Briefing Document on the Threat to Heatherwood Hospital and the NHS in East Berkshire

Background

This briefing document has been written in response to the Shaping the Future programme initiated by NHS Berkshire.

This document examines the organisations involved and many of the key factors involved in the decision making process.

Executive Summary

This document analyzes the key issues facing the NHS in Berkshire, Shaping the Future and the threat to Heatherwood Hospital.

Key findings:-

 Berkshire East PCT is the 9th lowest funded in the country and has had its funding reduced by the government. If we were funded at the national average rate there would be no need for local cuts.

 Heatherwood and Wexham Park Hospitals NHS Foundation Trust remains heavily indebted and off track on its turnaround plan. It suffers from “over activity” and operates at over capacity.

 An agenda is being pursued by the PCT to effectively make a case for the closure of Heatherwood via the creation of the Bracknell Healthspace. There is a conflict of interest issue and local GP’s are likely to make financial gains from this development.

 The toxic balance sheets of the PCT and Heatherwood means that only Government in the form of a cash injection (i.e. an increase in funding) can put the NHS in East Berkshire back on track whilst maintaining quality patient care.

 There is no justification in closing Heatherwood Hospital whilst the Trust is running at over capacity and the PCT is not meeting government targets on 18 weeks and A&E. Indeed the reverse is true investment is needed to improve the services provided and the facilities on site.

Save Heatherwood Briefing DocumentPage 1 How the NHS works in East Berkshire

Funds are distributed from the Government to Strategic Health Authorities (SHA’s) who in turn fund Primary Care Trusts (PCT’s). They are central to the NHS and control 80% of the NHS budget. It is the PCT’s who will be abolished should the NHS Bill currently going through parliament be passed. They will be replaced by GP Commissioning who will create Clinical Commissioning Groups. In preparation for this Berkshire East PCT and Berkshire West PCT have come together to form a cluster known as NHS Berkshire. Despite the fact that the NHS Bill has not been passed NHS Berkshire is already laying the groundwork for the changes.

The fundamental role of a PCT is to commission and pay for health care patients health care. Patients have a degree of choice in relation to which health care providers such as hospitals provide the treatment.

One of the major providers of healthcare in the region is the Heatherwood and Wexham Park Hospitals NHS Foundation Trust (HWPFT).

In 2010/11 Berkshire East Primary Care Trust (PCT), also known as NHS Berkshire East, was responsible for buying care from hospitals and other service providers as well as providing a range of community-based services. Berkshire East comprises both rural and urban areas within three unitary authority areas and five main towns; Slough, Windsor, Maidenhead, Bracknell and Sandhurst. The resident population for NHS Berkshire East is 387,200 (Office for National Statistics – ONS – data, 2009) which is different to the number of patients registered with local general practices (424,125).

Save Heatherwood Briefing DocumentPage 2 Berkshire East PCT and NHS Berkshire

Charles Waddicor, Chief Executive of NHS Berkshire told the Bracknell Forest Council’s Health Overview and Scrutiny Panel on 30 June that the closure of the Hospital (Heatherwood) in Ascot could be considered. He said “Nothing can be ruled out and nothing can be ruled in. Because the economy is significantly challenged, we have to look at a whole range of things.” He went onto to state that NHS Berkshire is looking to make £37m of savings in this financial year. (2011/12)

The 2010/11 annual report of the PCT reported the following “In Berkshire East we need to save £100m over the next four years. We have set out to find smarter ways of working, making every taxpayer’s pound go as far as possible”.

These savings have to take place in the context of efficiency savings made in previous years e.g. £12million in 2010/11.

The same annual report went onto state:- “The financial year 2011/12 will be equally challenging. However the PCT has established firm financial governance arrangements to tackle over-activity of its main providers and has introduced a number of mitigating actions to tackle the risks:  joint project (Shaping the Future) taking a three year view of the service provision across the health economy, with transition to a more sustainable financial position for HWPFT and ultimately for commissioners  signed contract of £137.5m 2011/12 with HWPFT”

Berkshire East PCT required financial support in 2010/11 and again the annual report stated:-

“The PCT was unable to contain spending within the original budget levels set for 2010/11. This was due to significant financial challenges faced by the PCT’s main provider of health services, Heatherwood and Wexham Park Foundation Trust (HWPFT), and over activity on the part of other providers. The financial position in 2010/11 was managed through a combination of PCT contingency provision, budgeted surplus and available reserves, and the Strategic Health Authority, System Reform Investment Fund (SIRF), in addition to other allocations. Hence the Audit Commission concluded that the PCT failed to put in place adequate arrangements for securing financial resilience.”

