FTN Letter

Last week there was a letter in the times signed by managers from NHS organisations supporting the change to the Private Patient Income Cap. (Note: it is not a 49% cap, the Bill says that income from NHS patients must be more than the private income. So that is a cap of 50% minus one penny.) I have analysed the list of names and the organisations (data here).

There are 57 signatories from 53 organisations. Out of these there are four nursing directors, one Chair, 51 Medical Directors, one (nursing) director from a private patient unit and one Business Unit Director.

Looking now at the organisations. Nine are NHS Trusts (ie they are not yet FTs); eight are teaching trusts (in total, there are 26 in England); nine are specialist trusts (there are 20 in England); ten are mental health trusts (one of which is a NHS Trust); two are community services providers; one is an ambulance trust; and the rest, 19, are FT acute hospital trusts of varying sizes.


The trusts who are most likely to benefit from a raised PPI cap are the specialist and teaching hospitals, and 40% of the English teaching and specialist hospitals are in the list. These types of trusts have the largest PPI, these are all represented in the list of signatories.

Mental health provision has been widely privatised over the last couple of decades with many private and voluntary providers now being paid by the NHS, as well as the many providers carrying out solely private work. The FT Mental Health Trusts on the list all had zero private patient income in 2003, but currently have a 1.5% PPI cap (the Health Act 2009 said that for a Mental Health Trust the PPI cap would be a minimum of 1.5%). If I wanted to be cynical I would say that these trusts have looked to the opposition - the private mental health providers - and decided that they want to get part of that business.

The glaring omission from this list, considering Cameron's promise of a "bare knuckle fight", are District General Hospitals; yet these are the trusts who are most likely to suffer from the cuts to the national tariff (1.5% cut in April 2011, "at least" 1.5% in April 2012). Indeed, whenever a Coalition MP is challenged over the PPI cap they never say that they want a big teaching hospital to "benefit" from more private income, instead they always say that they want their local DGH to "benefit". However, DGHs are unlikely to "benefit" because private patients are more likely to go to a big teaching or specialist hospital than a DGH, and this explains why few DGH managers have signed the letter: it simply does not concern them.

One final point. FT Governors are reminded frequently by their trusts not to associate the name of the trust with any political action they take. After all, an FT is a community, public benefit corporation and a governor's opinions are not that of the FT, they are of the individual governor. (I am an FT governor, and whatever I write here is my own opinion, and not the opinion of the governing board, nor the FT.) Have the signatories asked their governing bodies? If not, then I think the governors should censure them. After all, if governors as supposed to keep their political campaigning and their FT duties separate, so too should board directors, and this letter was definitely intended to be a political letter.