Exclusive: Regulator's list reveals trusts slated for takeover or franchise

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HSJ obtains historic NHS Trust Development Authority “segmentation” list after lengthy freedom of information battle
List from January 2015 shows Royal National Orthopaedic Hospital Trust was slated for takeover, and East Cheshire Trust and Dartford and Gravesham Trust were earmarked for potential franchising
NHS Improvement says catergorisation was “never implemented” and proposals have been “superseded”
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Several NHS trusts which were slated by officials for takeover or management franchise are revealed in a list obtained by HSJ, which regulators sought to keep secret for 18 months.

The list, compiled by the now defunct NHS Trust Development Authority in 2015, shows which trusts were expected to reach foundation status and which were expected to have no future as independent organisations.

It shows that the Royal National Orthopaedic Hospital Trust was slated for takeover and that East Cheshire Trust and Dartford and Gravesham Trust were both earmarked for potential franchising.

In late 2014, the TDA announced that it was undertaking a “segmentation” of trusts based on whether they were expected to have a future in their current form.

For those that were expected to achieve FT status, the list indicated how quickly this was predicted to be achieved.

NHS Improvement told HSJ the list was “historical information that has no bearing on our support offer or decision making”. It said it now segments trusts on a different basis, which which was published today.

The lists remain a good indicator of unsustainable provider organisations and some have merged since January 2015.

The list, obtained by HSJ after an 18 month freedom of information battle, places four acute and four non-acute trusts in “category B1” for “organisations that cannot reach FT status in their current from and where acquisition is likely to be the best route to sustainability”:

North Cumbria University Hospitals Trust.
Weston Area Health Trust.
West Middlesex University Hospital Trust (acquired by Chelsea and Westminster Hospital Foundation Trust in 2015).
Royal National Orthopaedic Hospital Trust.
Liverpool Community Health Trust (now set to be broken up).
Torbay and Southern Devon Health and Care Trust (acquired by South Devon Healthcare Foundation Trust in October 2015).
Barnet, Enfield and Haringey Mental Health Trust.
Hounslow and Richmond Community Healthcare Trust.

Six trusts were listed in “category B2”, “where a franchise, management contract or other innovative organisational form is likely to be the best route to sustainability”:

Bedford Hospital Trust.
Hinchingbrooke Health Care Trust (Circle Health announced it was pulling out of its Hinchingbrooke management franchise in early January 2015, shortly before it was placed in special measures. It is now part of merger discussions with Peterborough and Stamford Hospitals FT).
George Eliot Hospital Trust (The TDA had abandoned a tender process to franchise this trust in March 2014).
East Cheshire Trust.
Dartford and Gravesham Trust.
Manchester Mental Health and Social Care Trust.

There were 10 trusts in “category C”, “where further work is needed to determine the best route to sustainability”.

Trusts in this category included United Lincolnshire Hospitals Trust, Mid Essex Hospital Services Trust, Whittington Hospital Trust and Cambridge Community Services Trust.

A spokesman for NHSI said: “This draft categorisation of NHS trusts is out of date, historical information that has no bearing on our support offer or decision making.

“The establishment of NHSI, and the launch of the single oversight framework, has given us the opportunity to identify which trusts need extra support and which can be used as centres of best practice.”

Story updated 1.30pm following receipt of NHSI comment

How HSJ got the list

HSJ first asked the TDA for the list in January 2015, but was told the segmentation process was ongoing. In March 2015 the TDA said the list would be “set out publicly in summer 2015” – after the general election.

Requests were denied on the basis it would be published in future. However, when HSJ asked for the information again in the autumn of 2015, the TDA said the decision about whether to complete the work would now be up to NHSI – which was set to come into existence in April 2016 and would supersede the TDA.

When HSJ submitted an FOI request in October 2015, the TDA declined again, this time claiming disclosure was likely to prejudice the “commercial interests” of trusts by making it more difficult to recruit and retain staff if they were identified as unsustainable.

The TDA also claimed disclosure would “prejudice” its functions in “examining the economy, efficiency and effectiveness with which trusts use their resources” because it would make its work much more complex.

An internal appeal was requested but the original decision was upheld, so in February 2016 HSJ took the case to the Information Commissioner’s Office.

Last month the ICO ordered NHS Improvement – which inherited the TDA’ obligations – to disclose the withheld information.

In its decision notice the ICO said the TDA’s claim that disclosure would affect the recruitment and retention of staff was “very speculative”.

The ICO said the TDA had “not provided evidence as to why it considers this likely to occur”, and that in any case the prejudice was “unlikely to be considered significant”.

On the TDA’s second defence, the ICO said again that the TDA’s had “not established a causal link between disclosure of the information in this case and the prejudice claimed”.