TIM GEORGE
ANALYSIS
Full circle at privately-run NHS trust as operator hands it back While MPs and management argue about what went wrong at Hinchingbrooke, staff work to ensure care quality improves. Katie Osborne reports The only private company to run an NHS hospital announced last month it was pulling out of its contract early because it could not cope with funding cuts and rising patient numbers. The company, Circle, which took over Hinchingbrooke Hospital under a ten-year contract in February 2012, said the agreement had become unsustainable. Later on the same day, the Care Quality Commission (CQC) published an inspection report on the hospital, rating it inadequate and recommending it be placed in special measures.
The CQC gave the Cambridgeshire hospital an ‘inadequate’ rating for care, making it the first in the country to receive this lowest rating. CQC inspectors had found ‘poor emotional and physical care’. Pressure ulcer prevalence in medical areas was consistently high and staff did not always adhere to National Institute for Health and Care Excellence guidance on pressure ulcer prevention. Hand hygiene and infection control techniques were poor and some staff members were heard being rude or dismissive to patients, the report said.
One patient told inspectors that staff were ‘often too busy’ to help with visits to the toilet during the night. The individual reported being told ‘to go in the bed and it will be changed when we have time’. The patient said on one occasion there was a 20-minute wait for a nurse, by which time they had already soiled the bed.
Commons inquiry
Circle has announced it is ‘in discussion’ with the CQC because it disputes the ‘inadequate’ rating, arguing that the regulator’s report is unbalanced and misleading. The House of Commons public accounts committee has now begun an inquiry into the causes and consequences of Circle’s decision to withdraw from the contract. MPs
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ANALYSIS
questioned CQC chief executive David Behan over the regulator’s inspection report, the draft of which had been criticised by Circle for containing numerous inaccuracies. The MPs argued the CQC was unable to prove patients had been told to soil themselves. Nurses have been left impotent by Circle’s decision to ‘abandon ship’, and are ‘tearing their hair out’ over the uncertainty at the hospital, says RCN eastern region director Karen Webb. Many are shocked and hurt by the CQC findings, she adds. But a month on, and thanks largely to the hospital’s chief nurse Deirdre Fowler, she says the worst has passed. ‘While all this arguing is going on at the public accounts committee with senior figures shying away from their responsibilities, Deirdre Fowler has calmly gathered all the nursing staff together and is working with them to produce an implementation plan,’ says Ms Webb. ‘She is engaging with union representatives and stewards at every step and is putting together new nursing documentation and plans that are fit for purpose. Amid the chaos she is making sure nursing at Hinchingbrooke is given a high profile and a strong voice to influence positively the future of the trust.’
Powerless
Ms Webb is highly critical of Circle’s management structure, which she says did not involve nursing staff and left them feeling powerless and distressed. She says nurses felt they shouldered the blame for a situation that was not of their making and were appalled by the CQC report. ‘We have been through difficult times because of Circle and we have been calling for them to meet nurses for the past 18 months,’ she says. ‘But the priority now is to focus on what matters to patients and staff, and that is to provide care in a safe environment with enough of them to do it.’ Ms Fowler was appointed director of nursing, midwifery and quality at
Hinchingbrooke in May 2014, just months before the CQC first raised concerns about the hospital. Speaking shortly after the tumultuous events at the hospital in January, Ms Fowler admitted that staff were reeling. But she says that, although the past month has introduced significant challenges, she has remained focused on the future (see box). Circle continues to manage Hinchingbrooke Health Care NHS Trust while transitional arrangements are made with the NHS Trust Development Authority (TDA). A spokesperson for the authority has confirmed that Hinchingbrooke is now in special measures and a package of intensive support is being implemented at the hospital, adding: ‘Our focus now is to ensure the long-term sustainability of the trust and we will be working to make sure that services continue to operate throughout the transition and beyond.’
‘THE PRIORITY NOW IS TO FOCUS ON WHAT MATTERS TO PATIENTS AND STAFF’ The spokesperson also confirmed that Circle is applying for a £9.6 million government bailout, after the trust’s latest financial reports indicated an expected deficit of between £7.7 million and £12 million when it hands control back to the NHS. The company is not liable for this deficit under its contract, which places a £5 million cap on its losses. The company has already invested nearly that amount. Giving evidence before the public accounts committee last week, Circle chief executive Steve Melton said: ‘We are working closely with the TDA on details for transition. We are trying to progress plans to hand over responsibility formally at the earliest date, recognising that staff and patients need certainty in these situations.’ He said, if possible, Circle will hand over formal responsibility to the NHS by the end of March NS
‘WORKING HARD ON A NEW DIRECTION’ Director of nursing, midwifery and quality Deirdre Fowler (right) says: ‘I have always worked closely with our union colleagues and I recognise the benefit of working collaboratively. Our relationship with the RCN has gathered momentum and we are working hard to focus on a new direction.’ Many nurses struggled with the news last month that Circle was withdrawing, says Ms Fowler, who praises their ‘energy, resilience and loyalty’ and their determination to get back to a state of equilibrium. ‘There was huge disappointment and shock, but that was equal to, if not surpassed by, the news that we were going into special measures – that is what nurses were reeling from,’ she says. Because she was aware of the findings of the CQC report before it was published, Ms Fowler had already taken steps to explore the concerns and make sure all nursing care was safe. In addition, she invited a safeguarding team from Nottingham University Hospitals NHS Trust to review provision at the hospital and is acting on its recommendations. These include a training audit on issues such as the Mental Capacity Act. ‘We have accepted the CQC report but we did have concerns about the proportionality of it. We recognise there is always an opportunity for improvement but we should also remember that more than half of the report was positive,’ she says. The trust will invest £1.2 million to recruit more nurses because it recognises the weight of evidence that links a fit-for-purpose nursing workforce with positive patient experience, Ms Fowler adds. Nurses are being encouraged to come up with a range of initiatives to restore the confidence of patients and boost staff morale.
