The Royal Marsden NHS Foundation Trust

Population 550,000
Beds 180
Income £311,586k
Comprehensive Surplus £6,956k
Operating Surplus £10,969k
EBITDA £6,902k
PPI Cap 30.7%
PPI £51,144k
Public Members 2,579

The trust has private patient units at Chelsea and Sutton, Surrey. The Chelsea PPU is called Granard House [1]:

Granard House is our dedicated private wing for patients requiring inpatient care. It has recently benefited from a £6 million modernisation and expansion programme. The modernised Granard House now provides patients with a fully air conditioned, comfortable and well-lit environment. The ward houses 21 single, en-suite private rooms over three floors.

The Annual Report [2] lists the facilities in the private unit:

A new £3.2 million Nuclear Medicine Unit opened on the fourth floor of Granard House, Chelsea, in December 2011. This new unit means that patients can benefit from advanced nuclear SPECT/CT and PET/CT scanning facilities.

The trust’s website says that there is also a private medical day unit at Granard House:

The Private Patient Medical Day Unit (PPMDU) caters to the needs of the private patients requiring chemotherapy or simply requiring an outpatient appointment.

The trust’s hospital in Sutton has a private ward called the Robert Tiffany Ward [3]:

Robert Tiffany is the private patient ward at our hospital in Sutton. For patients requiring inpatient care, Robert Tiffany Ward offers access to the most up-to-date treatments and the highest standards of cancer care in comfortable surroundings.

The trust says that its NHS radiotherapy suite is available to private patients:

As part of an ongoing capital investment programme The Royal Marsden has recently expanded its radiotherapy suite at Sutton. It is now one of the largest radiotherapy units in the UK. It provides the very latest in radiotherapy technology, including intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT). The new unit accommodates seven linear accelerators and brand-new spacious patient facilities. Rapid access to radiotherapy is considered a key contributor to cancer patients’ long-term survival rates, and the new unit allows patients to be seen more quickly and treated with the latest equipment.

The trust also says that private patients have full access to the hospital’s NHS facilities:

Private patients have full access to all the hospital’s facilities, including the latest linear accelerators for radiotherapy and robotic techniques for surgery.

The Annual Report says that the trust’s efficiency programme increased its private patient income:

The efficiency programme is comprised of initiatives which will increase private income with less, or no, increase in costs; and those which reduce costs with less, or no, reduction in income.

The Annual Accounts gives the main sources of income for the trust. These are summarised in the following table:

Royal Marsden main sources of income

Income Source 2011/12 (£000)
Charitable 31,790
PCTs 168,516
Private Patients 51,144
Research and Development 30,083

The trust used £4.1m of charitable income in 2011 to purchase the “revolutionary technology” called the CyberKnife [4], the trust’s charity declared:

a £4.1 million appeal that ensured the purchase and installation of CyberKnife

This facility is described as:

The very latest in modern radiotherapy technology, CyberKnife uses a robotic arm and image sensors to track the movement of a tumour, allowing for hundreds of radiation beams to be delivered from almost any angle with pinpoint accuracy.

However, this facility, paid for from charitable funds, features in two of the three editions of the trust’s magazine for private patients [5] so it is clearly encouraging private patients to request this facility.

The charity also donated £4.3m for the trust’s new £18m Centre for Molecular Pathology [6]. (The other funding comes from the Department of Health, National Institute for Health Research and The Wolfson Foundation). This facility is also advertised as one of the trust’s “outstanding private facilities for patients” and that through the Centre for Molecular Pathology [7]:

Consequently, we can offer our patients early access to the very latest diagnostic techniques and treatment available – administered by one of the very best cancer care teams in the world today.

The Forward Plan [8] says that the trust is intending to increase private patient numbers:

A key element of financial stability will be successful delivery of the Trust’s Commercial Strategy, and the ongoing success of its private patient service. This is supported by the completed development of new Private Care facilities on both of the Trusts main sites including new outpatient facilities and a 25% growth in inpatient private bed facilities on the Chelsea site. With the completion of a recent market analysis it is clear there is potential for greater development of the private care work currently provided by The Royal Marsden. To that end a new Private Practice Business Strategy is being developed looking to secure and increase new and existing markets both within the UK and abroad and ensure appropriate opportunities are exploited for the benefit of the wider organisation and all its patients. This strategy will be completed during 2012/13.

Elsewhere in the Forward Plan the trust says that they intend to increase the numbers of private patients because there is a high demand, but significantly, it says that it is willing to give private patients priority over NHS patients:

Demand for services to private patients has consistently exceeded the Trusts ability to accept referrals. Plans assume current private capacity will be extended into Wiltshaw ward at Chelsea from the end of 2012; with only modest capital refurbishment.

Without new investment in hospital capacity any further increase in private capacity is likely to require a reduction in NHS capacity. Plans to do so will need to reflect the efficiency programme (particularly for length of stay and similar metrics) and any decommissioning of financially unviable activity.

The trust is clearly ambitious, in the section on how the trust informed governors it says:

Governors agreed to the development and implementation of a strategy for an increase in private activity. This is expected to achieve a business of £100m (50 – 60%) increase as soon as realistically possible.

In 2011/12 private patient income was £51m so “a business of £100m” is a significant increase.

The trust makes a rather chilling statement about NHS tariffs:

NHS tariffs do not currently cover the cost of delivering services to NHS patients; with an underlying loss of approximately £12m. Portfolio analysis has identified those activities that make the most significant contribution to this position however scope to influence tariff in the medium term is limited. This is likely to mean that any efficiency programme must consider reduction in those services that consistently give rise to the most significant losses.

This suggests that the trust cannot deliver treatment to NHS patients for the money it receives through tariff. The statement also says that they will consider reducing delivery of those services that cause the most losses. The report does not say what will happen to the patients who currently receive those services.

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[1] www.royalmarsden.nhs.uk/private-care/facilities/pages/chelsea-london.aspx
[2] www.monitor-nhsft.gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?id=13031
[3] www.royalmarsden.nhs.uk/private-care/facilities/pages/sutton-surrey.aspx
[4] www.royalmarsden.org/document.doc?id=27
[5] www.royalmarsden.nhs.uk/private-care/magazine/private-care-magazine-1.pdf
www.royalmarsden.nhs.uk/private-care/magazine/private-care-magazine-3.pdf
[6] www.cancerbrc.org/About_Us/Centre%20of%20Molecular%20Pathology/index.shtml
[7] www.royalmarsden.nhs.uk/private-care/why/Pages/expertise.aspx
[8] www.monitor-nhsft.gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?id=10781