Great Ormond Street Hospital for Children NHS Foundation Trust

Population
Beds 330
Income £293,001k
Comprehensive Surplus £11,417k
Operating Surplus £24,447k
EBITDA 6.8%
PPI Cap 9.7%
PPI £28,157k
Public Members 2,135

GOSH became a Foundation Trust on the first of March 2012 and consequently, their first Annual Report and Accounts is for one month. The accounts for the remaining 11 months is available on the GOSH website.

GOSH has a widespread private business called the International and Private Patient division (IPP) [1]. In 2007 the trust’s private business was split from the NHS business by turning the former into a charity: the Great Ormond Street Hospital Charity. The reason for this action was because in 2007 GOSH was an NHS Trust and wanted to achieve FT status. Its private patient income at £25 million [2] exceeded the PPI cap (9.7% of total patient income) set out in the 2006 NHS Act:

Chief Executive Dr Jane Collins said:

“We need to find a legal, open, fair, and sound solution to our international patient issue. We want to become a Foundation Trust, independent within the NHS. However, the ‘private patient cap’ would require us to limit our international income, from an estimated £25m this year to only £17m, an £8m shortfall. At a time of financial pressure, this would have a significant effect on our financial stability, particularly in future years.”

In 2007 the trust said that the IPP had 10% of patient admissions, but 16% of the trust income. The trust also said that 77% of the IPP patients were “sponsored by foreign governments and healthcare systems”, 15% were foreign self pay patients and 9% were UK patients. The majority of the patients came from the Middle East or Greek speaking countries. Using these figures, the trust argued that the majority of their international businesses was paid for by foreign governments rather than individuals, and hence argued that this could be regarded as “charity” rather than a private business. Thus, by channelling its private patient income through its charity, GOSH could conveniently avoid breaking the PPI cap and hence became a Foundation Trust in 2012.

GOSH have carefully managed the private patient income that they declare that the trust generates. For the first eleven months of 2011/12 the PPI was £25.502m and the total income from patient care activities was £265.635m, so the proportion of private income was conveniently 9.6% (compared to the cap, which was 9.7%). For the single month that GOSH was an FT, the Annual Report says that the total income from activities was £27.366m and the income from private patients was £2.655m, again, the proportion was conveniently 9.7%.

The 2011/12 Annual Report for the GOSH charity [3] gives the annual income of the charity to be £66.335m. Of this £12.343m was spent on research and £10.254m of the charity funds were spent on capital projects like equipment and property development.

The Annual Reports for the GOSH NHS Trust [4] and FT [5] say that in 2011/12 the GOSH charity contributed £5.828m to the NHS Trust and £3.506m to the FT for revenue expenditure (total £9.334m) and the charity donated £23.9m to the NHS Trust and £4.3m to the FT for property, plant and equipment expenditure (total £28.2m). Other trusts have to finance capital projects through their patient income (for example, through Public Dividend Capital or Private Finance Initiative), GOSH has the advantage that it has vast charity funds for its capital projects.

The Annual Plan [6] indicates that the private patient business grew in 2011/12:

The activity undertaken by the IPP Division has increased by almost 10 per cent over the past year; total income increased by almost 14 per cent. International referrals from Kuwait and other Middle Eastern countries have increased over the period.

Further, the Annual Plan shows that the trust is actively seeking more private patients:

Marketing in the Gulf region will be enhanced to raise the profile of GOSH as a world-class, specialist children’s hospital and encourage referrals to GOSH rather than to Germany, the US and Canada.

The PPI cap was abolished on the 1st October 2012. The GOSH board papers for September [7] shows the effect: for the first five months the total clinical income was £129.9m and the income from the IPP division was £17.8m. That is, in the first five months the proportion of income from private patients increased from 9.7% to 13.7%.

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[1] Interestingly, the website for this business is a Kuwait domain: www.gosh.com.kw
[2] www.gosh.nhs.uk/news/press-releases/2007-press-release-archive/great-ormond-street-proposes-to-manage-international-patient-division-through-new-charity/
[3] www.gosh.org/EasySiteWeb/GatewayLink.aspx?alId=124911
[4] www.gosh.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=125086
[5] www.gosh.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=125087
[6] www.monitor-nhsft.gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?id=11211
[7] Finance Report, page 5, www.gosh.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=122601