The Dudley Group NHS Foundation Trust

Population 400,000
Beds 782
Income £285,312k
Comprehensive Surplus £17,562k
Operating Surplus £11,906k
PPI Cap 0.1%
PPI £50k
Public Members 12,505

The trust does not publish board papers, nor does it even list the trust board meeting dates.

The trust has a commercial company through which it provides private clinical services. The Annual Plan [1] says:

Care Plus at The Dudley Group

The Trust has launched ‘Care Plus at The Dudley Group’ to offer patients private specialist-delivered care at affordable prices. Our plan for private work is to offer outpatient appointments and day case procedures in the evenings and on Saturday mornings at Russells Hall Hospital.

The new private patient service began with a skin lesion clinic to offer people who are seeking private care the option of choosing The Dudley Group. The clinics are run out-of-hours by our plastic surgeons and offer efficient, safe, consultant-delivered treatment for many procedures, including those no longer available on the NHS.

Conditions we will treat include: moles, seborrhoeic warts, tattoos, torn earlobes and botox injections for excessive sweating. Private patients have the reassurance of a team of NHS consultants and state of the art facilities with access to a range of diagnostics.

The service will not impact on NHS patients’ waiting lists and any income generated from private work will be reinvested into the NHS to develop our services for the benefit of all patients.

However, the same report says that:

To continue providing safe, effective care for women and their babies accepted for delivery at Russells Hall Hospital, we have reluctantly taken the decision to temporarily limit future bookings to the maternity unit for a period of 12 months from April 2012 while we look into the feasibility of increasing capacity to meet demand.

This indicates that the trust is turning away mothers-to-be because of capacity issues, but they still have the capacity to treat private patients.

The trust provides private rooms (at £80 per night [2]) for NHS patients.

In the Forward Plan [3] the trust says it will:

Adopting a more commercial attitude to developing services and broaden the Trust’s income base to reduce reliance on NHS income alone

It also says that it is considering working with private sector organisations:

Whilst working with commissioners to develop new ways of working into primary care and the local community, we will also protect our base turnover through a combination of sustaining patient numbers through existing services where possible and appropriate, development of new services, and exploration of acquisitions/franchises with other NHS and private sector organisations.

It says that it will

Undertake increased private patients activity through our “Careplus at Dudley” branding

And it also says:

Having completed this review for 2012/13 the clinical vision for the Organisation is to retain this existing range, adjusting provision as appropriate for commissioner intentions, and augmenting it by bidding for additional NHS work as appropriate, increasing private patient activity and service expansion along the community pathway.

More concerning, the trust shows a demand-led approach to healthcare, saying it will:

Maximise income through concentration on high margin services

If it is “concentrating” on these “high margin services” what about the “low margin” but mandatory services it provides? The trust also hints at anti-competitive behaviour, saying it will:

Reduce costs through collaboration with competitors in the delivery of clinical and support services

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[3] In contrast to most trusts, the Forward Plan available on the Monitor website omits the appendices that list risks, CIPs and financial commentary. A Freedom of Information request for these appendices was rejected on the grounds that the appendices “were considered to contain sensitive information of a commercial advantage to private and public sector competitors and to commissioners.”