The History...

By the mid-1970's it was already evident that the NHS was creaking and a growing minority - including me - both inside and outside the NHS were looking for better ways of delivering good care. At that time, there was almost a total monopoly of NHS hospitals and there were only about 100 independent hospitals, almost all of them charities, which had remained outside the NHS. Having left the NHS to set up the BUPA Hospitals organisation, I came to know most of the charities very well and subsequently provided consultancy advice to many of them. Perhaps not surprisingly, not all of them knew how to adopt the businesslike approach which was becoming increasingly necessary. International entrepreneurs increasingly saw the opportunity for profitable commercial medicine in Britain and in addition to new buildings sought increasingly to take over the charitable and religious hospitals at an alarming rate. In the belief that overtly private medicine in opposition to the NHS should not be the way forward, a group of likeminded people, all knowledgeable and eminent within their spheres of healthcare, decided to band together and form The Hospital Management Trust as 'a charity to protect the charities'.

Hence was born HMT in June 1985 and of the original Trustees three are still with us - the Earl of Gainsborough as President, John Underwood as Chairman and David Lock as Vice President. Of the other originals, Sir Gerard Vaughan MP and Dr John Anderson FRCP have sadly departed this life and our two American Trustees from the Sisters of Mercy in Michigan withdrew from the Board once HMT had become firmly established. Not many people will know that the Mercy Sisters had set up a large-scale organisation similar to HMT in the USA some years before and as a result were generous benefactors in loaning us the money to get started with the acquisition of St Hugh's Hospital in Cleethorpes in 1985. Then as now, our objects were very clear in seeking to be a bridging link between the NHS and the commercial private sector whilst at the same time seeking to develop hospitals and homes within the ethos of their founders. Those parameters are fundamental to the concept of HMT and to the values of the Trustees and Board members we have been fortunate to attract over the years.

HMT has always sought to support hospitals and homes rather than to be acquisitive and although there are now seven hospitals and homes owned or managed, over the years HMT has also run another eleven hospitals and numerous nursing homes. Not all of them have remained successful but at least their Trustees were able to make conscious decisions about their future as a result of the advice and support given.

Life does not stand still and the HMT Board has never been shy of making the decisions necessary to move forward. St Hugh's Hospital was completely redeveloped in 1993, Sancta Maria Hospital in Swansea, which came into HMT in 1988, will be replaced by a new hospital within the next couple of years and the Claremont Hospital in Sheffield, which was taken over in 2003 has recently completed a multi-million pound remodelling programme.

Strong relationships with the medical profession are integral to providing quality hospital care and HMT has been pleased to support the formation and administration of the London Consultants Association (LCA) and the national Federation of Independent Practitioner Organisations (FIPO)

Increasingly, care of the elderly has become a major part of HMT's activities and we are privileged to work in partnership with far-sighted religious Orders committed to improving the quality of life for the elderly. It is only in recent years that the emphasis on elderly care has grown and it is a marker for the way in which adaptation to change is necessary in order to continue to succeed.

HMT is a unique organisation in Britain. Life is not always easy but the qualities which have helped its success over the past 20 years will help continuity for the next 20.

The Future...

The only certain thing in healthcare in 2007 is the fact that it will continue to be uncertain. Never has there been such a political upheaval in the way that healthcare is delivered nationally - particularly when the growing commercialisation is being promoted by a Labour government in a way which the Conservatives would not have dared.

There is no doubt that the independent hospital sector will become an established part of provision in Britain and HMT is very well established in its locations. Ironically, however, where one might have expected the charitable non-profit hospitals to be welcomed by the NHS, instead the Government has opted to adopt a very commercial approach aimed at largescale international organisations being favoured for multi-million pound contracts set by the Department of Health. In theory this could leave relatively small organisations like HMT with a dilemma but there is likely to be a counterbalance over the next few years as patients and GPs are given greater choice of hospitals for surgical procedures. All of HMT's hospitals are respected and valued in their local communities and are likely to benefit in the mid-term, particularly as HMT's objectives are to work with the local NHS hospitals and not in competition with them. Strong relationships are being developed and the HMT Board is determined to see the hospitals as part of the 'new wave' of provision. Whilst competition is the focus of the Government's agenda at present, in the long run collaboration with the NHS can be the only way to meet the real needs and fulfil public expectation.

For care homes, the outlook is somewhat different. Already there is now almost no provision within hospitals and Local Authorities anymore and the emphasis is on developing relationships between the type of homes that HMT and religious orders can provide in giving the highest quality care at affordable prices. Because the homes with which HMT is associated are not seeking to make substantial profits and place an emphasis on the quality of care, their success is hardly surprising. We confidently expect HMT's involvement to increase across a wider spectrum of care of the elderly. Indeed in ten years' time it may be the largest part of HMT's activities.

No doubt other needs and opportunities will arise over the years and HMT will be sure to respond to them with the same commitment to public benefit.

J B Randle
Executive Director