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This can’t be not happening – horror as Hinchingbrooke fiasco fails to unfold


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Friday, 3 August 2012

This can’t be not happening – horror as Hinchingbrooke fiasco fails to unfold

Gnashing of teeth greeted the news of modest progress at the NHS’s first privately run hospital.

The management of Hinchingbrooke got a good half-term report after its first six months in charge.

Under NHS control the hospital had run up debts of £40m and had been condemned by the government as a clinical and financial basket case. It is now run by Circle, a private company.

Opponents of the scheme are cross that Circle has managed to improve services and started to turn its finances around.  What should have been a sizzling clinical farce in a rich fiasco sauce is showing disturbing signs of being not very tasty at all. 

Where are the dead patients, the terrifying increases in hospital-acquired infections, the vicious cuts in services, the unravelling finances, the disappointed shareholders? 

The Unison representative on Radio 4’s Today programme said that staff are worried about cuts, safe in the knowledge that staff everywhere are worried about cuts.  Searching for a patch of authentic gloom, the best she could manage was to accuse Circle of cutting cleaning contracts.

That could only mean three things: infection, death, headlines. The interviewer dug deeper, but there was nowhere to dig. Hinchingbrooke has cut cleaning services for residential areas of the hospital - doctors' and nurses' quarters - but increased cleaning in clinical areas, according to Ali Parsa, Circle's chief executive.

Worse still, patients are very happy with the service they receive – have they no shame?

The union rep could only grind her teeth as she struggled to congratulate the hospital without implicating the management in its success. It was early days. Still plenty of time for Circle to screw up, she implied.

Plenty of people hope she’s right. Many regard Hinchingbrooke as an aberration, the beginning of the end. 

The truth is less exciting.  The NHS has never been entirely run by the state. General practice has been a private franchise since 1948. Maybe it’s time for hospitals to catch up.

The BBC interviewer expressed incredulity at Circle’s claim to have identified £1.6m in savings on stationery, slightly more than the saving made by reducing stays for hip and knee operations. Never mind the clinical improvements, why was the previous management incapable of working out that the hospital was spending too much on envelopes?

Read the small print of the Circle deal at Hinchingbrooke and you’ll see that it’s hardly a cherry picker’s charter. This was not a fabulously successful hospital at the top of its game just waiting to be stripped of its assets, but a failing institution begging to be shut down. If Circle makes a small profit it will be able to keep the hospital going. If it makes a bigger profit it will be obliged to pay off the inherited debt. Patients won’t care about any of this as long as they keep getting a decent service. 

If Circle succeeds in turning Hinchingbrooke round it will have earned its money. If it fails, there will be plenty of losers ready to cheer from the sidelines, but no winners.

Listen to the interview with Karen Jennings of Unison (1:12.09), analysis by the BBC’s Mark Easton (2:10.37) and the interview with Ali Parsa (2:13.40). Select the relevant segments using the slider in the iPlayer pop-out box (timings are shown in brackets). It's all here.


anoop.maini@gmail.com says:
Aug 03, 2012 11:29 AM
Perhaps we ought to have an inquiry as to why Circle has not screwed up. We always do very well at investigating the reasons when things fail. But we seldom, if ever, investigate why things work. Humans are strange animals...
ewatson1972@gmail.com says:
Aug 03, 2012 11:45 AM
I agree with Anoop. Ali Parsa should be hauled up in front of a committee of MPs to explain himself.
diabetesw says:
Aug 03, 2012 11:51 AM
Although no great friend of PFI and its associated rip offs it is good to see that some private sector techniques can work in the NHS. All patients want is high quality, safe care and don't worry about who provides it. And it is good to see someone point out that GPs are no more than small businesses - I always laugh when I hear GPs complain about the privatisation of the NHS,
harry.longman@gmail.com says:
Aug 03, 2012 12:11 PM
Better, I would argue, than "who profits out of this?". Because if it works, we all profit. And if Circle make Hinchingbrooke work better, we have something which could benefit the entire NHS, whereas if it doesn't we've lost very little.
armacd@ntlworld.com says:
Aug 03, 2012 12:14 PM

There have been disturbing reports coming out of Hinchingbrooke that non 'Health-Professionals' can understand what managers say, and that they talk clearly about practical matters. Moreover, there is this alarming idea that you get things done quickly.

ewatson1972@gmail.com says:
Aug 03, 2012 12:25 PM
Yes, Harry, but it's amazing how many people have missed that point. Everyone gets steamed up about the idea that Circle could make a profit and claims the money should be used for care - but there would have been no surplus under the old management, just a continuing big fat loss. Or no Hinchingbrooke at all.
jason.scott@nhs.net says:
Aug 03, 2012 12:26 PM
My worry with private involvement in the NHS has always been that their driver is profits and that at some point they'll tweak the services to maximise and grow those profits, which might be incompatible with providing good healthcare.

