The sudden closure of Bootham Park Hospital in York at the end of September 2015 with just five days warning –  followed sixteen months later by the proposal for a replacement new build mental health hospital in York, provides a case study in the murky workings of a fast-privatising NHS that lacks democratic accountability

Revolving doors between the NHS and private companies mean that conflicts of interest are rife – but barely examined.

Bootham Park’s closure, on the order of the Care Quality Commission following an unannounced inspection, forced the immediate discharge or relocation of 30 inpatients  and affected 400 outpatients.

It was met by public outrage and opposition as the mental health hospital – the only one in York and the surrounding area – had been vital to the wellbeing and survival of many patients.

There was nothing wrong with the patient care at Bootham Park Hospital. Bootham had the safest rating and was accredited by AIMS as ‘excellent’.

The Care Quality Commission’s beef was that vital repairs requested in 2014 had not been made and there was a leaky toilet, scalding water running in one of the ward kitchens and a crack in the main hall ceiling.

Since the closure,  Mental Health Action York (Save Bootham Park Hospital) has run a sustained campaign to reopen the hospital and fully reinstate York’s mental health services.

But now York Press reports that Health bosses have suggested that the new hospital, due to open by December 2019, should have 60 beds – ten fewer than the Vale of York currently has.

Campaigners to save Bootham Park Hospital are not pleased. Most believe that the closure and replacement with a smaller new hospital has  nothing to do with the best interests of patients and more to do with a tangled web of vested interests that has so far evaded scrutiny.

Why weren’t necessary repairs carried out as planned?

The Bootham Park Hospital “landlord” is NHS Property Services – a private limited company set up in April 2013 with a sole shareholder: the secretary of state for health.

Bootham Park hospital was one of 3,500 NHS properties it was given to sell to raise revenue for the government if they become “surplus to NHS requirement”.

In September 2014 the 18th century building was deemed unfit for purpose; interim improvements had been planned – but not carried out.

There are varying accounts of who is to blame for this.

Leeds and York Partnership trust (LYPFT) was contracted by Vale of York Clinical Commissioning Group to provide services at Bootham Park until 1 October, when Tees Esk and Weir Valleys (TEWV) mental health NHS trust was due to take over the running of the hospital, after the Vale of York Clinical Commissioning Group awarded them the contract in June 2015.

Rachel Maskell MP told the House of Commons that:

“…a board member at the time has reported that the Leeds and York partnership trust did not invest in the required upgrades ‘in case it did not win the contract’.”

But Chris Butler, chief executive of Leeds and York Partnership NHS Foundation Trust, told the Sunday Express that:

“The Vale of York Clinical Commissioning Group with NHS Property Services has been leading work on the interim improvements at Bootham Park which have been subject to repeated delays.

“These delays have been outside the control of the Trust which has been a source of great frustration.
“Whilst we raised concerns about these delays with the CQC, the health regulator Monitor and with the Secretary of State for Health’s office, it appears we are now in a very difficult situation which is not of our making.”

According to Rachel Maskell MP, speaking in the House of Commons,

“There was no one in the NHS under the 2012 Act who had the authority to weigh up the balance of risk and decide, when greater risk to the lives of service users could occur with the sudden move, that an alternative call could be made, such as properly planned transition. No intervention was made, not even by the Minister—in other words, no one has overarching responsibility for patient safety in the NHS. That was confirmed by all the bodies.”

However, Prof Allyson Pollock points out that it was the New Labour government in 2009 that “stripped out public accountability for the NHS,” moving it to arms-length, market-based inspection and enforcement under the new Care Quality Commission and Monitor (the economic regulator for the newly-marketised NHS which has since morphed into NHS Improvement.)

Until New Labour’s meddling, the NHS was directly accountable to the public, since it was under the direct control of the government.

Shutting wards in favour of private beds out of the area

A Nurse at Bootham Park Hospital told York Press that the maintenance of the building had been unnecessarily neglected, two key wards had been closed and  patients were regularly sent to out-of-area private beds costing as much as £500 a day.

The nurse said,

“The cuts – the closure of the newly refurbished mother and baby unit and of ward three for intensive care – meant patients had to go into private care at great cost. They wasted so much money and lost so many good staff… if they had done the essential works that needed to be done and spent the money in the hospital instead of shutting wards in favour of private beds this would never have happened.”

Why did the CQC thwart Tees, Esk and Wear Valleys Trust’s plans for £2m repairs?

Following their unannounced inspection, the Care Quality Commission wrote to Leeds and York Partnership trust (LYPFT) on 24 Sept 2015 saying it had until midnight on 30 September to remove the hospital’s 30 inpatients.

A day later the CQC sent another letter to Tees Esk and Weir Valleys (TEWV) mental health trust saying it would be unable to legally re-register the hospital, meaning it would have to close.

Martin Barkley, chief executive of TEWV, replied to David Behan, chief executive of the CQC early in the morning of 28th September:

“I think it is the first time an NHS hospital has been closed … in such a short period of time.”

He  said that a contract was ready to be signed committing to an investment of £2m for repairs.

Behan responded that TEWV Trust could choose to invest in repairing Bootham Park but

“there can be no guarantees that the CQC would register these services”.

Martin Barkley resigned soon after –  although TEWV NHS Foundation Trust said this was because he had decided to retire, not because of the closure of Bootham Park Hospital.

TEWV trust’s claim of his retirement is belied by that fact that Martin Barkley is now Chief Executive at the MId Yorks NHS Trust.