The Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust

Population 550,000
Beds 711
Income £239,763k
Comprehensive Surplus £4,805k
Operating Surplus £8,583k
PPI Cap 1.1%
PPI £2,335k
Public Members 11,227

There is no separate private patient unit at the trust, instead, private patients use the trust’s single rooms [1]:

Will I get a private room?

In the Cardiology Department we have a limited number of comfortable well-appointed single occupancy rooms with en-suite bathrooms dedicated for private patient use. These rooms come equipped with TV and broadband. We are also pleased to offer our patients a complimentary pack of toiletries for their stay with us.

In other departments there are a number of side rooms available off the general wards which offer a certain degree of comfort and privacy. Although a private room cannot be guaranteed, we endeavour to arrange for a side room to be made available for you whenever possible.

The trust has a separate company called The Bournemouth Private Clinic (company number 06434541) which operates within the Royal Bournemouth Hospital and makes use of its facilities.

The Bournemouth Healthcare Trust charity (charity number 1122497) was created as a company Limited By Guarantee (company number 06430101) in 2008. The charity owns Bournemouth Private Clinic Ltd and all the profits from the company are donated to the charity. The charity makes donations to the Foundation Trust [2]:

The Bournemouth Private Clinic was established in 2008 by the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust to manage and develop private patient services carried out within its specialist facilities. […]

BPC is the trading subsidiary of a registered charity (The Bournemouth Healthcare Trust). BPC has its own Board of Directors and all donations are approved by The Bournemouth Healthcare Trust, which is managed by its own Trustees.

The trust also indicates that private patients benefit from NHS resources rather than NHS patients benefitting from facilities purchased for private patients:

The Royal Bournemouth Hospital benefits from some of the most modern clinical equipment including one of the latest specialist CT scanners in the country. Private patients who receive treatment within the Trust have access to the full range of clinical facilities (including ITU if necessary) as well as the expertise of the specialist clinical teams.

The Annual Accounts [3] are opaque about whether the private patient income is the income from private patients or the donated profits from the charity (the size of the figure suggests the former).

The April 2012 Board Papers [4] indicate that there was disagreement between the primary care trust and the trust on the clinical specifications of the services that will be tendered through AQP:

Recently Dorset cluster has publicly issued its specifications. Clinical consultants in these fields were asked to comment on a draft. The clinicians were dismayed that their comments to help ensure quality standards have been ignored. The PCT have not formally consulted on these proposals. They have informally mentioned these areas as possible AQP topics to stakeholders primarily to meet the significant growth pressures in these areas. The actual proposals though are significantly different from that informal briefing.

The trust was pessimistic about the result:

In Dermatology the express intention of the PCT is an effect 80% reduction in funding for the specific work undertaken by the three current Dermatology units. This equates to at least an £800k loss for Dermatology and £500k loss for Endoscopy. No provider could sustain current services and these losses. The direct effect could be the closure of services.

Further, the trust said that this could lead to “price competition”:

Despite trying to discuss this with local commissioners, there has been no substantive engagement and no indication they are willing to consider alternative ways of achieving their objectives. If the tender proceeds then GPs will have price competition for the same type of service but at different prices. This will destabilise the complex and acute care provided locally, as AQP providers “cherry pick” easy, profitable work.

The June 2012 board meeting [5] provided an update saying:

Amongst the issues highlighted were:

  • There has been no approach to local clinicians concerning the possibility of alternative providers securing consultant supervision. This is particularly important with regard to Dermatology where there is a clear requirement for GPSIs or nonconsultant grade staff to be supervised.
  • Both the PCT and potential bidders have failed to appreciate the importance of integration including how any third party providers would properly interface with existing MDT meetings when discussing future patient pathways. It is clearly critical that any patients with cancer are discussed at an MDT meeting and thus far no arrangements have been made that will enable this to occur.
  • Potential bidders have failed to factor into their proposals the cost of securing local histology services. In was noted that the cost of histology is likely to represent up to a third of the current price being quoted by the PCT for provision of surgical Dermatology services.

There was clearly a serious disagreement between the PCT and the consultants of all the trusts involved:

The Consultant Dermatologists have already made plain that they do not support the current specification and are not willing to engage in an exercise to bolster new providers in the context of providing a service that is sub-optimal and not of a standard currently offered by the Trusts.

The Borough of Poole Health and Social Care Oversight and Scrutiny Committee discussed the issue on the 9 July 2012 and wrote to the Secretary of State for Health saying [6]:

After careful consideration the Committee felt it had no alternative but to refer the matter to the Secretary of State for decision and to request that the PCT suspend its process of implementation in respect of these proposals until the outcome of such referral is known. We have not been adequately consulted and believe the proposals are not in the interests of the local health service (Health and Social Care Act 2001, 2002 regulations).

The case was referred to the Independent Reconfiguration Pane l[7] who rejected the HSCOSC concerns:

Whilst that decision is ultimately the committee’s prerogative, its consequences are also their responsibility. Given the timing, the decision introduced potential delay for the start of new services for patients, affecting the legitimate interests of others across Dorset. In these circumstances, there is a need to act quickly and pragmatically with the local NHS to agree and execute the further consultation with the HSCOSC that would address their residual concerns. This has not happened yet and so there remains the clear opportunity and responsibility to resolve the matter locally as quickly as possible for the benefit of patients.

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[4] p72
[5] p47