CCG orders trust to axe 'unaffordable' waiting list blitz

Minutes presented to South Warwickshire Clinical Commissioning Group’s board this month showed the CCG had told South Warwickshire Foundation Trust to close its mobile theatre, provided by Vanguard Healthcare, which was opened to boost orthopaedic procedures.

This is despite an NHS England directive sent to trusts in August last year, ordering them to draw up contingency plans to hit the 18-week elective target, including boosting the use of independent provider capacity.

While the CCG acknowledged the mobile theatre had reduced waiting times for patients, it said the increase in activity had been mainly “high-cost hip and knee replacements”, which were “unaffordable” for the CCG.

“For the CCG this has resulted in a significant, unaffordable, financial over performance against the contract,” it added.

The minutes also indicated the trust had used reduced waiting times for these procedures to “mask” long waits for other procedures, such as orthodontics, where only 56 per cent of patients were seen within 18 weeks (against a target of 92 per cent).

The minutes stated the CCG has “requested the trust close down the additional mobile Vanguard theatre capacity purchased for this additional orthopaedic activity, which they have agreed”.

However, when approached by HSJ, a trust spokeswoman said the mobile unit was closed in December to divert staff to meeting urgent demand, not in response to CCG concerns. The trust planned to reopen the unit in March.

A trust spokeswoman also disputed claims the mobile theatre was used to mask poor performance elsewhere and said the primary aim was “to ensure we continue to meet national waiting list standards”.

The spokeswoman added: “The Vanguard [theatre] has facilitated the trust’s orthopaedic work, freeing up some existing theatre capacity for other surgery, which has supported other specialities to maintain performance.

“Due to clinical demand and the additional capacity available as a result of Vanguard, the trust may exceed the CCG’s forecasted elective activity, which we appreciate can impact on financial planning.”

Vanguard Healthcare is a private company that provides mobile medical units, including theatres. It’s often contracted by NHS trusts seeking to clear elective backlogs or temporarily boost bed capacity.

South Warwickshire FT has periodically hired mobile theatres and nursing staff from Vanguard for several years. In the 12 months to December 2018, the trust paid Vanguard £677,000 for these services. Between April and December last year, 535 procedures were undertaken at the trust using the mobile theatre.

The CCG raised similar concerns about the mobile theatre with the trust this time last year. Board papers from January 2018 revealed the CCG felt the additional operations posed a “financial risk”. But, despite the CCG formally requesting the mobile unit be shut, the trust had continued to use it.

The trust is currently building additional permanent theatre capacity at Warwickshire Hospital, which is expected to be operational toward the end of 2019.

South Warwickshire CCG was approached for comment.