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Circle is the first private company to assume the management functions of an NHS Trust. This report examines how the NHS East of England Strategic Health Authority designed, initiated and managed the project to franchise Hinchingbrooke Health Care NHS Trust, and highlights early lessons that can be learnt. The Trust developed a cumulative deficit of £39 million between 2004-05 and 2007-08, on an annual income of around £73 million. This report finds that the Trust's performance against standards for cancer and accident and emergency waiting times has improved since the franchise began in February 2012. However, the Trust had generated an in-year deficit of £4.1 million by September 2012, which was £2.2 million higher than planned to that point. Circle plans to achieve £311 million in projected savings over the ten-year life of the franchise, which is unprecedented. However, Circle is not committed to delivering the proposed savings initiatives submitted during bidding, such as reducing the lengths of hospital stays. Most of the savings are expected to be made in the later years of the ten-year franchise. Although the Authority assessed the reasonableness of bidders' savings proposals, it did not fully consider the relative risks. However the agreement transfers all demand and financial risk up to £5 million to Circle. The Authority also rejected a guaranteed payment towards the Trust's cumulative deficit in favour of an ambitious bid that aimed to repay the debt in full. The cumulative debt stood at £38 million at the end of March 2012
The taxpayer has been left exposed by the failure of the Hinchingbrooke franchise according to the Public Accounts Committee's report. In February 2012, Circle took operational control of Hinchingbrooke Health Care NHS Trust, becoming the first private company to run an NHS hospital. In January 2013, the Committee expressed concerns that Circle's bid to run Hinchingbrooke had not been properly risk assessed and was based on overly optimistic and unachievable savings projections. The Department of Health responded that the NHS Trust Development Authority would monitor progress and take action if the Trust was failing to deliver on its plans to make the hospital financially sustainable. In the event, Circle was not able to make the Trust sustainable and the NHS Trust Development Authority did not take effective action to protect the taxpayer. In January 2015, Circle announced that it intended to withdraw from the contract, just three years into the 10-year franchise. It was clear at the time the franchise was let that the Trust would only survive if it secured substantial savings. The Comptroller and Auditor General's 2012 report highlighted that the savings projected in Circle's bid were unprecedented as a percentage of annual turnover in the NHS.
The strategic management of health resources across the East of England Strategic Health Authority has failed. Ultimate responsibility for this rests with the Department of Health. For many years to come, the local community as well as the NHS and taxpayers will have to live with the consequences of separate decisions to build a new PFI hospital at Peterborough and to award a franchise to a private company to run the nearby Hinchingbrooke hospital. These decisions were taken separately despite the fact that the two hospitals are only 24 miles apart in an area where the NHS has long acknowledged that healthcare provision is running ahead of local needs. The reality is that there is not enough funding there for both Trusts to thrive as currently configured. Their financial viability will be further eroded if more people are treated outside hospitals, in line with present and past government policy. Circle Healthcare, the franchisee of Hinchingbrooke, has not achieved its expected savings in its first few months and its Chief Executive has already left. The bid was not properly risk-assessed and the successful bidder was encouraged to submit over-optimistic savings projections. The PFI deal for Peterborough and Stamford PFI hospital has proved catastrophic, with the Department now being forced to pay out nearly £1 million a week of taxpayers' money to keep the Trust afloat. Both Trusts will have to make unprecedented levels of savings to become viable. In Peterborough and Stamford's case, this won't be enough
This update finds that there was a surplus of £2.1 billion across the NHS as a whole in 2012-13, matching that in 2011-12. The financial performance of NHS trusts and foundation trusts should be considered in the context of a period of little to zero growth in funding for NHS services over the last two years and during a period of significant structural change across the NHS. Measured by the total surplus or deficit of hospital trusts, financial performance for the NHS appears stronger in 2012-13 than it did in 2011-12. However, there are signs of increasing pressure. As last year, there was a substantial gap between the trusts with the largest surpluses and those with the largest deficits. When primary care trusts (PCTs) and strategic health authorities are also included, there is a similar variation between local health economies. NHS trusts in difficulty rely on cash support from the Department of Health or non-recurrent local revenue support from strategic health authorities and primary care trusts but this is not a sustainable way of reconciling growing demand with the scale of efficiency gains required within the NHS. At the end of 2012-13, there were still 100 NHS trusts that had not achieved foundation trust status. The risk that NHS trusts will not maintain their planned trajectory to foundation trust status increased substantially in 2012-13. This is a period of major transition for the NHS, as clinical commissioning groups take over from strategic health authorities and PCTs the responsibility for commissioning health services.
As information systems become ever more pervasive in an increasing number of fields and professions, workers in healthcare and medicine must take into consideration new advances in technologies and infrastructure that will better enable them to treat their patients and serve their communities. Healthcare Administration: Concepts, Methodologies, Tools, and Applications brings together recent research and case studies in the medical field to explore topics such as hospital management, delivery of patient care, and telemedicine, among others. With a focus on some of the most groundbreaking new developments as well as future trends and critical concerns, this three-volume reference source will be a significant tool for medical practitioners, hospital managers, IT administrators, and others actively engaged in the healthcare field.
In Remaking Policy, Carolyn Hughes Tuohy advances an ambitious new approach to understanding the relationship between political context and policy change.
This timely book examines the legal regulation of Public_Private Partnerships (PPPs) and provides a systematic overview of PPPs and their functions. It covers both the contractual relationships between public and private actors and the relationships be
On cover and title page: House, committees of the whole House, general committees and select committees. On title page: Returns to orders of the House of Commons dated 14 May 2013 (the Chairman of Ways and Means)
This report summarises the key areas of the Committee's work over the past five years. It draws out the areas where progress has been made and where their successors might wish to press in future. The Committee has assiduously followed the taxpayer's pound wherever it was spent. Since 2010 they held 276 evidence sessions and published 244 unanimous reports to hold government to account for its performance. 88% of their recommendations were accepted by departments. In many cases they successfully secured substantial changes, for example with the once secret tax avoidance industry. They secured consensus from government and from industry that private providers of public services do have a duty of care to the taxpayer, and in pushing the protection of whistleblowers further up the agenda of all government departments. By drawing attention to mistakes in the Department for Transport's procurement of the West Coast Mainline, more recent procurements for Crossrail, Thameslink and Intercity Express have all benefited from more expert advice and a more appropriate level of challenge from senior staff. After discovery in 2012-13 that 63% of calls to government call centres were to higher rate telephone numbers, the Government accepted our recommendation that telephone lines serving vulnerable and low income groups never be charged above the geographic rate and that 03 numbers should be available for all government telephone lines. They also secured a commitment to close large mental health hospitals.
The success of the London 2012 Games demonstrates that it is possible for government departments to work together and with other bodies effectively to deliver complex programmes. The £9.298 billion Public Sector Funding Package for the Games is set to be underspent. The Department is also committed to reflect on what more it can do to present costs in a way that goes further and brings out those costs associated with the Games and the legacy that are not covered by the Funding Package. The notable blemish on planning for the Games was venue security. Also, during the Games a large number of accredited seats went unused at events for which the public demand for tickets could not be met. International sports bodies and media organisations wield a lot of power but demands should be challenged. It is now up to the London Legacy Development Corporation to attract investment in the Olympic Park and generate the promised returns to funders. There is concern that the lottery good causes do not have any clear influence over decisions about future sales, despite these decisions directly affecting how much will be available to them and when. On the wider legacy, we look to the Cabinet Office to provide strong leadership to ensure delivery of the longer term benefits. The Government also needs to do all it can to learn and disseminate lessons and to encourage volunteering opportunities both within sport and beyond