A group of just 19 acute trusts were paid almost half of NHS England’s £11.2bn budget for acute specialised services in 2013-14, exclusive analysis by HSJ revealed.

The research also showed that England’s 19 standalone specialist hospitals shared 13 per cent of the budget. The remaining 40 per cent was split between 51 independent and more than 200 NHS providers.

The outturn spend for all providers with NHS England specialist services contracts in 2013-14 underlined the challenge the organisation would face if it pushed forward with proposals to centralise such services into 15-30 centres. This plan was put in doubt when NHS England chief executive Simon Stevens indicated in April that he still saw a role for smaller hospitals in delivering specialised care.

The data confirmed that NHS England has contracts for acute specialised services with all NHS acute trusts, as well as with 10 community trusts.

Of the 292 contracts, 24 were for less than £1m each and mainly with independent sector providers, for services such as dialysis and hyperbaric oxygen therapy.

Spends at the 19 acute trusts ranged from £393m at Leeds Teaching Hospitals Trust to £175.5m at Salford Royal Foundation Trust.

The next largest spend was £136.6m at North Bristol Trust, suggesting acute specialised services in England are already fairly centralised, as Mr Stevens indicated in his first Common’s health committee appearance.

The analysis also indicated that some trusts received a significant proportion of their income from specialised commissioners.

Almost half of University Hospitals Birmingham Foundation Trust’s income came from such commissions (see table, below).

Of the 19 specialist trusts, nine received more than half of their income from NHS England, including the Clatterbridge Cancer Centre Foundation Trust which received 100 per cent from the board.

graph

Of the 141 acute trusts, 23 had contracts worth less than £10m, where work accounted for up to 5.6 per cent of turnover.

Foundation Trust Network chief executive Chris Hopson told HSJ that losing even these small amounts could make a huge difference to small and medium district general hospitals as it could be the difference between breaking even or going into deficit.

Losing specialised services could also make it difficult to maintain an on call rota with senior consultants and leave trusts with residual overhead costs, he said.

However, Mr Hopson stressed there was a difference of views between members, with large teaching hospitals generally in favour of further centralisation to drive up quality.

“What our small and medium DGHs are telling us is that even though it’s a relatively small proportion of turnover and relatively small amounts, in the current environment small amounts like that are really important,” he said.

NHS England is due to publish a five year strategy for specialised services later this year.

HSJ understands that while there is likely to be some further centralisation of specialised services, such as paediatric heart surgery and vascular surgery, there is likely to be a greater focus on networking between providers.

 

Topics