• Department of Health has identified the 20 as 'clinically and financially unsustainable'
  • South London Healthcare NHS trust has gone 150million in the red over the past three years
  • Many of the debts run up thanks to PFI deals agreed by Labour that will cost 2.5billion in the long term
  • Departments and wards set to be closed in restructuring
  • Trust is first to be put into special measures and faces being dissolved

By Matt Blake and Tim Shipman

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Emergency treatment: Health Secretary Andrew Lansley has drafted in a crisis team to deal with problems at South London NHS Trust

Emergency treatment: Health Secretary Andrew Lansley has drafted in a crisis team to deal with problems at South London NHS Trust

Another 20 debt-laden NHS trusts could be put under special measures, it emerged today, after a crisis team took control of three London hospitals.

A squad of doctors, accountants and administrators was parachuted into South London Healthcare NHS Trust on the orders of Health Secretary Andrew Lansley after racking up debts of 1million a week.

It was the first time in NHS history that a trust has been forced hand over its administration powers to the Department of Health after failing to meet prescribed standards.

But today it emerged that the crisis could run far deeper than just one trust as it emerged there are 20 more that have been identified as 'clinically and financially unsustainable'.

They have been set goals by the Department of Health to perform better but ultimately, if they do not achieve the results, they could also face being put in special measures.

While all are in dire financial straights, many have also been told to clean up a string of performance issues which range from some of the longest waiting times in the country to alarmingly high death rates among patients.

They include Surrey and Sussex Healthcare Trust, Epsom and St Helier University Hospitals Trust and Hinchingbrooke Trust, whose hospital in Cambridgeshire had historic debts of more than 40 million and became the first to be taken over in February by a private firm.

Barking, Havering and Redbridge University Hospitals Trust and North Cumbria University Hospital Trust are also under the spotlight. They were among seven trusts handed a 1.5 million bailout to ease their debts earlier this year.

If any do find themselves in the place of beleaguered South London Trust, the cost to the Government could run to many billions of pounds.

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In trouble: The Hinchingbrooke Hospital in Cambridgeshire Hinchingbrooke Trust had historic debts of more that 40 million

In trouble: The Hinchingbrooke Hospital in Cambridgeshire Hinchingbrooke Trust had historic debts of more that 40 million

The three hospitals belonging to South London will cost 2.5billion under the long-term construction and management scheme.

It had gone 150million into the red over the past three years, largely because of crippling Private Finance Initiative deals agreed by the last Labour government.

THE 20 NHS TRUSTS IN TROUBLE

Newham University Hospital Trust

Oxford Learning Disability Trust

Barking, Havering and Redbridge University Hospitals Trust

Whipps Cross University Hospital Trust

North Cumbria University Hospital Trust

North Middlesex University Hospital Trust

Surrey and Sussex Healthcare Trust

Ealing Hospital Trust

Epsom and St Helier University Hospitals Trust

Hinchingbrooke Hospital Trust

Trafford Healthcare Trust

North West London Hospitals Trust

Scarborough and North East Yorkshire Trust

Weston Area Health Trust

Winchester and Eastleigh Healthcare Trust

Great Western Ambulance Service Trust

George Eliot Hospital Trust

Dartford and Gravesham Trust

Nuffield Orthopaedic Centre Trust

Suffolk Mental Health Partnership Trust

The financial chaos has already hit patient care at the hospitals – Queen Mary’s in Sidcup, Queen Elizabeth in Woolwich and the Princess Royal University Hospital in Bromley.

While services have improved in recent months, patients still face some of the longest waits for operations in the country.

One in six patients waited longer than the 18-week Government target – the worst figure for any NHS trust in London.

It also performs poorly on casualty unit waiting times, ranking 20th out of 23 trusts in the capital. Some departments and wards face closure.

The Trust took on a large debt when it was formed - mainly from the PFI that had been used for building at the Princess Royal and Queen Elizabeth hospitals.

Mr Lansley has activated an ‘unsustainable providers regime’, putting the trust under the control of a special administrator with powers to demand rapid changes.

The Health Secretary stepped in after draft financial plans showed the trust would have a deficit of 30-75million a year for the next five years.

In his letter to the trust, he wrote: ‘South London Healthcare NHS Trust faces deep and longstanding challenges, some of which are not of its own making.

