Royal Berkshire NHS Foundation Trust

Population 1,000,000
Beds 718
Income £317,414k
Comprehensive Surplus (£9,871k)
Operating Surplus £8,375k
EBITDA £23,500k
PPI Cap 1.6%
PPI £1,995k
Public Members 18,122

The Annual Report [1] says that the trust has a subsidiary called Healthcare Facilities Management Services Limited (company number 06657007):

These consolidated financial statements have been prepared incorporating the accounts of Healthcare Facilities Management Services Limited, a wholly owned subsidiary of Royal Berkshire NHS Foundation Trust.

According to the company’s annual accounts [2] the purpose of the company is:

The principal activity of the company is the provision of fully serviced properties for the healthcare sector.

The properties mention are the Royal Berkshire Bracknell Clinic, and princes House, both are used by the trust. The Annual Accounts say that the trust paid HFMS Ltd £6,719,000 in 2011/12 and had an income of £132,000. The company has assets of about £34m, which appear to have been transferred to the company from the Royal Berkshire FT. The Accounts says:

The Trust has two loan facilities, totalling £40.6m, from the Foundation Trust Financing Facility, one to finance the development of the Royal Berkshire Bracknell Clinic, on which we have started to make repayments, the other to fund the development of the Trust’s EPR project, against which there is one drawdown remaining.

So the trust owes the government £40.6m part of which has been invested in a subsidiary company that built a £28.8m clinic which is leased back to the trust.

In the Annual Report the trust indicates that Circle in Reading will be a competitive threat:

The Trust delivers services to Berkshire, south east Oxfordshire and north Hampshire. Overall, Referrals to the Trust by GP has increased in Berkshire and Oxfordshire. Despite this our market share in east Berkshire and Newbury has decreased. This is in light of competition from neighbouring trusts. This year we will see additional competition from the private sector with a new Circle hospital opening in Reading.

Further, the trust says that it had to have a “challenging cost improvement programme” because of:

Increased competition from the private sector, in particular as a result of an expected increase in operating theatre capacity within nearby private hospitals

The trust also talks about a focus on:

Collaborative working with NHS, private sector and 3rd sector providers to enable a greater degree of one stop healthcare and faster more effective pathways for the benefit of patients.

The trust says that there are significant issues with competition, particularly with the private sector:

The economic environment in which we operate is changing significantly and we have already felt the impact of increased competition on our activity, particularly first outpatient appointments. We further anticipate inroads being made into our in-patient planned care, particularly Orthopaedics, from other acute NHS Trusts and private providers due to our longer waiting times in some areas. The risk of losing market share to our competitors is a significant risk within the forward plan.

Reading is a prime market for private providers offering NHS services through Choose and Book. Private providers Spire, Ramsey and BMI all have strong presence in the area and Circle are opening a new hospital in Reading in August in 2012. This will have significant day case capacity and will, at least initially, be able to offer shorter waiting times. We believe this poses a very significant threat to our activity.

The trust says that it is likely to lose services; it says that it has received:

Notice given that Oral Surgery is to be tendered. The Trust may lose this service from April 2013.

The Forward Plan [3] says that AQP is a real threat to the trust:

In addition the introduction of Any Qualified Provider (AQP) is going to have a marked impact on us. In Berkshire direct access hearing aid services and direct access non-obstetric ultrasound are moving to an AQP delivery model as of September 2012. We currently have a 95% share of the audiology market and are the only provider of direct access non-obstetric ultrasound for GPs in Berkshire West. Following the introduction of AQP we will almost certainly see a reduction in market share and income. Where market shares are not retained services will be redesigned to mitigate any losses with transitional support where necessary and where affordable to NHS Berkshire West.

The trust also sees AQP as an opportunity and even says that it is hoped that its out of area AQP activity could help compensate for the loss of income due to AQP in its catchment area:

Increased competition also brings opportunities which we will harness. AQP gives us the opportunity to expand our services into other geographical areas. We will be actively marketing our direct access hearing aid services outside of our traditional catchment area with the aim of increasing our market share in these areas. The new activity we hope to generate will help compensate for the loss of share that is probable in Berkshire West.

The trust says it will focus on:

Pursuing AQP bids which enable a wider market penetration [and] Focusing on market intelligence and pro-actively redesigning services that are likely to be delivered under AQP contracts over the next three years, including pathology.

However, in spite of the plans for wider market penetration, the trust also says:

We have no plans for further market diversification.

The trust is also looking at “partnering” with private companies:

Outside of our core Berkshire West market and where the market is not large enough to support the range of providers seeking to deliver services we will effect options for partnering with other NHS or independent organisations to deliver services. We are taking this approach at the Royal Berkshire Bracknell Clinic.

The trust is also looking at a private sector partner with pathology services:

A project to consolidate pathology services is being undertaken by RBFT in partnership with Heatherwood & Wexham NHS Foundation Trust. Alternative ways of improving quality and securing savings within pathology to ensure value for money are being reviewed, looking at the potential of either an NHS Private Sector Joint Venture or through the development of an intra NHS option.

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