The Queen Elizabeth Hospital Kings Lynn NHS Foundation Trust

Population 240,000
Beds 514
Income £165,017k
Comprehensive Surplus £1,955k
Operating Surplus £3,217k
EBITDA 4.9%
PPI Cap 1.4%
PPI £910k
Public Members 5,172

In 2011/12 Monitor found that the trust was in breach of its terms of authorisation [1]:

The Trust has experienced financial problems over the last year stemming from an ongoing failure to plan effectively and to address underlying performance issues. Having recorded a high financial risk for the first two quarters of 2011-12, the Trust subsequently failed to keep up with its financial recovery plan.

In addition the trust received a qualified audit certificate from their external auditors [2]:

this relates to Monitor finding the trust in significant breach in January 2012 due to the trust missing its financial targets and issues with financial governance. The trust has experienced financial problems over the last year stemming from an ongoing failure to plan effectively and to address underlying performance issues.

The Annual Report [3] says that the trust has had income of £910k from a private hospital in its grounds:

The Trust has also received revenue from and incurred expenditure with the Sandringham Private Hospital. The Trust’s Medical Director also provides some consultancy services to Sandringham Private Hospital, the total income in the period amounted to £910,000 there expenditure of £33,288 with the Sandringham Private Hospital.

The Sandringham Hospital is operated by BMI [4] and their website says:

BMI The Sandringham Hospital is a 35 bedded private hospital located in the grounds of The Queen Elizabeth Hospital, King’s Lynn. Through partnership with the NHS Trust, we are able to offer a full range of medical services with the benefit of extensive clinical support services.

The Forward Plan [5] says about competition:

The QEH reviewed its market position in 2011/12, and has assessed the NHS and private provider competition across Norfolk, Lincolnshire and Cambridgeshire and where their strategies have an adverse impact on ourselves. Additionally we have identified private healthcare organisations within the wider locality that provide low-level acute care, and offer similar services. In contrast, we are also taking forward improved strategic relationships with specific FTs, that support the alignment of respective strategies.

This analysis is on an area that is wider than the catchment area of the trust. The finance strategy section of the Forward Plan talks about providing consultant-led services closer to patients’ homes and:

Originally established at Littleport, Cambridgeshire, for 2012/13 new outreach services are being established in Fakenham, Norfolk. These include General Surgery, Ophthalmology, Gastroenterology, Rheumatology, Gynaecology, Midwifery services and Paediatrics. A £100k capital fund has been identified to equip the GP surgery/treatment centre, with services going live in Quarter’s 1 and 2. This service will increase the geographical area served by the QEH. This strategy will be progressed further during 2012/13 with investment cases being developed for other sites in Norfolk, North Cambridgeshire and South Lincolnshire.

The statement that “this service will increase the geographical area served by the QEH” shows that the trust has already got a policy to encroach on the catchment area of other trusts, and the statement that “this strategy will be progressed further” shows that the trust has an ambition to continue to widen its catchment area.

In one section they are quite blatant about this:

in 2012/13 we continue our two broad strategic aims of maintenance of market share, through the development of existing services, and a growth in market share, for services which are currently provided by others.

The trust have  KPMG as consultants advising them, but they also provide an interesting remark that they are buying in IP from other FTs

we have commissioned support from high performing organisations to share implementation of best practice. In particular this includes the University College of London “Quality, Efficiency and Productivity” programme.

The competitive strategy says that the trust will “take advantage of AQP”:

Competitive Strategy

The QEH has undertaken a review of its competitors and this review will inform the refreshed Trust strategy planned for later in 2012/13. This will allow for sub strategies to mitigate or take advantage of AQP, acute and community trust potential changes and the evolving private sector market. Within this work the Trust will progress clinical partnership development with other organisations with new ones being developed for vascular surgery. Competitive risks exist in Ophthalmology and Colorectal surgery.

However, this section also say that the trust will “take advantage of … the evolving private sector market” which indicates that the trust intends to increase private patient income.

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[1] www.monitor-nhsft.gov.uk/home/news-events-and-publications/latest-press-releases/monitor-finds-the-queen-elizabeth-hospital-k
[2] www.monitor-nhsft.gov.uk/home/browse-category/reports-nhs-foundation-trusts/nhs-foundation-trusts-review-and-consolidated-acc
[3] www.monitor-nhsft.gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?id=13001
[4] www.bmihealthcare.co.uk/hospital/about-the-hospital?p_hosp_name=BMI%20The%20Sandringham%20Hospital&p_hosp_id=306&in_page=About%20the%20hospital
[5] www.monitor-nhsft.gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?id=10651