NHS stealth privatises thousands of jobs


4:24 pm - November 16th 2010

by Sunny Hundal    


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The Department of Health sent out this innocuous sounding press release today: Thousands of frontline NHS staff take control of £900 million of services.

It’s a nice day to bury bad news (hat-tip Richard Blogger).

The press release states quite excitedly:

Thousands of frontline NHS staff are taking control of the services they deliver in a drive to transform patient care and improve health outcomes, Secretary of State for Health Andrew Lansley announced today.

Thirty-two projects will form the third wave of NHS organisations that want to set up social enterprises, through the NHS ‘Right to Request’ scheme that gives public sector workers the opportunity to become their own bosses.

Sounds exciting! Public sector workers getting more control over budgets and having decision making localises! Who would be against that??

But scroll further down and you get this gem:

These proposals will transfer an estimated £900m of services and almost 25,000 NHS staff into the social enterprise sector.

The proposals in this third and final wave span nine of the 10 Strategic Health Authorities and include services like primary care access for the vulnerable and homeless, sexual health services, and support for bereaved children and families.

In other words these jobs have essentially been privatised.

It’s worth emphasising the difference however. A social enterprise reinvests profits in the business or the community rather than deriving profits for shareholders. That’s not entirely a bad model.

But there a lot of unanswered questions here: will these organisations be subject to national standards? Will they be subject to FOI requests? What impact will this have on service delivery?

The Nursing Times reports that similar attempts to localise maternity services, rather than be run by the national commissioning board, faced criticism.

Doctors’ groups have joined midwives in opposing a government U-turn that would see control of maternity services handed to GPs, warning such a move would lead to a fragmented service and a potential postcode lottery.

The potential for the same here is also obvious.

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About the author
Sunny Hundal is editor of LC. Also: on Twitter, at Pickled Politics and Guardian CIF.
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Reader comments


I should point out that this was set up by New Labour who created the Right To Request policy to off load Community Health Services (about 15% of NHS funds are spent on community services). The difference is that Lansley intends to extend this to all NHS services, so in 2015 all hospitals will be taken out of public ownership in a similar way to how many Community Health Services have.

Also note that not all Community Health Services have been taken out of public ownership, in some areas they have been transferred to a local hospital Foundation Trust.

As far as I can tell, the only people opposing this stealth privatisation are the unions (particularly Unison and Unite), the Labour party are extremely quiet about this, understandably since it is their policy. I reckon Labour will be quiet about hospitals being taken out of public ownership too. We will know that Labour has finally returned to the side of public opinion when they ditch their policy of approving the change of NHS providers into “social enterprises”.

“It’s a nice day to bury bad news”

Nice, I see what you did there. A subtle smear against the Tories here, another smear there, and soon you have quite a stain. Keep it up.

How do they manage to run healthcare services in other west European countries where they achieve better outcomes and attract better ratings by patients compared with the NHS?

“At least 100 patients are dying or suffering serious harm each year after healthcare workers give them the wrong medication. The number of alerts relating to errors or ‘near-misses’ in the supply or prescription of medicines has more than doubled in two years, the National Patient Safety Agency said.

“More than 86,000 incidents regarding medication were reported in 2007, compared with 64,678 in 2006 and 36,335 in 2005. The figures, for England and Wales, show that in 96 per cent of cases the incidents caused ‘no or low harm’, but at least 100 were known to have resulted in serious harm or death.”
http://www.timesonline.co.uk/tol/life_and_style/health/article6820090.ece

“Accidents, errors and mishaps in hospital affect as many as one in 10 in-patients, claim researchers. The report in the journal Quality and Safety in Health Care said up to half of these were preventable.

“Checks on 1,000 cases in just one hospital found examples of fatal surgical errors, infections and drug complications.”
http://news.bbc.co.uk/1/hi/health/7116711.stm

The Tories must be sobbing at my attempts to besmirch their fine reputation

Sunny

The Nursing Times story is about GP commissioning, and their lack of capacity to commission maternity services properly, rather than about privatisation/social enterprisification of maternity services directly. The point is that GPs will in many instances outsource their commissioning function to the private sector e.g. Capita, Serco etc., although there are ex-PCT staff TUPE issues in there.

Of course, once the commissioning teams come from the private sector, then mas privatisation of service delivery may follow more easily, but it’s not exactly the same issue as the outsourcing to social enterprise of a range of community health services, which as you say may be no bad thing in itself if both staff conditions and service standards are guaranteed.

In an interview on the BBC Today programme with John Humphrys in 2007, Professor Lord Darzi, then a New Labour health minister, trotted out that old myth that the NHS is the envy of the world. Had he bothered to ask around in other west European countries, he could have easily learned that is not true.
http://www.guardian.co.uk/commentisfree/2007/oct/05/health.publicservices

And selling off the cleaning contracts to private firms under the tories who employ illegal immigrants was such a great success (not)

Infection rates shot through the roof as a bunch of low paid de motivated staff took over. I don’t remember this in the Lie Dems manifesto. But then as we know the Lie Dems lie and lie and lie.

