[2] It was administered by Hinchingbrooke Health Care NHS Trust which developed financial problems and was obliged to borrow £27.3 million in Public Dividend Capital in the year ended 31 March 2007.

It found that while Circle had made early improvements in some clinical areas, the projected deficit for the year ending 31 March 2013 was already £2.2 million higher than planned.

The NAO also found that while NHS East of England had assessed bidders' savings proposals, the relative risks had not been fully considered, which had the potential to encourage over-optimistic bids.

[15] The hospital made an offer in September 2014 to pay local GPs a £50 'administrative fee' for surgery referrals in an email, signed by Hinchingbrooke chief executive Hisham Abdel-Rahman, which was rapidly withdrawn when the company was accused of bribery.

[19] UNISON called for Circle to be 'sacked', claiming that papers tabled for the Board meeting in October - which did not include a financial report - showed the organisation faced (i) potential penalties of up to £200,000 per month for failure to meet targets for patients waiting longer than four hours in the accident and emergency department (ii) potential penalties for failing to reach electronic discharge summary targets which already stood at £138,000 and (iii) potential penalties of a further £150,000 for failing to increase the number of patients discharged at weekends.

In response Circle said: "We are a bit bemused as we haven't changed our financial forecasts for the year and Hinchingbrooke's clinical outcomes remain very strong.

[28] The Trust then announced in April 2015 that it expected the deficit for the year ended 31 March 2015 to be £14 million, which was considerably worse than had been forecast by Circle.

Despite this the small size of the Trust was making it hard to sustain high quality clinical services and so alternative management solutions were sought.

[32] The Guardian newspaper noted that a 2020 proposal to rebuild Hinchingbrooke Hospital was not funded by HM Treasury during Rishi Sunak's term as Chancellor of the Exchequer, despite a "catastrophic" grade of risk and a warning that an incident was "likely".