So long as we get the same and better standards whilst still retaining a free at the point of care health system I guess this can work.
justine.owens@ipswichhospital.nhs.uk says:
Aug 03, 2012 12:47 PM
Something finally to smile about in the NHS. Just loved this and so true.
robert.rowell@nhsemployers.org says:
Aug 03, 2012 01:32 PM
Regardless of anyones personal point of view, it is refreshing to see the editors blogs used for a well thought out articulate commentary on current NHS issues.
The existing format (repeatedly negative, sarcastic views passed off as comedy) was fine occasionally, but IMHO was getting tired.
stephanie.edusei-basra@newcastle-pct.nhs.uk says:
Aug 03, 2012 01:38 PM
The Today programme presented a very different view of things to yesterday's HSJ report http://www.hsj.co.uk/[…]/5047838.article

I suspect that the truth lies somewhere between the two
olayaip@hotmail.com says:
Aug 03, 2012 06:06 PM
Sorry but I have to wholeheartedly disagree with one of your last sentences; "If Circle succeeds in turning Hinchingbrooke round it will have earned its money."

While I would be very happy for any enterprise to improve the care of our nation NO ONE should 'make a profit' out of public health. You get your wages and any profit (i.e.savings, because they should not be paid more than the cost of providing the service) should be reinvested to continue to drive up quality and availability of care... no public service should be victim to the demands of shareholders, only users are entitled to that.

Let's face it, the highest tiers of management (both private and public) get rewarded enough to have a fantastic quality of life themselves with a nice early retirement(I only get a fifth of what they get despite the huge stress, responsibility and lack of work-life balance and the prospect of retiring with 52 years of service under my belt, and, probably a hip replacement). And in reality most 'frontline staff' are just happy to keep their wages and employment benefits as they have been since AfC. We don't want bonuses, we just want to help people...

Please let's not normalise the existence of healthcare, 'profit' and similar capitalism-related ideals in the same conversation... THAT will be the beginning of the end. Or have you not seen what happens when personal gain and profit supersedes moral obligation to society?
harry.longman@gmail.com says:
Aug 04, 2012 11:43 AM
Dear Anonymous,
Firstly, if you believe in your views, please own up to them and state your name.
Now, let's look at the arguments. I was struck recently by a map of Europe which showed, some 20 years after the fall of the Berlin wall, that the Iron Curtain still held its grip across the continent in the form of life expectancy. A huge gap, something like 10 years from memory. The communist system did not deliver.
Now you are berating the idea of capitalism and "profit" as a dirty word. We are only too aware of our travails from the failings of capitalism, risky bankers in particular, but be careful about condemning everything we now enjoy in our standard of living and our standard of healthcare as the fruit of evil. In our society you can't insulate yourself from the benefits of profit. You could in North Korea (there aren't many places left, it has to be said).

In our society we have chosen to have a state run health system and have achieved better results than many other nations. But "better" in my book is simply not "good enough". We need continuously to innovate and improve, as all our political and NHS leaders keep saying. That is going to come from lots of different sources, public and private, but it is not going to come from one single top down central plan. They don't work. NPfIT anyone?

I've worked in the private sector and in the NHS and in both I've seen an exemplary service ethos, in both I've seen gross incompetence, political lies, backstabbing, bonus driven skulduggery, and waste on a colossal scale. In roughly equal measure in both public and private sectors. Now I work in a social enterprise. It doesn't really matter - back to my earlier question: what works?
s.cribb@nhs.net says:
Aug 06, 2012 02:26 PM
Its a sad day when the weekly blog is a true to life success story... i look forward to the whimsical work of fiction.

Reluctantly, seriosuly, well done all.
Theo.Bowman@nelft.nhs.uk says:
Aug 06, 2012 05:19 PM
Those for or against shoulnd't make rash judgements. They say it takes 2 years to turn around a failing school so surely a hospital, which is a much more complex organisation,will take longer. This is not selling baked beans so we must give it a chance to see what it can do OVER A REASONABLE period of time and should be treated as a pilot before plunging into 'any willing provider.
As for using the example of the Gp franchise as a shining becon of such an enterprise, as a senior nurse working in community for many years, my comment is "don't make me laugh!"