With 1.3 million employees, the NHS is the largest, centrally managed employer in the whole of western Europe.

And as we’ve seen from the public inquiry now in progress into care at the Mid Staffordshire Hospital Trust, the failings in care there were deep rooted and went on for years.

“The inquiry follows a report which found appalling standards of care had led to 400 more deaths than should have been expected between 2005 and 2008.”
http://www.bbc.co.uk/news/uk-england-stoke-staffordshire-11711097

“Nurses and doctors face being struck off over Stafford Hospital scandal”
http://www.telegraph.co.uk/health/healthnews/8131135/Nurses-and-doctors-face-being-struck-off-over-Stafford-Hospital-scandal.html

In a recent study of the care of the elderly in NHS hospitals, only just over third were judged to have had good treatment:
http://www.bbc.co.uk/news/health-11728163

“The NHS has seen a year-on-year fall in productivity despite the billions of pounds of investment in the service, latest figures show. The data from the Office for National Statistics showed a fall of 2% a year from 2001 to 2005 across the UK.”
http://news.bbc.co.uk/1/hi/health/7610103.stm

This news item recently appeared in my local press:

The chief executive of St Helier Hospital has called for a crackdown on nurses accessing Facebook at work after a complaint they have been ignoring patients because of it.

Sam Jones told the hospital’s IT team to stop staff logging on to the social networking site after an allegation nurses were checking their profiles rather than helping vulnerable patients at meal times.

The complaint was made to MP Tom Brake by one of his constituents.

A spokesman for Epsom and St Helier University Hospitals NHS Trust confirmed Facebook had been blocked from trust computers for at least two years, but conceded staff may have found ways to get round the ban.
http://www.yourlocalguardian.co.uk/news/local/suttonnews/8381082.Nurses_told_not_to_Facebook_at_work/

For curious reasons, this post has disappeared so I’m reposting it:

With 1.3 million employees, the NHS is the largest, centrally managed employer in the whole of western Europe.

And as we’ve seen from the public inquiry now in progress into care at the Mid Staffordshire Hospital Trust, the failings in care there were deep rooted and went on for years.

“The inquiry follows a report which found appalling standards of care had led to 400 more deaths than should have been expected between 2005 and 2008.”
http://www.bbc.co.uk/news/uk-england-stoke-staffordshire-11711097

“Nurses and doctors face being struck off over Stafford Hospital scandal”
http://www.telegraph.co.uk/health/healthnews/8131135/Nurses-and-doctors-face-being-struck-off-over-Stafford-Hospital-scandal.html

In a recent study of the care of the elderly in NHS hospitals, only just over third were judged to have had good treatment:
http://www.bbc.co.uk/news/health-11728163

“The NHS has seen a year-on-year fall in productivity despite the billions of pounds of investment in the service, latest figures show. The data from the Office for National Statistics showed a fall of 2% a year from 2001 to 2005 across the UK.”
http://news.bbc.co.uk/1/hi/health/7610103.stm

Although it’s right that the social enterprise sector does not keep it’s profits, that doesn’t mean that itbehaves any differently than commercial companies with shareholders; all organisations have PIs to meet and a bottom line. Building a vigorous and entrepeneurial social enterprise sector though can have unforeseen consequences: they become good at identifying and attracting new funding – not necessarily good at providing better services. Look at the Supporting People funding regime where the New Business departments of the Housing Association Sector jumped on every perverse incentive and ambiguity within the funding regime to push it many times over the expected spend.

I’m not sure how I feel about this.

Unlike some, I don’t have a problem in principle with non-governmental but non-profit organisations running services. Well run, it could work. However, given the current climate (and given the perpetrators) I suspect the sequence of events will go something like this:

1) Hand organisation to co-operative
2) Remove virtually all funding for the service
3) Blame co-operative model and staff for subsequent collapse of service
4) Declare obvious need for ‘ruthless private sector efficiency’, and sell service to commercial sector
5) Service continues in semi-collapsed state, but with increased funding to cover shareholder dividends and expensive board of directors

@10: “Building a vigorous and entrepeneurial social enterprise sector though can have unforeseen consequences”

Quite so. Try this outstanding example of Social Enterprise in the delivery of personal services across the London borough where I live:
http://www.visitingsuttonescorts.co.uk/

13. the a&e charge nurse

“The NHS is the ONLY health system in the industrialised world where wealth does not determine access to care – providing the most widely accessible treatments at low cost among rich nations”.
http://www.guardian.co.uk/society/2010/nov/18/nhs-best-free-access-healthcare

This focus on clinical need, irrespective of ability to pay, is one of the main drivers to doctors and nurses routinely putting in hours and hours of unpaid work each week – abandon such an ethos in favour of the market at your peril – a development NuLab completely failed to understand when they vandalised GP out of hours care which soon led to an increase in complaints once these services were taken over by private firms.
http://news.bbc.co.uk/1/hi/health/6935018.stm

According to this report “the average number of extra hours (worked by nurses) has remained around seven every week”.
http://news.bbc.co.uk/1/hi/health/2395659.stm
Now given that there are some 400,000 nurses working in the NHS that translates to a lot of good will – a factor that we seldom here about when commentators champion the findings of one consumer group or another?