'Nonetheless, there must be a point when these problems, however they have arisen, are tackled

'I appreciate that any decision to use these powers will be unsettling for staff, but I want to stress that the powers are being considered now so that patients in South East London have hospital services that have a sustainable future.  This will benefit patients and bring more certainty to staff, the public and other local stakeholders.

'I am determined to improve healthcare services for patients in South East London and will take whatever difficult steps are necessary to achieve this.'

A Department of Health source said Mr Lansley was not prepared to run the risk of a repeat of the Mid Staffordshire scandal in which poor quality care and mismanagement led to the needless deaths of hundreds of patients.

Stephen Powell, chairman of the Health Select Committee, told Radio 4's Today programme that there was clearly a need for change in the face of such enormous losses.

Queen Mary's Hospital, Sidcup: A squad of doctors, accountants and administrators was parachuted into South London Healthcare NHS Trust after running up debts of 1million a week

Queen Mary's Hospital, Sidcup: A squad of doctors, accountants and administrators was parachuted into South London Healthcare NHS Trust after running up debts of 1million a week

He said there was an 'over-dependence on hospitals' and that one focus of the restructuring may be improving 'care in the community'.

The move means that, unlike loss-making companies in the private sector, the Trust will not have to pay back the money it has lost.

Mr Powell added: 'Politicians are responsible but the Secretary of State can't make all the decisions. There is a need for change.'

An administrator could now be brought in and the Trust could go bust, leading to it being dissolved and some services closed.

Queen Elizabeth Hospital, Woolwich: South London Healthcare NHS Trust's three hospitals will cost 2.5billion under the long-term construction and management scheme

Queen Elizabeth Hospital, Woolwich: South London Healthcare NHS Trust's three hospitals will cost 2.5billion under the long-term construction and management scheme

The Department of Health said in a statement: 'The hospitals in this Trust have faced multiple problems for many years, which the previous Labour Government made worse by a merger, and the approval of two huge PFI deals that have further destabilised the Trust. The trust lost over 1 million a week last year, enough to pay for 1000 cataract operations per week, 200 hip replacements per week, or pay the salaries of 1200 nurses.

'The unsustainable providers regime was created by Labour’s Andy Burnham when he was Health Secretary. However, Labour never made use of them, preferring instead to sweep the  problems facing some parts of the NHS under the carpet.

Princess Royal University Hospital, Bromley: One in six patients waited longer than the 18-week Government target - the worst figure for any NHS trust in London

Princess Royal University Hospital, Bromley: One in six patients waited longer than the 18-week Government target - the worst figure for any NHS trust in London

'South London Healthcare NHS Trust is an exceptional case, showing most of the problems which are characteristic of “challenged” NHS Trusts. There are about two dozen sucg Trusts where the Government inherited serious longstanding problems.

'Andrew Lansley’s decision will send a strong signal to unsustainable NHS organisations that they cannot continue to provide poor services or rely on bailouts from other parts of the NHS.

'All the hospitals deemed to be unsustainable have signed agreements with the Department of Health to turn their performance around, and it is possible that the Government will consider putting some of them or others who cannot deliver sustainable services into special measures if their leadership does not make progress fast enough.

'South London Healthcare NHS Trust has previously owned up to multiple challenges including not being efficient enough, delivering low quality services, having poor contracting arrangements and having a weak board. Like the many other hospitals yet to become part of the elite NHS Foundation Trusts, the Trust faces problems which – according to the National Audit Office - "have lain unresolved for a number of years".'

Chris Ham, chief executive of health think tank the Kings Fund, warned on Radio 4's Today programme that not only other NHS Trusts, but potentially even Foundation Trusts at the very top, could go through the same thing.

He said it was important to face up to the problems, and that administrators would be able to restructure.

VIDEO: What is the future for South London Healthcare NHS Trust?... 

Here's what other readers have said. Why not add your thoughts, or debate this issue live on our message boards.

The comments below have not been moderated.

