For all the optimism that surrounded the opening of the eight TCs we were following, by 2006, when our three-year study ended, St Urban’s had closed and Ruckworth was on the verge of doing so (see Table 2.1, Chapter Two). Three of the others (Robbleswade, Stanwick and Northendon) were in deep difficulties due to a paucity of patients and were in discussions about selling space and/or capacity to the independent sector. (Since then, however, they have resolved their problems in their different ways and are still, in 2010, operating as NHS TCs.) Only three of the eight were functioning in 2006 comfortably within the NHS as part of the NHS TC programme. Two of these, Pollhaven and Lakenfield, were relatively small-scale initiatives that had been absorbed back into their host trusts, but were still attempting, with differing levels of success, to practise the ideals of re-engineered care pathways that separated elective and emergency care, increased activity and improved patient experience. Only one of the eight, Brindlesham, appeared in 2006 to have weathered the storm to emerge as a standalone unit that largely mimicked the early ACAD and exemplified key elements of the original policy model of what an NHS TC should be.

What were the reasons for the ways the TCs turned out at the end of our study? To a large extent the answer lay in the available capacity of the hospitals in a TC's catchment relative to the total number of patients. At one extreme, Ruckworth, Stanwick and St Urban's were opened in an environment where there were simply not enough patients to allow them to compete effectively in an era of Patient Choice, ‘G-Supp’ or independent sector TCs (see Chapter Four), and the effects were devastating. Lakenfield, at the other end of the spectrum, had a shortage of beds and therefore faced little threat from such policy shifts. At the other four TCs it took a great deal of wheeling and dealing, competitive marketing and collaboration with the commissioners and providers of healthcare to achieve a reasonable throughput of patients because the original planning assumptions had proven to be over-optimistic. The immediate question, therefore, is why the predictions of patient numbers had proven so unreliable.