Treasury delay risks 'smashing up' Papworth

John Wallwork, who took over as chairman in February, said he was “baffled” by the Treasury’s reluctance to rubberstamp the trust’s move to Cambridge Biomedical Campus.

Papworth wants to relocate to a new £165m hospital, next to Cambridge University Hospital Foundation Trust’s main site.

Just over half of the funding would be supplied through the new version of the private finance initiative. The remaining 45 per cent is being drawn down from the foundation trust financing facility.

Papworth first published an outline business case for the new hospital in 2004 but the process has become frustratingly protracted.

The trust’s relocation was signed off by the Department of Health in October 2013. But it has not received Treasury approval.

Professor Wallwork told HSJ that “Papworth is a jewel in the [health service’s] crown” and holding back the move was akin to “smashing it up”.

“There is an inertia and people are nervous to make decisions. I don’t hear anyone saying that this is a bad idea….but there is a nervousness around PFI.”

The chairman, who spent more than 30 years at the trust as a surgeon, warned that if no decision was made before May it could be further delayed by a period of purdah because of local and European elections.

The trust appointed Skanska in December 2013 to design, build and maintain a new 310-bed hospital, following a two-year final bidding stage.

After numerous re-appraisals of the business case, the trust now hopes to be on the new site by 2017.

The business case says the move will allow the trust to radically improve care, with all major clinical specialties on one site. In addition to a state of the art hospital facility, it will be able to develop closer partnerships with Cambridge University Hospitals Foundation Trust and Cambridge University’s school of clinical medicine, which are both based on the campus.

Papworth offers lung cancer patients diagnostic biopsy, staging and surgical resection services. But over 80 per cent of patients have to be referred on, usually to Cambridge’s Addenbrooke’s site, for chemotherapy and radiotherapy.

In the long term, the trust is likely to merge with Cambridge University Hospitals, although this would not happen immediately. The trust stresses it wishes to remain autonomous. But senior NHS figures say a long term merger makes logistical sense and is nearly inevitable.  

The Treasury has offered no official explanation for the hold up, however its reluctance to sign off the move is likely to be related to the financial problems faced by nearby Peterborough and Stamford Hospitals Foundation Trust.

The acute trust was declared financially unviable in its current form by Monitor, largely due to a disastrous PFI contract for Peterborough City Hospital. The trust will invite bidders to outline plans to make the hospital financially viable in February.

Monitor appointed a contingency planning team to investigate options for making Peterborough City Hospital viable. One potential solution it examined was the relocation of Papworth to Peterborough – although this is largely seen as a non-starter by those in the local health economy.   

The team’s report agreed with Papworth and Peterborough’s boards that the Cambridge relocation offered the best clinical outcomes.

Yet, despite this conclusion, there are concerns the Treasury may push for exploration of such a move – or at least delay signing off the project until legal uncertainties around the foundation trust failure regime are resolved.

Proposed amendments to the Care Bill could hand trust special administrators  - officials appointed by Monitor to control failing trusts - specific legal powers to push through changes which involve neighbouring trusts.

The proposed amendments are designed to avoid a repeat of the problems experienced recently in south London. 

South London Healthcare Trust’s special administrator recommended nearby Lewisham Healthcare Trust be downgraded as part of the failure regime. But the High Court ruled special administrators did not have power to include neighbouring trusts in their recommendations. Ministers tabled the Care Bill amendment to avoid a repeat of this.

If the amendment is passed, ministers would – if they wished – be able to include Papworth’s relocation in a solution designed to rescue Peterborough.