating costs, would mean the DH did not get back any of the £207m it will have spent by the end of March this year to cover those costs. In addition it would have to spend another £313m to implement Kershaw's proposals, including £55.3m to meet the extra losses that will be incurred over the three-year transition period he envisages is needed to implement them in full, starting in 2013-14.
The PFI deal at the Princes Royal will have cost a total of £304m by the time the contract ends in 2038-39, while the Queen Elizabeth's PFI deal will cost a total of £269.2m to cover until 2032-33.The PFI deal at the Princes Royal will have cost a total of £304m by the time the contract ends in 2038-39, while the Queen Elizabeth's PFI deal will cost a total of £269.2m to cover until 2032-33.
However, Kershaw's report also makes clear that the DH will ultimately save money – £449.7m by 2033-34 and £664m by 2043-44 – by implementing his proposals.However, Kershaw's report also makes clear that the DH will ultimately save money – £449.7m by 2033-34 and £664m by 2043-44 – by implementing his proposals.
A DH spokesman accepted that big changes were necessary. "Where trusts face longstanding problems we have been clear that doing nothing is not an option. It is crucial that patients in south-east London have high quality health services that will last.A DH spokesman accepted that big changes were necessary. "Where trusts face longstanding problems we have been clear that doing nothing is not an option. It is crucial that patients in south-east London have high quality health services that will last.
"There isn't an easy solution to the problems at South London Healthcare NHS Trust. The secretary of state has received the recommendations from the trust special administrator which he will carefully consider and will announce his final decision by early February 2013.""There isn't an easy solution to the problems at South London Healthcare NHS Trust. The secretary of state has received the recommendations from the trust special administrator which he will carefully consider and will announce his final decision by early February 2013."