Further Work

This work has been carried out on the 144 Foundation Trusts that had submitted Annual Reports and Forward Plans to Monitor in June 2012. The data was obtained mostly from these documents, but the information was supplemented by board papers and other information on the trusts’ websites. Consulting board papers is time consuming, but is potentially more productive since the board papers often give the reason behind the decisions noted in the Forward Plans.

The discussion above identifies FTs that have announced that they will either start treating private patients, or that they have an intention to expand their existing private patient business. It is important that a close watch is kept on these trusts to determine how much FT capital is used in these expansion plans and how profitable (or not) the new business is. Foundation Trust governors at these trusts will have a duty to ensure that the private patient provision does not interfere with the provision of NHS services.

There are around one hundred NHS Trusts yet to achieve FT status. There is no central repository for the Annual Reports of these trusts, and since obtaining these reports will be time consuming, these trusts have been omitted from this work. Analysis of these reports is important because NHS Trusts have not been subject to the restraining influence of the Private Patient Income cap that was applied to FTs.

This report has concentrated solely on secondary care and mental health providers. The Health and Social Care Act creates Clinical Commissioning Groups as the local commissioners of NHS care. CCGs are currently in shadow form but will be statutory bodies from April 2013, so from that date it will be important that board papers from these organisations (particularly papers concerned with finance and commissioning decisions) are monitored and analysed.

There are some parts of the country where some NHS services are delivered solely by private companies, charities or social enterprises. Unlike Foundation Trusts, these organisations do not have to produce detailed public reports about their performance. It is important, from a public service point of view, for the patients using the service, that an “Annual Report” is produced that is equivalent to the report that would have been produced if an NHS organisation had been commissioned to deliver the service. Such a report could be collated from information submitted to Companies House or to the Charities Commission, from reports commissioned by Local Healthwatch and Health and Wellbeing Boards, and from the CCGs commissioning the service. Such a report will enable the public to compare the performance of the non-NHS provider with equivalent NHS providers. It is possible that the publishing of such “alternative annual reports” could persuade the non-NHS providers to voluntarily produce their own Annual Reports equivalent to those provided by the public sector.

Charity funding is important to the finances of a few Foundation Trusts, particularly the specialist children’s and cancer trusts. Some trusts use charity to fund research, and others use it to fund capital projects. However, in some cases the majority of charity funding is used for expenditure. There is a need for a proper study to see where charity funding is spent, and whether this expenditure is significant in the delivery of core NHS services.

AQP tenders are advertised on the supply2health website, and other NHS tenders are advertised on the OJEU. These offers to tender are often more detailed and less opaque than the consultation documents provided by commissioners and providers.

Further work can be summarised as the monitoring of:

  • Board papers of the Foundation Trusts who have said they will increase private patient income
  • Annual Plans, Annual Reports and board papers of NHS Trusts
  • Board papers of CCGs
  • Charity income to Foundation Trusts
  • Public reports from and about the private companies delivering NHS services
  • Supply2Health and OJEU for AQP and other NHS tenders

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