Trust halts use of Vanguard theatre after CCG raises concern over costs

South Warwickshire NHS Foundation Trust (SWFT) has halted use of a mobile operating theatre run by Vanguard Health Solutions after the local CCG said it had become unaffordable.

In Board Papers published this month, NHS South Warwickshire Clinical Commissioning Group said use of the additional theatre capacity for orthopaedics had resulted in high costs and ‘over performance’ in referral to treatment time (RTT) targets.

According to the CCG, the Trust’s RTT performance in orthopaedics is ‘significantly’ above the required target of 92% of patients treated within 18 weeks at 97-98%. Waiting times for inpatients stood at six weeks at the end of last year, while inpatient waits averaged just 13 days.

‘For the CCG this has resulted in a significant, unaffordable, financial over performance against the contract as the additional orthopaedic activity is mainly high cost hip and knee replacements,’ it said.

Independent sector providers have continued to report weakened NHS demand for elective procedures. NHS England wrote to trusts and CCGs at the end of last summer urging them to use independent sector capacity when they were at risk of breaching performance targets. However, there is little incentive for trusts and CCGs to over-deliver on targets at a time when penalties have been relaxed and budgetary pressures mean commissioners are looking to make substantial cost savings.

In addition to the cost impact, the CCG said performance against RTT targets in orthopaedics was masking shortfalls in other specialties, where activity levels continued to fall below the 92% target – in some cases significantly.

The CCG said it had collaborated with the Trust over the last 12 months to redesign the MSK pathway and had implemented a ‘demand management service that improves patients’ outcomes and may reduce their need for invasive surgery.’

At the same time, it said it was working with the Trust to improve RTT performance for other specialties such as dermatology to ensure all patients have equitable access to services within 18 weeks.

‘As the Vanguard Theatre is utilised only for orthopaedic procedures, it is recognised that a different approach is required to improve the waiting times for outpatient based specialties that do not require surgical procedures,’ said the CCG.

In a statement, SWFT said: ‘The Trust stopped using the Vanguard in December 2018. It was always planned to stop using the Vanguard over winter to meet the increased demand in emergency work which is anticipated during this period.’