• Disruption to services looming at Nottingham Treatment Centre
  • Seven-month transition period condensed into eight weeks
  • Circle hits out at “rushed transfer of care” amid procurement dispute
  • But CCG boss preferred one-month “hiatus” of all services rather than to extend contract

Patients will see their treatment delayed by a private provider’s “hard exit” from a major treatment centre after a clinical commissioning group chose not to extend its contract for a smoother transition, HSJ can reveal. 

Cancer care is among the services expected to be provided at a much-reduced capacity when Nottingham University Hospitals Trust takes over the contract for Nottingham Treatment Centre from Circle Healthcare.

The facility, which the Care Quality Commission described as the “largest independent treatment centre in Europe” in 2015, has 700 staff and treats around 250,000 patients annually.

NUH will take over services at the centre from Circle on 29 July after winning a bitterly contested procurement.

An early draft of its mobilisation plan, seen by HSJ, shows NUH will only provide limited capacity in the first few weeks of the contract for services, including:

  • Vascular;
  • Radiology;
  • Colorectal;
  • General surgery;
  • Endocrinology;
  • Rheumatology;
  • Respiratory; and
  • Gastroenterology.

The activity levels gradually improve over the next four weeks, after which it is expected the centre will start running at full capacity.

Capture

Part of NUH’s mobilisation plan (dated 10 May) showing reduced capacity in specialties at the treatment centre.

The above details were presented in a mobilisation plan dated 10 May. Considering activity estimates, it indicates there will be delays to thousands of appointments.

NUH chief executive Tracy Taylor told HSJ last week the plan is being “constantly updated and added to” and that “care should be taken when considering any older versions”.

The plan is based on a “hard exit from Circle” and relies on cooperation from the private company, which has run elective services from the centre since it was built 11 years ago.

Transition squeezed from seven months to eight weeks 

Rushcliffe Clinical Commissioning Group, which led the procurement for services at the centre on behalf of a number of CCGs, had originally hoped there would be a seven-month transition period after attempting to award the contract to NUH in December 2018.

However, Circle challenged the procurement, which resulted in the contract award being suspended for more than five months.

The company argued NUH’s troubled financial position rendered it unfit to provide the contract and questioned the trust’s ability to deliver annual savings worth around £10m (16 per cent) during the five-year deal.

In 2018-19, NUH ended the year with a £31.8m deficit (after provider sustainability funding) which was £39.7m behind plan. The trust changed its financial forecast from a £7.8m surplus to a £43.8m deficit (before PSF) in January, one month after being named the preferred bidder for the treatment centre.

The trust achieved its target of around £40m efficiency savings in 2018-19, although £18.3m of this was non-recurrent.

Two weeks ago, deputy High Court judge Sir Antony Edwards-Stuart ruled the CCG could award the contract to NUH, after deciding damages would be an adequate remedy for Circle if the company wins its legal challenge against the CCG.

‘One-month hiatus’ better than contract extension - CCG chief

Giving evidence to the court in April, the CCG’s chief officer Amanda Sullivan indicated a “hiatus” of all services at the centre for at least one month (caused by the “hard exit”) would be preferable to extending the contract with Circle.

amanda-sullivan

Amanda Sullivan told the High Court in April she preferred a one-month hiatus of services at the centre over extending the contract with Circle.

Asked about this last week, the CCG told HSJ that, at that stage, Circle was only offering a 12-month extension, which the CCG rejected because that would have “caused an unacceptable delay to the service transformation required in the new contract”, as well as being “excessive” and “potentially unlawful”.

“Due to mitigation plans agreed with the trust we no longer foresee a hiatus in service,” a spokesman said.

“This transformation will significantly benefit patients,” he added. 

However, Circle told HSJ it had been proposing a “short contract extension” since January.

A company spokesman said the CCG “declined discussions with Circle” and instead advised that “disruption of services at the treatment centre was preferable to any contract extension”.

He said the CCG had made an “incomplete proposal” to Circle when the risks of a “rushed services transfer” to NUH became apparent in May.

“Circle asked to meet urgently to discuss the significant gaps in this proposal before any public announcement, but unfortunately the CCG turned down this request and Circle was forced to commence demobilisation,” the spokesman said.

In response, the CCG said it had ”made a number of offers to extend Circle’s contract to support a smooth transfer of services, which have been rejected.”

Mobilisation plan

According to NUH’s mobilisation plan, all urgent cases (patients) across all specialties will be identified, appointed and “seen from the first week”, followed by “routine patients”.

The plan depends on several factors, including:

  • The “timely provision” of all information from Circle about patient data, staff, and subcontractors;
  • Rapid access to the building to inspect the facility;
  • Equipment and theatre; and
  • The “majority” of Circle employed staff transferring to NUH under TUPE.

The trust believes it can deliver its plan by, for example, using additional space at NUH, including three theatres at Queens Medical Centre, running clinics in the evenings and weekends in some specialties, and using its 1,500 volunteers to support patients on-site during the transition process.

Tracy Taylor

NUH chief executive Tracy Taylor said mobilisation had been “constrained” by Circle’s legal challenges.

Condensing the mobilisation into eight weeks will cost the trust £1m, according to court documents. 

NUH CEO Tracy Taylor said: “The timescale for mobilisation has been determined by the multiple legal challenges which Circle Nottingham Ltd has made to the procurement processes… over the last 18 months or so. 

“Clearly we have had to follow the timetable set by those legal proceedings and the constraints that placed on our ability to mobilise.

“We are prioritising the safe transfer of services and this remains the focus of the discussions with the CCG and Circle.”

 

‘Not a simple transition’ - Circle

In an interview with HSJ, Circle’s medical director Massoud Fouladi warned against the “rushed transfer of care” that will now happen.

“This is not a simple transition,” he said.

“A general hospital does not have the same volume of our patients coming through the treatment centre.

“When we opened the treatment centre we opened it in phases. It took us eight months to bring all the services to the same place. On what basis can you do that in eight weeks?”

“We have offered them many ways not to get to this point. Now they have got it I hope they find a sensible way out.”

Massoud Fouladi

Circle’s medical director Massoud Fouladi said the CCG has had many chances “not to get to this point”.

Asked how many of the 700 staff were likely to move from TUPE to NUH, Dr Fouladi said the clinicians worked under different models of employment on various types of contracts.

“We know 50 per cent of the clinical services we do at the moment is delivered by doctors who are not fully employed by us. They are a flexible workforce with different packages, and those people may or may not decide to go and work for NUH.”

Asked what would happen to the equipment in the treatment centre when Circle’s contract ends, Dr Fouladi said: “I have no idea. We can use all this equipment tomorrow at our other hospitals. But the disruption that would cause would be significant and not be fair on the patients.”

He accused the CCG of taking the best performing bit of the Nottinghamshire health economy and dismantling it by awarding the contract to the trust.

The centre is rated “good” by the CQC. Dr Fouladi said the centre has always hit the 18-week referral to treatment target.

The CCG’s previous attempt to procure services at the centre was derailed by Circle after the company threatened legal action over the price offered. 

Asked how much money the CCG had spent in legal fees on the procurement for the centre, the spokesman said costs could not be disclosed “at this time” and said it would be subject to publication in future.

  • Article updated at 9.59am on 5 June to include additional CCG comment about making offers to Circle to extend the transition period.