Hospital row becomes clear

TODAY, the full details behind the £2.4million stand-off between Suffolk's leading health care providers can be revealed.

TODAY, the full details behind the £2.4million stand-off between Suffolk's leading health care providers can be revealed.

Claim and counterclaim over whether a payment should be made for operations carried out within a minimum 122-day waiting time, soured Ipswich Hospital and Suffolk Primary Care Trust's (SPCT) relationship.

The breakdown of trust revolved around surgeries for 2,253 non-urgent patients. All the operations were carried out were carried out sooner than they should have been between November 29, 2005, and March 31, 2006.

The hospital's ultimately futile claim for payment from the PCT was £2,366,883.

After the spat went to arbitration, the East of England Strategic Health Authority threw out the cash-strapped hospital's case earlier this year.

Now, following a Freedom of Information request by The Evening Star, the extent of row between the hospital and Primary Care Trust - as it was called then - can be seen for the first time.

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Now, as the hospital and SPCT endeavour to rebuild their relationship, they issued a joint statement pledging to move on for the good of Suffolk's health service.

The statement reads:

“Ipswich Hospital and Suffolk Primary Care Trust (PCT) have, in response to a request from the Evening Star, disclosed the internal documents that show the nature of a dispute between the hospital and the PCT regarding payment for hospital services in 2005/06.

The organisations are committed to openness and are both very willing to provide the information requested.

The matter was submitted for arbitration to the East of England Strategic Health Authority. Both the Trust and the PCT had an opportunity to put their case and through due process the SHA reached a decision to rule in favour of the PCT's argument. Whilst this was disappointing for the (hospital )Trust, the Trust accepted the decision and each organisation is keen to move on.

Relationships between the Trust and the PCT have been very strong over the past 18 months, and this is seen by both organisations as an isolated incident. However lessons have been learnt to strengthen further the way we do business with each other. Negotiations this year have gone very well leading to the service level agreement for 2007/08 and the contract is due to be signed on time by the end of March.

The £2.4 million that was at the centre of the dispute is not lost to local people. The money remains in the NHS in Suffolk and the Trust and the PCT will continue to work together to deliver quality services.”

Mike Brookes Tony Robinson

Chairman Interim Chairman

Andrew Reed Carole Taylor-Brown

Chief Executive Chief Executive

Ipswich Hospital NHS Trust Suffolk Primary Care Trust

A SUMMARY of Ipswich Hospital Trust's submission to the East of England Strategic Health Authority for payment of the £2.4m, submitted by Andrew Barber, assistant director planning and performance.

THE commitment to pay the £2.4m was made by the PCT at executive director level and supported at chief executive level.

It was made at the time when, had the commitment not been given, we could have prevented the work from being carried out and reduced our capacity accordingly.

The absolute nature of the commitment was that it was to be unwritten.

The commitment was made to the (Ipswich Hospital) Trust's chief executive in person by the PCT's chief executive as recently as August 2006 and in the presence of two senior members of the Trust's finance staff, albeit couched in terms of 'being taken in the round'.

On at least four occasions the PCT indicated its intention to pay the disputed amount.

Initially Chris Dooley (the hospital's financial director) had sought assurance in a meeting on January 10, 2006, that the hospital would be paid for the operations. Julian Herbert (the PCT's former finance director) clearly indicated payment would be made as although the patients had been treated before the 122-day minimum wait deadline they would have been treated in 2006/07 anyway and the PCT would therefore have had to pay for them.

On July 25, 2006 the hospital's interim director of finance and performance Andy Morris spoke to Mr Herbert, who indicated again the intention to pay the £2.4m after the half-yearly accounts had been closed.

This commitment was repeated to the hospital's chief executive Andrew Reed by Carole Taylor Brown, the PCT's chief executive in August 2006 in the presence of two senior members of the hospital's finance directorate.

It should also be noted that had the commitment not been given to pay during 2005/06 then the hospital could have prevented further work being carried out.

In summary the PCT made a number of verbal commitments to defer rather than withhold payment, without qualification, which it is now not honouring.

A SUMMARY of Suffolk Primary Care Trust's submission to the East of England Strategic Health Authority, by chief executive Carole Taylor-Brown.

The PCT representatives have a completely different recollection of the meeting on January 10, 2006, than set out by the hospital.

The PCT had been clear for some time prior to that date that the 122-day rule was going to be enforced and even raised at the January 10 meeting that a request for clinical exception and exception cases to the 122-day rule still had not been received from the hospital. Agreeing to pay for whatever activity was undertaken would have been nonsensical.

The 2005/06 audited accounts of both organisations were approved and signed off. The issue was not raised as an outstanding dispute item.

No agreement to pay this amount in 2006/07 has ever been approved or documented.

Between December 8, 2005 and February 1, 2006 various letters were sent between the Primary Care Trust and Ipswich Hospital Trust raising concerns regarding 122-day over activity and the increase in the ratio of urgent patients.

The issue now being raised by the hospital is whether the PCT committed to pay the £2.4m to Ipswich Hospital Trust in the 2006/07 financial year. Whilst there was clearly no requirement to do so the director of finance had discussed earlier in the year a potential intention on the part of the PCT to pay this money over to the Trust during the 2006/07 year subject to further discussion. The 'in the round' position was confirmed by the PCT chief executive at a meeting with Ipswich Hospital's chief executive and the finance director at which the strategic health authority was present.

There has already been wide local and national media coverage of this issue with significant negative coverage for the PCT and the NHS generally.

Despite the chief executive agreement and advice given the issue was handled in the year end accounts by the Trust in such a way that it raised considerable audit attention. This has led to the PCT auditors raising the payment of the £2.4m as a key audit issue.

Consequently, the PCT, as a result of the Trust's own actions, discuss further any option to pay the £2.4m to the Trust in 2006/07.

Clearly it is unfortunate that the Trust see this as 'a matter of fundamental trust' between two organisations, however the PCT has always maintained a formally agreed and documented position that the payment is not due and feels equally let down by the Trust's handling of this issue.

IPSWICH Hospital's former chairman has today told of her disappointment at a decision to penalise the organisation for carrying out operations too quickly.

Christine Smart, who stood down from her role at the hospital in May, said: “To my mind it defies logic. If patients have been treated you would expect the hospital to get paid for it.”

Her comments come after The Evening Star revealed the hospital would definitely not be paid £2.4m they believed was owed to them by the Suffolk Primary Care Trust (PCT).

The ruling was made after the hospital carried out a number of operations before a minimum 122 day deadline imposed by the PCT, which then refused to pay for them.

When the trusts could not resolve the dispute between themselves it was referred to the East of England Strategic Health Authority (SHA) which, last week, ruled in favour of the PCT.

Ms Smart said: “I was very disappointed to read about the SHA's decision.

“If these patients had not been treated when they were, there was a chance that this would cause a build-up within the system and waiting-time targets may have been missed, which would then have had an impact on the hospital and the PCT.”

Ms Smart, who was still working at the hospital at the time when the initial contract with the PCT was signed, said the 122-day rule had been written in to it, but she and other board members were “under the impression” that they would be paid for any extra work that was carried out.

The hospital is currently battling to clear debts of around £24m and, while they had not counted on recouping the £2.4m owed to them this year, chief executive Andrew Reed admitted last week that it would have been “a big benefit” to the hospital.

Suffolk PCT also has huge debts of around £35m.

It claims the 122-day rule ensures fairness by meaning all patients wait a similar amount of time. It has since been reduced to 98 days.

Do you think the SHA made the right decision? Write to Your Letters, Evening Star, 30 Lower Brook Street, Ipswich, IP4 1AN or e-mail>

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