Monday, 14 November 2011

Is sentimentality getting in the way of progress for the NHS?

As predicted – there has been much ruffling of feathers and beating of breasts following the coalition’s announcement that a private health partnership Circle, will take over the running of the failing NHS Hinchingbrooke Hospital, near Cambridge.

‘No-one should make profit from health’ said Terry Christian, TV presenter on a daytime chat show. Liz Kendall, shadow health minister is ‘deeply worried’. ‘An accident waiting to happen’ warns Christina McAnea, from the union Unison.

In a £1bn deal, Circle has 10 years to run the hospital, which is currently £40m in debt. This debt has been accepted by Circle as part of the deal.

Perhaps the nay-sayers to this franchise agreement should hold their horses for one cott’n pickin’ moment. Let’s look at the facts…

Hinchingbrooke Hospital serves a community of over 150,000 people. A community who vehemently want their hospital to remain open, delivering care ‘free at the point of delivery’ as per the NHS founding values. Hinchingbrooke Hospital has been ‘failing’ for years. Failing to reach minimum standards in quality, safety and financial control. The hospital has floundered under a succession of NHS management teams who failed to take control of the escalating debt, poor morale and falling standards.

My grandmother had a saying ‘never throw good money after bad’. There was a growing pit of debt at this hospital. Something had to give and there were three options. Try yet another NHS management team, close the hospital, or put the management of this wounded beast up for tender. The third option had to be the best choice, although in true NHS fashion – the tender process took over 18 months, as money and quality dripped away in Cambridgeshire.

The appointment of Circle health partnership is, I think, courageous and worthy. Their track record in running hospitals is good so far. Their approach of partnerships – so effective in organisations such as the retail giant John Lewis, sits comfortably with NHS principles. And I think they have a very good chance of turning the hospital into an efficient, high quality care provider. Yes services may need to be rationalised – but show me an NHS hospital that isn’t going through rationalisation.

What are the real dangers of this decision? Not many in my opinion. There is an opt-out clause so the government can pull the contract if sufficient progress isn’t made. There must be regular and effective lines of communication between the NHS and its franchisee.

‘No front line jobs will be lost’ according to Simon Burns, health minister. I see that as a potential negative rather than a positive. One of the biggest problems with the NHS is the lack of performance management in some areas. I would like to think that Circle will ensure that staff perform to the standards required and poor attitude or performance is not rewarded with continued tenure.

The main ‘danger’ I perceive? Sentimentality. Speaking as one who is dreadfully sentimental (bereavement, age, parenthood are my excuses) – I feel we really must put sentimentality aside in this case. ‘Save our NHS’ is a popular Twitter hashtag, and I don’t think anyone would argue with that particular sentiment. But trusting the management of a failing hospital to an existing failing system for sentimental reasons just isn’t good enough.

Yes – I do get very sentimental about the NHS, especially when I comment on the Health and Social Care Bill, which I believe will do harm to the state funded care system in general. But when bits are broken and need fixing – sometimes you need to look further afield for the best organisation to do the job. And if Circle make some profit AND save a hospital, turn around £40m debt while providing cost effective high quality care and keep good staff in their NHS jobs - good luck to them.


Chairman Chegwin said...

Good piece Marcia.

This hospital hasn’t been financially viable for some time and was carded for possible closure. I won't debate the rights and wrongs of that, if however the John Lewis model works and the hospital is turned round, then why couldn’t this be a template for the future?

This hospital remains in the NHS and users of the hospital won’t pay fees - their medical care is free at the point of use just as it is in the rest of the NHS. As far as I’m aware, the clinicians who work there are fulfilling their NHS service contracts and consultants are not using it as a private hospital for their private practices.

The only thing that is changing as far as I can see is that the hospital is being removed from the dead hand of NHS management which has managed to run up £40m plus of debt (which the new investor is assuming). Control is being taken from the NHS managers and given back largely to the clinicians. How is this a bad thing?

I would imagine that the company is driven, in part, by a profit motive. I realise the P-word is anathema to many when spoken of in the same breath as the NHS but it can actually be an incentive for good if it isn't distorted as it has been in the financial markets.

The hospital itself is not the NHS, it is a tool that the NHS uses to deliver patient care. As long as the NHS has hospitals within which it can treat patients, who owns or runs them is not in my mind critical, and IF this company can run them within the current budget and without incurring any further losses then good luck to them.

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