The Berkshire East PCT board meeting of 6 April 2011 reported that the budget for 2011/12 has been reduced to £1,452 per person which makes it the 9th lowest funded PCT in the country. If Berkshire East were funded at the national average of £1,673 per person the PCT would have £98m more. The PCT required support of £9 million in 2010/11. This support would have to be repaid during 2011/12. Funding increase for the PCT for 2011/12 is only 2.2%-well below inflation.

The Chief Executive’s report to the Cluster Board meeting on 27 September 2011 reported “Disappointingly Berkshire East PCT remains assessed as “failing” by the SHA. This is because the system is not meeting the 18 week targets and is now failing the A&E targets as well.”

Save Heatherwood Briefing DocumentPage 3 Heatherwood and Wexham Park Hospital NHS Foundation Trust

Background to a very local crisis

The Hospitals attained their Trust status at the second attempt in June 2007. From the attainment of Trust status it has lurched from crisis to crisis. The Verita report published in August 2011 reviews the recent turbulent years. It makes grim reading and outlines poor financial management, poor data accuracy and clinical coding and poor operational performance in maternity, A&E and thrombolytic services. Despite this poor performance the Trust continued to pay bonuses to executive directors.

Financial Performance

 2005/06 Deficit of £3.7m

 2006/7 Surplus of £2.5

 2007/8 Surplus of £4.4m

 2008/9 Surplus of £1.8m

 2009/10 Deficit of £34.2m

 2010/11 Deficit of £13.2m

The Foundation Trust is part way through its Turnaround Plan. It was judged as failing by Monitor, the government watchdog, and continues to have a status of “Highest Risk” for Finance and is adjudged to be “in significant breach of its terms of authorisation”.

In June 2010 the Foundation Trust axed 470 full time roles to save £33.4 million. Julie Burgess the Chief Executive stated that “We must increase efficiency....”. There was a streamlining of the clinical structure and a reduction in beds.

 In September 2010 the Trust had to take an £18m loan from Andrew Lansely (Health Secretary). The loan is at commercial rates of interest and payable over 10 years.

The finance report (25/05/2011) of The Berkshire East PCT stated that they commissioned £151m worth of services from the Foundation Trust. This is £7.76m over plan (plan = £143.2m). The 2011/12 plan has been reduced to £137.5m (see above).

The finance report of 25/5/2011 stated that the key risk facing the PCT this year “related to control of overall activity, both in contracts, in particular Heatherwood and Wexham Park Foundation Trust...”

Current Finance performance of the Foundation Trust

At the Council of Governors meeting on 14/9/2011 the following was reported:-

Save Heatherwood Briefing DocumentPage 4 July 2011 the Trust had a deficit of £1.2m. The reported YTD deficit was £4.7m. “The adverse performance is largely due to continued high levels of activity. The plan for the year was predicated on significant reductions in inpatient spells, particularly in elective care. Not only have these reductions not materialised, but volumes have in some areas increased – particularly elective day cases. Referrals in from our primary commissioner continue to run at approximately 30% above plan”

A recent significant and misleading press statement was issued by Adam Afriyie. On the BBC website 30/9/2011 he was quoted as follows:-

“The PCT and local GPs have decided to send patients to other hospitals. Every time that happens, the hospital misses out on money. That worries me.”

The Hospital Trusts own minutes (see above) clearly contradict him. They report “over activity” i.e. too many referrals.

He went on to say “Heatherwood and Wexham Trust don't want to close this hospital. “

However evidence tends to suggest otherwise. In November 2010 the Hospital Trust attempted to remove protected property status from Heatherwood Hospital. This would have allowed the Trust to sell land. However Monitor, the Government watchdog blocked the proposal as the Trust failed to provide key information.

The Chief Executive of the Trust surprisingly resigned her £165k per year role during September 2011. The reason given was “health reasons”. The decision was immediate and allowed the Trust to avoid 6 months notice and the CEO to avoid 3 months notice.

The closure of the Maternity unit and the non renewal of a key contract in Heatherwood Hospital indicate that the Hospital Trust is already running down the hospital....even before the consultation has begun.

