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| Flagship PFI hospital in £17m
debt crisis |
Special investigation reveals chaos
at six-month-old University College
Just three months ago the Queen officially
opened the new £422m University College London Hospital. Now
it is drowning in debt and has ordered an inquiry after baby Albie
Jago was misdiagnosed and later died from meningitis. When he was
admitted the brand new children’s A&E unit was closed.
Kim Janssen reports
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The new UCLH building in Euston Road
Albie Jago
Robert Naylor
The Queen greets staff at the official opening of the UCLH
in October
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A HIT squad of City accountants has been ordered into crisis-torn
University College London Hospital this week as it plunged into
more than £17 million of debt – less than three months
after it was officially opened by the Queen.
The £422-million Private Finance Initiative building –
which began treating patients in June – is one of the top-rated
hospitals in the country and was heralded as a flagship for New
Labour’s NHS reforms.
But on Friday government regulators sent highly-paid City consultants
KPMG in to slash costs as they warned trust bosses were “failing
to exercise the hospital’s functions in an effective, efficient
and economic way” and that the failings were “significant”,
ranking UCLH bottom of the 32 foundation trusts nationwide for financial
management.
UCLH, in Euston Road, is now deeper in a financial hole than the
more poorly-rated Royal Free Hospital in Hampstead, itself forced
to close wards because of a £10 million overspend.
Plans to renovate the Rosenheim wing – opposite the new hospital
– update endoscopy cleaning equipment and renovate the Eastman
Dental Hospital have already been delayed because of UCLH’s
cash crisis but far further reaching cuts must still be found. Two
wards at the National Neurological Hospital in Queen’s Square
have already been closed because of the debt.
The harsh words from government regulator Monitor have revived criticism
that the PFI deals cost hospitals too muclh, diverting cash from
patient care to private investors in the City.
Under the deal for the new hospital the trust must pay a consortium
called Health Management UCLH (HMU) plc £64 million a year
for 40 years.
HMU comprises contractors AMEC, Balfour Beatty – involved in
three other PFI hospitals including one in North Durham criticised
for being “too small” – and Interserve, part of the
PFI consortium at Cumberland Infirmary, the nation’s first
PFI hospital, which has been plagued with problems since opening
in 2000.
The business case for the landmark UCLH hospital relied on increasing
the number of patients it treated while reducing staff numbers.
But the planned £12-million-a-year efficiency savings have
not materialised, with some departments too slow to move from their
existing homes in the old UCLH buildings around Bloomsbury and Fitzrovia
and the July 7 bombings blamed for further reducing patient numbers.
The Trust estimated closures forced by the terrorist atrocities
cost £2 million in missed operations – they are paid
for each operation carried out – but it claimed in a press
statement that the “knock-on effect” was far larger –
an argument challenged by opponents of PFI and not referred to in
chief executive Robert Naylor’s report on the situation to
the Trust board last Wednesday.
Geoff Martin, chairman of campaign group London Health Emergency,
said: “To put the blame on the terrorist bombings is just a
red herring.
“The real problem is the massive burden of debt placed caused
by the PFI scheme, which is diverting funds from patient care, just
as was warned.
“But for them to be in the position where they are talking
about closing beds at a hospital that was supposed to be the most
prestigious in London just six months after it opened shows what
a circus it has become.
“Taking £17 million out of the local health economy will
have a devastating impact on patient care and the people responsible
should be held to account.”
The trust insists a rising property market means it will eventually
reclaim the losses when it sells the vacated Middlesex Hospital
in Mortimer Street and other buildings.
But it must find further cuts in the meantime after regulators found
that existing savings targets were not being met.
Medical director Professor David Fish, speaking for the Trust board,
said: “As the move to the new hospital is a one-off disruption,
we are confident of regaining financial balance on an ongoing basis.
“We welcome the additional assistance and support from KPMG
and Monitor to do this as quickly as possible.
“Our priority, while making this happen, is to keep up the
high quality of services that we offer to our patients.”
Monitor’s report was published as it emerged that UCLH managers
were warned a month before tragic baby Albie Jago died that the
specialist children’s section where he should have been treated
was often closed due to a lack of trained staff.
Hospital bosses denied there was a problem and only made staffing
changes one week after his death, when his grieving parents launched
a complaint, official statements show. A nurse, who asked to remain
anonymous, contacted the New Journal in early November, making a
series of allegations about mismanagement and a bullying culture
in the Accident and Emergency ward.
She claimed a specialist children’s section within the ward
was often closed because of a shortage of trained children’s
nurses.
Hospital bosses denied the claim – and all the other allegations
– in an emailed response to the New Journal on November 9.
The statement said: “There is no shortage of nurses in A&E
trained to treat children.”
But when Albie was taken to the hospital on December 5, the specialist
children’s unit was closed, forcing him to be seen in an eye
cubicle with no bed, where his parents say he was neither taken
out of his pushchair nor given a proper examination.
He died of meningitis soon after being misdiagnosed by a junior
medic.
Last week a trust spokesman said the children’s section –
where Albie would have been seen on a bed and his symptoms may have
been correctly diagnosed – was closed because “sometimes
we have not had enough appropriate nursing staff in A&E to oversee
the separate [children’s] facility.”
But she said changes brought in a week after Albie’s death
to staff the specialist children’s section with doctors from
the hospital’s pediatric department were “already planned”,
and that it was a coincidence the fix came on the day the New Journal
first contacted the hospital about Albie.
Although medics told Albie’s parents the cash shortage was
to blame for the children’s section’s closure, the Trust
insisted that was “completely untrue”.
Dr Howard Baderman, who ran UCLH’s A&E department for 30
years until five years ago and is one of the leading experts in
his field, said he was “not surprised” that the move to
the new hospital had led to financial problems, which he said could
have contributed to the shortage of trained children’s nurses.
But he added: “The main problem is a shortage of children’s
nurses nationwide, although you have to say that when the decision
to build the special children’s section in the new hospital
was made, the question of how it would be staffed should have been
properly addressed.”
In a statement the UCLH said: “There is not currently a separate
paediatric A&E department. However, we do have separate cubicles
and a child-friendly waiting area for the assessment of children.
When this area is in use it has been staffed by A&E doctors
and nurses and the clincial treatment provided is the same.
“How the staff utilise the various cubicles and assessment
areas across the whole A&E department depends on the activity
levels, the total number of attenders (adults and children), their
condition, and the skills and experience of the staff available
in the department at that time, hence the paediatric cubicles are
not always utilised. There will always be paediatric trained staff
available.” |
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