Just one of the troubles with the NHS is that the quality of care it provides is very uneven – as is shown by events at the Mid Staffordshire Hospital Trust and the findings of the recently completed study on care of the elderly.

As a recent guest of the NHS, I can testify to that too – just for starters, like being handed a consent form to sign for surgery which specified the wrong operation and which had to be corrected by the surgeon in manuscript before I would sign.

Contrary to NHS advice, I insisted on going on convalescence – which I had to pay for – after discharge just seven days following major surgery because I was advised to do so by a (hugely experienced) retired professional social worker who had had the personal experience of the same operation and wasn’t just repeating NHS propaganda handouts.

Having said that, I did experience many examples of exemplary NHS care as well as the other variety. After just seven days in an NHS hospital, I arrived at the convalescence home with bed sores. Other patients at the convalescence home had their own stories to relate about witnessing bad nursing care in several hospitals – escpecially in the treatment of elderly patients reckoned to be not quite with it.

The statement quoted @8 from the chief executive of our local hospital telling nurses to stay off Facebook while on duty gives an insight into what really goes on.

In independent international assessments, the NHS rates only as mediocre compared with the healthcare systems in other west European countries.

For the latest comparisons for 2010 by the Health Consumer Powerhouse in Sweden between the healthcare systems in Canada and most European countries, try:
http://www.fcpp.org/files/1/10-05-10-Euro-Canada_Index_2010_FINAL.pdf

The healthcare system of the Netherlands was rated best. The UK was ranked at number 17.

16. the a&e charge nurse

Time and again you quote HCP data despite it’s value being dismantled on several occasions (I’m not going to do it again).
You also persist with your idealisation of ‘Europe’ – as if any meaningful conclusion can be drawn from comparing a single system with an entire continent.

Can you find a single country in Europe that offers treatment (supported by clinical evidence rather than Daily Mail type scare stories) that is not available on the NHS.
Or put another way – pick a condition that you think represents the zenith of European health care then lets compare it to the NHS.

If you waffle in grandiose terms we cannot get to the meat of your concerns – and I certainly accept there are significant failings, just as there are strengths with our system.

I think about it this way (if we take cancer as an example) – a train leaving from London to Glasgow takes ‘x’ amount of time – if we measure this time at various points along the journey it still does not affect the overall distance.
Now if somebody with prostate cancer, say is diagnosed at a slightly earlier stage this fact does not necessarily guarantee longer life although it may improve stats on detection, and therefore create an illusion that one countries cancer care is more effective than anothers?

“You also persist with your idealisation of ‘Europe’ – as if any meaningful conclusion can be drawn from comparing a single system with an entire continent.”

Rubbish. The whole point about the HCP as well as the aged WHO studies was that these compare the national healthcare systems in other countries – and the NHS regularly rates as mediocre compared with other west European countries. I also often talk with French friends and what they know from relatives of what happens there.

“If you waffle in grandiose terms we cannot get to the meat of your concerns – and I certainly accept there are significant failings, just as there are strengths with our system.”

That’s more rubbish. The reports of the public inquiry into the failings at the Mid Staffordshire Hospitals Trust and the study into the care of the aged are very specific – and so is my recent personal experience of NHS care, such as being asked to sign a consent form prior to surgery for the wrong operation and arriving at a (private) convalescence home with bed sores after just 7 days in an NHS hospital.

Go on, be innovative for once and address the facts in the public domain instead of regurgitating NHS propaganda.

What of the news @8 from our local press on instructions to nurses at our local NHS hospital from the chief executive to stay off Facebook while on duty?

Links for those who evidently missed the news reports into the public inquiry into the failings in care at the Mid Staffordshire Hospital Trust and the recent study into the care of the elderly:

Relatives of patients who died unexpectedly at Stafford Hospital filled the front rows of seats at the start of the public inquiry into what went wrong.
http://www.bbc.co.uk/news/uk-england-stoke-staffordshire-11711097

Only a third of elderly patients who are admitted to hospital for an operation get good care, according to an authoritative report published today which found that their needs were not often fully understood by doctors.
http://www.guardian.co.uk/society/2010/nov/11/nhs-hospital-care-elderly

19. the a&e charge nurse

[17] “address the facts in the public domain instead of regurgitating NHS propaganda” – I will give my opinion if you really want to hear it, but you have to deal with specifics (rather than comparing one countries health system to an entire continent).

So, SPECIFICALLY, what facts are you asking me to address?
Let me start the ball rolling – you imply that NHS nurses are too busy on ‘facebook’ to care for patients, such a glib comment tends to suggest that you have very little insight into the demands placed on most nurses working in acute settings, neither do you seem to have much of a grasp as to WHY there is a world of difference between private health services who can SELECT patients (based their on ability to pay) rather than a truly comprehensive service expected to deal with all and every patient who comes in through the door.


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