Save Heatherwood Briefing DocumentPage 5 Shaping the Future

The threat to close Heatherwood Hospital has it’s current origins in the Shaping the Future strategy. The press statement issued by the NHS Berkshire on 30/6/2011. It stated that “It is recognised that with substantial reductions in funding for healthcare in East Berkshire the board will need to review the way all services are delivered.” Earlier in the same press statement they stated that “...with an aging population and the development of more expensive drugs and treatments, the cost of healthcare is going to rise”.

A September 2011 statement by NHS Berkshire and Heatherwood and Wexham Park Hospitals NHS Foundation Trust stated “But we have to keep within existing budgets....becoming more efficient”.

They went onto say “We will take into account planned future developments such as the Bracknell Healthspace”.

The 3 options are being reported as “not finalised” and “work in progress”. They have not been costed. Consequently Engagement meetings are currently taking place with the public consultation taking place early next year.

The 3 options can be broadly described as follows:-

Option 1 – Move all existing services to Wexham Park

 This would result in the closure of King Edward VII (Windsor), St Marks (Maidenhead) and Heatherwood (Ascot)  The capital receipts from the sale of the land at heatherwood would be invested in Wexham Park  According to the PCT this has an “Affordability Challenge”

Option 2 – Hub and Spoke

 This would result in the closure of Heatherwood with the other existing units remaining in place.  The capital receipts would be invested in Wexham Park  According to the PCT this is “Affordable”

Option 3 – Wexham provides A&E/Acute Services and heatherwood elective care

 The PCT would sell some more of the Heatherwood land to a private health provider to generate some investment  According to the PCT this is “Relatively affordable”

A caveat needs to be added to these three options as the PCT stress these are not final, not costed and are Work in Progress. However it’s clear that option 2 curries favour with the PCT.

Save Heatherwood Briefing DocumentPage 6 At a recent Engagement Meeting in Windsor on 26/9/2011 the medical director of NHS Berkshire David Buckle stated that the “Bankers had triggered this discussion” He stated that the cuts would mean that the PCT would have to “Manage the demand”.

The Bracknell Healthspace

The Bracknell Healthspace has been initiated by the PCT. The site has been identified and now has planning permission. It represents a potential get rich scheme for East Berkshire GP’s at the expense of Heatherwood. There is much concern amongst staff at the Hospital Trust about the plans for the Healthspace and the role of the PCT.

The Healthspace raises a number of issues in respect of the relationship between the PCT and the Trust as well as a potential for a conflict of interest by a key individual involved both on the PCT board and also a financial interest in the Bracknell Healthspace.

The GP Group hoping to have a role to play with the Healthspace has established a limited company called “Specialist Health Services Ltd”. One of the Directors is Dr Adam Greig. He also happens to be on the PCT board and remunerated to the tune of £65-70k pa. As well as that his GP practice received payments of £935k in 2009/10 and £835k in 2010/11. The website (http://specialisthealthservices.co.uk/) of the company states that they are currently based at Skimped Hill Health Centre in Bracknell and the private Princess Margaret Hospital in Windsor. According to its Annual Return of 1/6/2011 the shareholders include Dr William Tong, Dr Robert Koefman and Dr Adam Greig amongst others.

The Bracknell Health Space will be built on the existing site of the Skimped Hill Health Centre. The development plans are outlined on this website http://www.ashleyhouseplc.com/index.php/portfolio/no_js/casestudy/bracknell_healthzone/

The website states

It aims to do the following:-

 The £20 million HealthSpace will bring a wide range of services closer to home for many people. These will include GP and dental services, diagnostics, outpatients, x-ray, physiotherapy, podiatry, mental health and sexual health services. It will also house an urgent care centre, an alternative to A&E for minor injuries and ailments such as sprains, stings and fever. The HealthSpace is expected to be used by thousands of patients a year.

 Demands for a multi-purpose ‘one-stop shop’ for health in the centre of Bracknell offering an extended range of services was one of the key themes to emerge from the local Right Care, Right Place public consultation which finished in 2008.

Services: 2 GP practices, diagnostic services, out-patient, urgent –care, children services, dental care, mental health and pharmacy.

The Healthspace may be an invaluable additional asset to our local NHS and could contribute to a lessening the pressure on other units. We do not see it as an alternative to Heatherwood. The issues

Save Heatherwood Briefing DocumentPage 7 raised above in respect of the conflict of interests should be investigated and clarified in the public interest..

Save Heatherwood Briefing DocumentPage 8