The Clatterbridge Cancer Centre NHS Foundation Trust

Population 2,300,000
Beds 81
Income £75,296k
Comprehensive Surplus £2,188k
Operating Surplus £4,424k
EBITDA 10.4%
PPI Cap 4.6%
PPI £639k
Public Members 5,264

The Annual Report [1] indicates that the trust intends to increase its private patient income by developing a new private patient unit:

Private Patient Joint Venture

As part of an extension of the services it provides the Trust is currently concluding a voluntary OJEU [Official Journal of the EU] to establish a joint venture private patient facility with a private sector partner at its Clatterbridge site. At its April 2012 Trust Board, the Trust appointed a preferred partner. Subject to final negotiations, the Trust intends to open a Private Patient Facility with a private partner early in 2013.

However, it is not possible to check the sources since the trust holds its Board meetings in secret and it has not published board papers since 2006. The Forward Plan [2] says that the joint venture partner will be secured by May 2012.

The announcement in the OJEU [3] says:

Clatterbridge Centre for Oncology (“CCO”) is seeking to enter into a joint venture partnership with a suitably qualified contractor (“the Partner”) to provide private patient services on its site in the Wirral. This is likely to involve the refurbishment (to the Partner’s specification), operation and management of a private patient unit. The selected Partner will be required to demonstrate considerable expertise and experience of operating and managing such a private patient unit offering oncology services. The Partner will also be required to propose a solution for the provision of a new Linac [linear particle accelerator, used for radiotherapy].

The trust’s Expressions of Interest & Information Memorandum [4] as part of the OJEU submission says that the intention of the Private Patient facility is:

The key aim of the project is to increase the market share of the private patient cancer activity from the site primarily within the Cheshire and Merseyside area but also wider nationally and internationally.

Currently there is no dedicated PPU at the trust and the Expressions of Interest notes:

It is understood that the lack of dedicated private facilities has deterred private patients in the past, notably Middle East clients who require separation and first class facilities. There has also been some anecdotal evidence that insurers have offered (and made) potential private patients a cash payment rather than them utilising its private health insurance and visit CCO as an NHS patient due to the fact that the patient experience would be the same. It should be noted that there is no firm evidence of this.

The Expressions of Interest offers to sell to private patients low energy proton beam therapy, a service funded through public capital:

CCO has proposed the use of space adjacent to its outpatient department which would enable access to a separate discrete entrance for separation from NHS facilities. It is expected that the facility would be outpatient focussed and offer radiotherapy, chemotherapy and proton beam therapy for ocular tumours. All of these are made possible by the adjacency of the proposed space to the cyclotron unit and also the location of an existing high specification Trust Linear Accelerator (Linac).

The Douglas Cyclotron [5] unit was installed at Clatterbridge in 1984 with funds from the Medical Research Council (for neutron therapy), and in 1989, the treatment of  tumours of the eye at Clatterbridge was introduced following funding by the Imperial Cancer Research Fund and Cancer Research Campaign (now amalgamated as Cancer Research UK) and local charities. This is a facility funded by public (and charity) money and the intention was never for the facility to be a business.

The Expressions of Interest says that the trust has identified a possible site for the PPU:

Space has been identified within its estate which could be utilised as a private patient facility. The area (adjacent to outpatients) has its own discrete entrance and would require refurbishment as a dedicated private patient facility. The space is 301 square metres and houses a high-spec Linac.

The trust says that “both to maintain CCO’s reputation for excellent NHS patient treatment and to avoid negative publicity” the bidder for the PPU must provide a Linac:

Therefore, prior to commencement of a new private patient service within the proposed facility (with the existing Linac bunker), an additional Linac with OBI facilities must be fully commissioned and in operation at the Clatterbridge site. As the Trust do not have capital available for funding a new Linac, Bidders are requested to indicate how they might fund the Linac investment as part of their proposals for operating the private patient unit.

The Expressions of Interest also says that the private patients will be allowed to jump the queue at a facility that was funded by the public purse:

Treatments given by the Cyclotron would be delivered under an SLA with CCO. The Partner would be able to specify arrangements such as the timing of the treatments etc.

The Expressions of Interest say that the trust expects to be paid through rent and revenue share:

It is expected that CCO will receive a fixed lease rental for the un-refurbished facilities, valued in line with market rates and in addition % revenue share of private patient activity.

In the Expressions of Interest the trust seems to misunderstand section 164(1) of the Health and Social Care Act because it says that it can extend its private patient business “without limitation”:

The most important element to CCO (in relation to private patients) is the removal of the private patient income cap. Whilst the Trust does not currently perform up to its cap of 2.2%, the removal of the cap enables the potential to extend private patient business without limitation.

The trust’s Forward Plan says that competition is a risk that could lead to “significant loss of activity”. It says that its aim is:

To maintain services at a level that supports the necessary infrastructure in the face of potential competition that could undermine the Trust’s position if it led to a significant loss of activity.

Further, it says [CCC: Clatterbridge Cancer Centre the new name for CCO]:

CCC is currently the sole provider of non surgical oncology within the Merseyside and Cheshire Cancer Network. It is crucial that we continue to ensure that we are aware of any risks or threats from potential competitors and the impact of competition, co-operation and patient choice.

The Forward Plan mentions its intention to create a joint venture:

We will ensure our plans are aligned with commissioning intentions, build relationships and partnerships with other providers including a joint venture with a private partner to ensure that it can offer a service to both NHS patients and patients utilising private medical insurance.

The Forward Plan expresses their ambition:

We are now poised at one of the most significant points in our history. The Trust is committed to the development and implementation of plans for a major capital investment in a World Class cancer centre located in Liverpool. This is a once in a generation opportunity to design oncology services to ensure the people of Cheshire, Merseyside and beyond benefit from world class care that is of the highest possible quality.

However, this is somewhat different to the text in the OJEU submission which implies that they need private sector investment to get a new Linac.

The trust also says it:

has the additional and very significant challenge / opportunity presented by the proposed investment and development of a new £95m World Class Clatterbridge Cancer Centre in Liverpool in 2017/18.

In the section on “Continuous improvement and innovation in Chemotherapy services” the trust says:

The development of the chemotherapy services at CCC will ensure that we continue to provide treatment and individualised support to patients that will both optimise outcomes and provide the best patient experience possible to the people we serve.

And then in the section explaining how to achieve this it makes the statement:

To establish a subsidiary company

The Forward Plan says that this company will be operation by Q4 2012/13. In the section on the trust’s strategy to maintain its position as “the lead provider of nonsurgical oncology services for Merseyside and Cheshire” it says that to mitigate the risk of losing work from Welsh commissioners it will:

Build a joint venture with a private partner to ensure that it can offer a service to both NHS patients and patients utilising private medical insurance.

Under its section on finance and capacity it says its aims are:

To develop private practice (in conjunction with a joint venture partner) to bring in increased income to the Trust which will further support NHS activity.

But it says that risks of this aim are:

Income from joint venture does not offset loss of NHS income

Poor relationship / governance with joint venture partner

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[1] www.monitor-nhsft.gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?id=12981
[2] www.monitor-nhsft.gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?id=11581
[3] www.clatterbridgecc.nhs.uk/document_uploads/Public_documents/OJEUNoticev2.pdf
[4] www.clatterbridgecc.nhs.uk/document_uploads/Public_documents/ ExpressionofInterestInformationMemorandum.pdf
[5] www.clatterbridgecc.nhs.uk/professionals/physicsdepartment/cyclotron/