The Inside Story of the Hinchingbrooke Hospital Contract

Our articles last week (here and here) concerning Hinchingbrooke hospital drew some perceptive and informed comments from people who know about the topic for various reasons. You may have seen this from Stephen Heard, but it’s worth featuring in full, as he had some personal involvement in the original procurement process. I found this fascinating; understanding some history certainly helps put the recent story into perspective. Thanks to him for contributing - he runs his own consulting firm now (see via this link) and has a wealth of experience to offer!

“I was involved in this process and you have to go back to the very beginning to make sense of the present. Who was it who said that to understand the future you have to have an appreciation of history? Anyway back to the here and now problem.

Hinchingbrooke was always a political football with planning for this commencing during the local MP’s tenure as PM (the hospital is in John Major’s constituency and it was opened in 1983; he was PM from 1990 to 1997). I doubt whether there was any true due diligence on the need to site a new hospital between two existing large Acute NHS Foundation Trusts at Peterborough and Cambridge. So there is a need for the NAO to investigate the real need.

Huntingdon and the local burghers, which includes the local GPs, have never got over the fact that they lost their county shire status in 1974 and became a non-metropolitan district of Cambridgeshire. The fact that they could have their own “county” hospital at Hinchingbrooke was a real consideration in their attempt to operate as a quasi county.

However Hinchingbrooke has always struggled to operate as a General District hospital and to recruit clinical staff with such powerful Foundation Trust neighbours. In fact most of the specialist clinical consultants were historically employed by Addenbrookes and seconded or leant to Hinchingbrooke as senior clinicians prefer to have this on their professional accreditation. In fact at one stage in the early days of Circle’s tenure, Addenbrookes did threaten to withdraw “their” clinical staff in order to derail the franchise.

My involvement was as part of the then commissioners Cambridgeshire Primary Care Trust (PCT and before the Clinical Commissioning Groups). We were asked to conduct a “beauty parade” of the potential new providers to ascertain who we thought, as commissioners, we could work with in the future. From memory we saw about five potential providers including Serco and Addenbrookes as well as Circle. I can’t recollect who the others were and Addenbrookes withdrew shortly after as their Business Development Director left to run the West Suffolk hospital. He has now moved onto to be Chief Executive of Peterborough.

The procurement competition itself was being managed by the then new Strategic Project Team (SPT) which was working for the then East of England Strategic Health Authority (SHA and now defunct being replaced by the NHS England Area team). The SRO sponsor at the SHA is now the Chief Executive of the West Suffolk.

Anyway it was obvious to me, as someone who had just joined the NHS from OGC Buying Solutions, that the SPT was out of its depth. I would suggest that any subsequent NAO investigation needs to look at the role of this dysfunctional team and the decision process in deciding which procurement route to take and the governance around this decision.

I had, as the commissioner during my time at the PCT, lots of concerns about Hinchingbrooke and their performance and we were quite pleased when the PCT started the procurement. However we, as local commissioners, always saw Addenbrookes as favourites. Their business case to close the A&E and use the site as an elective (planned operations) factory would see the main Addenbrookes site released for emergency non electives and as a centre of excellence for tertiary services along with their world-class clinical research. As it was, local ambulances on out-of-hours “blue light” emergency calls were by-passing Hinchingbrooke and driving straight to either of the two local Foundation Trusts, as there was no senior clinical coverage at the emergency department at Hinchingbrooke.

However local GPs, who were also involved in the beauty parade, were keen to gain control of their local hospital and the carrot of a John Lewis type share options for staff, including local GPs was, I believe, a big part to play in the award decision. It is somewhat ironic that the Local Commissioning Group of GPs in Huntingdon are now the commissioners of Hinchingbrooke and I wonder what their view (rather than the parent Cambridgeshire and Peterborough Clinical Commissioning Group) is of Circle’s withdrawal."

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