Agenda item


The following question has been received:


From Alan Stanley – Keep our NHS Public Leicester, Leicestershire and Rutland


I am writing to you on behalf of keep our NHS Public Leicester, Leicestershire and Rutland to ask you to investigate the Birkdale contract which provides for orthopaedic operations to be carried out in UHL.  This contract, we understand after only four weeks following what appeared to be significant errors on the part of the Birkdale surgeons.


We are concerned that this contract was drawn up despite a previous history on the part of Birkdale of poor quality and complaints.  We would like the Health Overview and Scrutiny Committee to investigate:

How the contract came to be drawn up

What alternative approaches to meeting the 18 week treatment target were explored what would keep health care publicity provided and why these were rejected

Why Birkdale was selected when information about previous poor quality was already in the public domain

What the terms of the contract are

Why more information about the contract has not been made public

What quality procedures were in place within Birkdale and within UHL’s monitoring of Birkdale

What Birkdale will be paid despite these apparent errors

What the standing of Birkdale’s surgeons is

What the standards of post-operative care were

What the financial loss to the local health community has been.


We believe that an investigation of this matter would be entirely appropriate under s244 of the National Health Service Act 2006 and the Local Authority (Overview and Scrutiny Committees Health Scrutiny Functions) Regulation 2002 (Statutory Instrument 2002 No. 3048)’




Janet Rowe was present on behalf of Alan Stanley, Keep our NHS Public Leicester, Leicestershire and Rutland, and read out the question as outlined on the report.  Malcolm Lowe-Lauri, the Chief Executive of the University Hospitals of Leicester NHS Trust (UHL) responded to the question as detailed below:




UHL entered into a contract with the Birkdale Clinic in January 2008 to assist the Trust in meeting its 18 week waiting list targets in relation to the following services:-


  • Orthopaedics,
  • Plastic surgery,
  • Maxillofacial.






The arrangement was for NHS Consultants from other parts of the country, who were contracted to the Birkdale Clinic, to carry out operations in UHL operating theatres at weekends to help reduce waiting times for patients.



UHL made it a condition of the contract that the Consultants were NHS Consultants and registered on the General Medical Council Specialist Register.



The decision to enter into the contract was taken by UHL Trust Board in December 2007.  The Trust’s Solicitors prepared the contract documentation under which Birkdale was obliged to provide healthcare to best standards and to comply with the Trust’s policies and procedures.



The Trust’s own Consultants were already committed to working at full capacity in these specialties, and it was therefore necessary for the Trust to access additional capacity and capability to help reduce patient waiting times and meet national waiting time targets by 31 March 2008.



The Birkdale Clinic was known to the Trust as an experienced provider of clinical services to the NHS.  In 2003, Birkdale had been appointed by the Department of Health to run an Independent Sector Treatment Centre to treat NHS patients.



Prior to entering into the contract, the Trust carried out due diligence and reviewed reports published by the Healthcare Commission assessing Birkdale’s own hospital facilities in Rotherham.  UHL governance procedures were put in place to make sure that, on important issues like infection prevention and control, the clinicians worked to the Trust’s exacting standards.  The Trust also spot checked wards for reassurance that UHL quality processes were being met in practice.



Eight weeks into the arrangement, in March 2008, UHL Consultants raised a number of clinical concerns regarding some orthopaedic cases.  No difficulties were encountered with Birkdale’s maxillofacial work, and, in the event, no plastic surgery work had then been undertaken by Birkdale.



As a result of these concerns, the Trust decided to suspend the arrangement with Birkdale and has since conducted a review of the 210 patients who had received orthopaedic treatment. 



The Trust informed the Healthcare Commission of its actions in suspending the contract and has since made information available to the Healthcare Commission at its request.



Whenever surgery is undertaken, complications are expected in a proportion of cases.  In other words, all surgery carries an element of risk.  However, thankfully our review has not established any significant overall pattern of poor outcomes in those patients treated by the Birkdale Clinic.



The period of the original contract has now expired and the Trust will therefore not be renewing the arrangement with Birkdale.



Dr Allan Cole, Trust Medical Director has reported on this matter at the Trust’s public Board meetings held on 3 April, 15 May and 18 June 2008.



Dr Cole will submit a final report on the results of the Trust’s review to the next public Trust Board meeting on 4 September 2008. 



The fees payable to Birkdale for the work undertaken were at the standard NHS tariff for such clinical procedures, less 7.5%.  There has been no financial loss to the local health community as a result of the Trust entering into this contract.


Janet asked a supplementary question, as to why Birkdale had been employed in spite of the negative reports.  In response Malcolm stated that an assessment was carried out before Birkdale were employed which had not given cause for concern.