The Christie NHS Foundation Trust

Population 3,200,000
Beds 174
Income £185,308k
Comprehensive Surplus £3,684k
Operating Surplus (£3,951)
EBITDA 8.5%
PPI Cap 9.1%
PPI £10,708k
Public Members 22,514

The trust has a private patient unit called The Christie Clinic. The Annual Report [1] says:

The Christie Clinic LLP was formed on the 15 September 2010, and is a joint venture partnership with HCA (Healthcare America) for the provision of private oncology activity.

The in year profit reported of £3.578m is an accumulation of the 2011/12 annual profits plus arrears from the previous period (as per the terms of the LLP membership agreement). This is a significant movement from the position reported in the 2010/11 accounts where due to one off set up costs The Christie Clinic reported a loss of which the Trust took 49% (as per the terms of the LLP) into its accounts.

The improvement in position is due to increased activity and case mix together with improved tariff from private medical insurers.

The Annual Accounts in the Annual Report lists the income from the private unit as “Share of profit/(loss) of associates/joint ventures accounted for using the equity method”. The segmented income says that the trust has zero income from private patients (2010/11: £4.557m). The reason for this is given in a note saying:

Private patient income generated directly by the Trust ceased on 14 September 2010. From 15 September 2010 all private patient activity was novated to The Christie Clinic.

However, the income from The Christie Clinic is not their only private income because the statement that the trust has to make as part of Section 44 of the NHS 2006 act, it gives the private patient income (including the joint venture income) as £10.708m or 7.6% of trust patient related income. The segmented statement on “other operating income” says that the joint venture delivered an income of £7.129m, this is described as

Joint venture income relates to services provided to The Christie Clinic via Service Level Agreements, property rental income and other contractual payments

This leaves £3.579m that is not covered by SLAs and rent. The trust says that it got an income of £1.978m in rents which included leases to the University of Manchester, the National Blood Transfusion Service and:

The Trust entered into an agreement with The Christie Clinic whereby the joint venture leases from the Trust part of the new patient treatment centre for 20 years, effective from 15 September 2010.

The Annual Report includes disclosure of the operations of The Christie Clinic LLP, it says that the trust’s share of the profit was £3,578m (so when combined with the “other operating income” mentioned above this comes to the £10.708m figure declared in the Section 44 section of the Annual Accounts). The source of the £3.578m profit was from the £18.514m income of the LLP.

The Annual Report also says:

The Christie Clinic LLP is a related party to the trust with net income/expenditure transactions totalling £6.7m and net receivables/payables totalling £1.5m. The Christie Clinic LLP is also a related party to HCA International Limited.

In the Annual Report the trust gives the impression they want to expand their private services saying:

The Christie works with a number of partner organisations [including] working with our private patient joint venture partner Health Corporation of America to continually develop private patient services at The Christie

In the Forward Plan [2], a strategy of the trust is given as:

To maximise the opportunities for generating Comprehensive Surpluses from non NHS funded cancer services to reinvest in core NHS provision.

There is no mention in the Forward Plan about AQP.

The trust has a sizeable income from charity, the Annual Report says:

Over the past 12 months we spent £306k on capital projects from charitable grants and we received a charitable revenue contribution of £6.4m to enable us to enhance our services.

Further, the Annual Report says:

The Trust has also received revenue (£6.4m) and capital monies (£0.3m) from The Christie Charitable Fund, for which the Trust is the sole corporate trustee and for which the Trust Board are responsible for the management and accountability.

The internal Audit Committee in February 2012 [3] contained a concern from Lee Childs, a non-executive director, that

LC expressed concern that the Christie clinic could create a potential reputation issue for The Christie.

Further, the Audit Committee noted that The Christie Clinic (the private unit) could benefit from AQP:

[Dame Jenni Murray, non-executive director] asked whether there would be an impact on the relationship between the two organisations when the concept of any willing provider [sic] becomes part of the NHS. [Ian Moston, Director of finance & business development] indicated there would not be any impact issues and indeed the act may allow the Clinic to secure higher revenues but this is a long way in the future.

The trust has been selected by the Department of Health to operate one of the two Proton Beam Therapy Units planned for England; the unit is scheduled to open in 2017. The Department of Health [4] estimate that the cost of providing one site with a proton beam therapy unit is £150m, but the department’s own press release indicates that the investment for two sites would be £250 [5]. Board papers from April 2012 [6] indicate that the government will require that £10m per site will come from charitable funds:

Proton update – IM reported on ongoing discussions with the DH and felt an announcement on the preferred sites was imminent. He explained the DH has approached both potential sites to explore the option of a £10m per site charitable contribution. He envisaged a national fundraising campaign to compliment local fundraising.

This means that there will be significant public sector investment in The Christie. The trust’s strategic objectives given in February 2012 board papers say that the trust intended to provide proton beam therapy to private patients:

It includes our joint venture with Health Care America to provide private patient services such as the proposed proton beam therapy services.

The Board papers in January 2012 [7] indicate that the trust is planning to build a new private patient unit (Christie Clinic Ambulatory Centre) near the proton beam therapy unit:

We continue to work closely with University College London Hospitals (UCLH) and the Department of Health to assist the DH with their Proton Beam Therapy strategy. However the majority of the work undertaken to date remains ‘frozen’ awaiting a positive indication from the DH. The intention remains to locate the new Christie Clinic Ambulatory Centre above the PBTU and design considerations are ongoing.

The DH strategic outline case for proton beam therapy indicates that the average cost of treatment at an overseas facility is currently £110,000 [8], but under the plan to develop two proton beam therapy centres in England (one at The Christie, the other at University College London Hospital) the units will be able to provide treatment at a cost of £39,500 [9] per patient. The cost of treating a patient in an NHS provided facility is clearly far less than for a UK national to travel overseas for the treatment. Clearly The Christie plan for private patients to benefit from the multi-million pound investment by the NHS.

The plan to have two sites means that every year there will be capacity for between 1,200 and 1,500 patients a year leaving little spare capacity above the 1,487 needed for NHS patients. The commissioned figure includes 5% for research and so that means there is some capacity for private patients if they are classed as “research”.

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[1] www.monitor-nhsft.gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?id=12971
[2] www.monitor-nhsft.gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?id=11551
[3] www.christie.nhs.uk/media/272567/Board_Agenda_270212.pdf
[4] “National Proton Beam Therapy Service Development Programme: Value for Money Addendum”, p14, www.wp.dh.gov.uk/publications/files/2012/10/national-proton-beam-therapy-service-development-programme-value-for-money-addendum.pdf
[5] www.dh.gov.uk/health/2012/10/proton-beam-therapy
[6] p172 www.christie.nhs.uk/media/282877/Public_final_300412.pdf
[7] www.christie.nhs.uk/media/268678/Board_Agenda_300112.pdf
[8] “National Proton Beam Therapy Service Development Programme: Value for Money Addendum”, p13
[9] Ibid, p16

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