The board of Peterborough and Stamford NHS Trust failed to recognize in 2007 that a PFI scheme to build a new hospital, Peterborough City Hospital, would place considerable strain on its finances for years to come. The then board compounded the decision to proceed with the scheme, which it could not afford, with a failure to monitor other changes affecting its income and costs between 2007 and 2011. In 2011-12, the in-year deficit was GBP46 million and the Trust is predicting an in-year deficit of more than GBP50 million in 2012-13. Monitor, the regulator of foundation trusts, raised well-founded concerns about the scheme's affordability with the Trust Board and the Department, however neither addressed these concerns fully before approval of the business case. Despite its earlier views, the regulator rated the Trust as a very low financial risk, reflecting its reported financial position but this risk rating did not reflect the future impact of the PFI development. Monitor had a number of opportunities to intervene before finally placing the Trust in breach of its terms in October 2011 but concluded that an intervention would not necessarily improve or change the outcome positively. The level of healthcare undertaken by the Trust is also greater than envisaged in the PFI business case, which assumed a 14 per cent drop in outpatient activity whereas this increased by 21 per cent. In addition, NHS Peterborough, the Trust's main commissioner, which has been in financial difficulty itself, has used national and local performance indicators to withhold payments for activity undertaken by the Trust
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