Slippage

In August Ali Parsa went on a PR campaign to try and get the media to think that Hinchingbrooke and Circle were doing well. He succeeded, the compliant media reported what Parsa said rather than report what was actually happening (Hinchingbrooke was behind plan financially and Circle had to beg for extra capital from its shareholders telling them it was insolvent).

In an interview with the Today programme Parsa was asked about the finances at the trust (4:30):

Justin Webb: and you're still on course? my interest is when you expect to begin to be able to take some profit from your activities at Hinchingbrooke?
Ali Parsa: we are still on course, we think the hospital should balance its books next year, it should finish this year on a balanced book, that is what we are working on

Parsa is saying that by next April the trust will have a "balanced book". Webb, unfortunately, didn't have the then recent July finance report which said that the trust was doing badly financially, and so didn't challenge Parsa on this point. (It's not Webb's fault: the quality of research in the health section of the BBC news department is extremely poor, as we have seen during the passage of the Health and Social Care Act. BBC health journalists have little knowledge of the NHS or what is happening to it.)

On Thursday Hinchingbrooke gave its finance report for quarter 2 and their finances are no better than before. HSJ report that a spokeswoman for Circle said:

"We’re confident that we're now on track to reach a sustainable break-even position by the end of the next financial year."

That's the next financial year, Parsa said that the "balanced book" would be achieved this year. So Circle are now saying that their plan has slipped by a year.

Filed under "Interesting"

I'm working through the various documents that FTs have submitted to Monitor and I came across the following in the Forward Plan (next year's plan) for Cambridge University Hospitals Foundation Trust.

In the section "Goals and milestones to deliver vision" and under "Financial strategy and goals for the the three years" it says:

Developing a mutually beneficial relationship with Circle Health, with CUH providing and/or supporting a number of services either on the Hinchingbrooke site or CUH campus.

and later on under "Strategic Position"

Hinchingbrooke Hospital The Trust is committed to seeing a sustainable future for Hinchingbrooke as part of the regional family of healthcare organisations and to this end we will develop a mutually beneficial relationship with Circle Health, with CUH providing and/or supporting a number of services either on the Hinchingbrooke site or CUH campus.

CUH runs Addenbrooke's which is local to Hinchingbrooke and, depending on your point of view, is either a partner in delivering healthcare to the local community, or a competitor.

The phrasing of the statement is important. First the "beneficial relationship" is with Circle, not with Hinchingbrooke Healthcare NHS Trust. The hospital is owned by the trust, not Circle. Circle are merely management consultants brought in to run the hospital for the next 10 years. Any relationship should be with the trust. Instead CUH has decided to have a relationship with Circle.

The second point is the statement "providing and/or supporting a number of services" does not name the services and doesn't even indicate the site for the "services" (it says, either your place or mine). That shows that the services are unimportant. It is the "beneficial relationship" that is important. Since Circle Holdings is bankrupt, it is difficult to see what could be beneficial to CUH in a relationship with Circle.

Finally, the Health and Social Care Act says that Monitor has to act to prevent "anti-competitive behaviour". Two neighbouring trusts striking up a "beneficial relationship" does not sound competitive. Monitor have had three months to look at this plan and as yet have not complained. remember this if/when Monitor comes down heavy on your local trust for being "anti-competitive" and ask why CUH and Circle are allowed to have a cosy relationship and your trust isn't.

AQP Nonsense

As part of the government's NHS privatisation plans they have produced a policy called Any Qualified Provider. They "sold" this to the electorate by saying it is "patient choice" it isn't, it is commissioner choice. And what's worse, the government are forcing it upon commissioners by telling them they have to provide at least three community services via AQP.

This is having stupid effects. The Forward Plan for Berkshire Healthcare FT (BHFT, a provider of community health services) says this:

"NHS Berkshire is extending patient choice during 2012 by offering some audiology services and podiatry services through the Any Qualified Provider initiative. Audiology services will be offered from September 2012, and podiatry services in the autumn 2012. BHFT is mitigating the potential loss of business by focussing on enhancing service quality, and patient outcomes and satisfaction levels. The Trust will also apply for AQP status to offer services in new geographical areas where the Trust can offer high quality accessible services with minimal risk."

So BHFT fear that they will lose the income for audiology and podiatry because NHS Berkshire (the commissioners) will use another provider via AQP. Like many NHS organisations they cannot afford to lose this income so they intend to register as an AQP themselves are supply these services elsewhere!

What a load of bollocks this policy is.

Leader's Speech

In spite of a slight wobble on Saturday (which was more due to a misunderstanding than anything else), the overarching theme of the Labour conference is that the next Labour government will stop the marketisation of the NHS that the Coalition government is introducing.

This is an apt time because the government have just announced the third phase of Any Qualified Provider (AQP): 398 services will be opened up to private providers. It is now that private companies will be making the decisions whether to seek the investment so that they can become an AQP provider.

Incidentally AQP has nothing to do with patient choice as was touted at the last election. It is commissioners’ choice. CCGs will be allowed to commission any provider, and in some cases will have to use private providers since the government regards a choice for the NHS to be an invalid choice. The investment providers ill make is not insignificant. Yes, there are some that are relatively low risk investments (for example audiology, where there are already providers in the private sector, who will presumably seek to expand their business by providing NHS services). But other services, for example MRI and CT diagnostics, there are significant investments needed.

Ed Milliband’s conference speech said that the next Labour government will repeal the Health and Social Care Act, and significantly, it would stop the marketisation of NHS service: the NHS ill be the preferred provider. Private companies invest to make a profit and profit depends on gaining business. In the environment of flat funding it is even more difficult for a private provider to make a profit. To make a return on their investment they will need a sustained profit over a long period of time, and that includes the time after the next election. Ed Milliband said that when a Labour government is elected that profit is not guaranteed. It is possible that Ed’s statement could curtail the number of companies willing to become an AQP and could limited the policy.