Jenny, London, 26/6/2012 21:53... Snap! Been there, done that. So, well said. But this is the DM. Most of its readers are prejudiced idiots who won't understand a word of what you are saying, let alone get anywhere close to having the remotest chance of believing it. Be prepared for an imminent death from a shower of red arrows

The saddest thing about this is that the politicians who originally determined the policy behind this and drove it through will walk off washing their hands of it, and the politicians now in power will sit there saying that the sort of really really big decisions that need to be taken to fix the mess are not actually within their ambit. Meantime NHS staff of all kinds, clinicians, nurses, other managers (doctors and nurses are managers too, you know) who have put their hearts and souls, and committed their whole working lives, into making the NHS work for those who need it, regardless of what these pernicious politicians throw their way, will get vilified by an unaccountable and mendacious media, and dragged through the putrid swamp of public opinion, as if whole debacle were their fault in the first place.

I'm writing this thinking will DM not post this comment (again) because of my opinion as someone who ACTUALLY works in Finance for the NHS (for a relatively small Trust I might add). 9 times out of 10 when things go wrong the Chief Exec takes it in the neck (hence a number of them stepping down over recent times). To be honest I'm absolutely astonished at the deficit that South London NHS Trust has been carrying considering the stringent measures in place the routine internal and external audits carried out - and they are brutal! the SHA regulations in place and year end deadlines and believe me you have to evidence EVERYTHING you spend money on. It's not just a case of 'sack managers' it's a heck of a lot more complex than that, services are generally run for profit and believe me the NHS is fighting against the private sector to keep services public so we have to be competitive otherwise we don't exist and services are no longer free....SO much I want to say but have no space!

i had to price a job in a hospital still owned by the nhs but maintainance in pfi hands.i was pricing it for the nhs,the pfi were miffed to say the least.my price went in and battle commenced.the pfi did not like it because they had not added their bit onto my price.the nhs were trying to save money,they owned the building after all.my price was around £1600,the pfi price over £3000 guess who got the job,it was not me.who pays,the tax payer.not only that i was caught up in the middle and have not been asked to price any work since.2 years back.if a outside contractor is used by a pfi it costs the tax payer twice the normal amount.it will not take long to bankrupt these hospitals.

Well it happens in business,so why shouldn't it happen within The NHS. - MrAngry, SW UK, 26/6/2012 18:27 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Because if it happens in business no one cares, if it happens in a hospital people die

i was a contractor working in a old hospital 45 years old,at the time the pfi contract negotiations were going on.the people representing the trust were known to be hopeless at their own day to day job,but were somehow at the forefront of very serious maintainance contract talks.ie..,they decided it was ok to pay £115 to get a key cut,£140 to hang a cuboard ,departments would not have pictures on the wall because of the cost.not only do we pay this rent and maintainance costs,there is still a tier of nhs management in place,ie, estates management at huge cost to make sure the maintainance is carried out properly,so jobs for the boys was looked after.by the way the private firms who run the hospitals i know about are FRENCH and i think the other was swedish.so the profits going abroad.

i hope you have plenty of hit squads standing by, cause you'r gonna need em.

All were baffled with figures and brainwashed to accept PFIs with open arms. PFIs are not charities but are businesses guaranteed to make lots and lots of money over a long period of time. It is about time to put names to these PFIs who are taking our money - of course legally. I have a feeling you will not be able to link any names to any PFI because they might be the same people who baffled us into accepting the PFIs in the first place.

The country is bust simple logical and many have written on here and with other blogs we are are carrying way way too much debt and this debt needs to be rearranaged BUT no banks want the loans they want savers. Q.E printing money never works and you can see this the banks have kept the printed money to make the books look bigger and better. Cash is king and is becoming wortless every week.

To just blame Labour for this is a bit short sighted. PFI is a Conservative idea from the 1990s, much used and abused by Labour and not ruled out for use by the current incumbents. Our entire political class is wedded to the concept of PFI. It makes no fiscal sense to borrow £50m via PFI at significant interest rates when Govt 10 Year Bonds are significantly better value. We wouldn't borrow from a loan shark if our bank will lend to us at an affordable rate, so why do Govts whether Conservative, Labour or Coalition do so? I am sure it is entirely unrelated to the fact that when Ministers and Special Advisors leave Govt they take up jobs at the very banks and investment houses which make millions in interest and advisory fees from these very deals. Meanwhile the banks create secondary markets buying and selling debts and turning even more profits, whilst hospitals close wards and waiting lists grow because they can't finance unaffordable debt. Whatever your party we all should be angry.

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