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ANALYSIS
Full circle at privately-run NHS trust as operator hands it back While MPs and management argue about what went wrong at Hinchingbrooke, staff work to ensure care quality improves. Katie Osborne reports The only private company to run an NHS hospital announced last month it was pulling out of its contract early because it could not cope with funding cuts and rising patient numbers. The company, Circle, which took over Hinchingbrooke Hospital under a ten-year contract in February 2012, said the agreement had become unsustainable. Later on the same day, the Care Quality Commission (CQC) published an inspection report on the hospital, rating it inadequate and recommending it be placed in special measures.
The CQC gave the Cambridgeshire hospital an ‘inadequate’ rating for care, making it the first in the country to receive this lowest rating. CQC inspectors had found ‘poor emotional and physical care’. Pressure ulcer prevalence in medical areas was consistently high and staff did not always adhere to National Institute for Health and Care Excellence guidance on pressure ulcer prevention. Hand hygiene and infection control techniques were poor and some staff members were heard being rude or dismissive to patients, the report said.
One patient told inspectors that staff were ‘often too busy’ to help with visits to the toilet during the night. The individual reported being told ‘to go in the bed and it will be changed when we have time’. The patient said on one occasion there was a 20-minute wait for a nurse, by which time they had already soiled the bed.
Commons inquiry
Circle has announced it is ‘in discussion’ with the CQC because it disputes the ‘inadequate’ rating, arguing that the regulator’s report is unbalanced and misleading. The House of Commons public accounts committee has now begun an inquiry into the causes and consequences of Circle’s decision to withdraw from the contract. MPs
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ANALYSIS
questioned CQC chief executive David Behan over the regulator’s inspection report, the draft of which had been criticised by Circle for containing numerous inaccuracies. The MPs argued the CQC was unable to prove patients had been told to soil themselves. Nurses have been left impotent by Circle’s decision to ‘abandon ship’, and are ‘tearing their hair out’ over the uncertainty at the hospital, says RCN eastern region director Karen Webb. Many are shocked and hurt by the CQC findings, she adds. But a month on, and thanks largely to the hospital’s chief nurse Deirdre Fowler, she says the worst has passed. ‘While all this arguing is going on at the public accounts committee with senior figures shying away from their responsibilities, Deirdre Fowler has calmly gathered all the nursing staff together and is working with them to produce an implementation plan,’ says Ms Webb. ‘She is engaging with union representatives and stewards at every step and is putting together new nursing documentation and plans that are fit for purpose. Amid the chaos she is making sure nursing at Hinchingbrooke is given a high profile and a strong voice to influence positively the future of the trust.’
Powerless
Ms Webb is highly critical of Circle’s management structure, which she says did not involve nursing staff and left them feeling powerless and distressed. She says nurses felt they shouldered the blame for a situation that was not of their making and were appalled by the CQC report. ‘We have been through difficult times because of Circle and we have been calling for them to meet nurses for the past 18 months,’ she says. ‘But the priority now is to focus on what matters to patients and staff, and that is to provide care in a safe environment with enough of them to do it.’ Ms Fowler was appointed director of nursing, midwifery and quality at
Hinchingbrooke in May 2014, just months before the CQC first raised concerns about the hospital. Speaking shortly after the tumultuous events at the hospital in January, Ms Fowler admitted that staff were reeling. But she says that, although the past month has introduced significant challenges, she has remained focused on the future (see box). Circle continues to manage Hinchingbrooke Health Care NHS Trust while transitional arrangements are made with the NHS Trust Development Authority (TDA). A spokesperson for the authority has confirmed that Hinchingbrooke is now in special measures and a package of intensive support is being implemented at the hospital, adding: ‘Our focus now is to ensure the long-term sustainability of the trust and we will be working to make sure that services continue to operate throughout the transition and beyond.’
‘THE PRIORITY NOW IS TO FOCUS ON WHAT MATTERS TO PATIENTS AND STAFF’ The spokesperson also confirmed that Circle is applying for a £9.6 million government bailout, after the trust’s latest financial reports indicated an expected deficit of between £7.7 million and £12 million when it hands control back to the NHS. The company is not liable for this deficit under its contract, which places a £5 million cap on its losses. The company has already invested nearly that amount. Giving evidence before the public accounts committee last week, Circle chief executive Steve Melton said: ‘We are working closely with the TDA on details for transition. We are trying to progress plans to hand over responsibility formally at the earliest date, recognising that staff and patients need certainty in these situations.’ He said, if possible, Circle will hand over formal responsibility to the NHS by the end of March NS
‘WORKING HARD ON A NEW DIRECTION’ Director of nursing, midwifery and quality Deirdre Fowler (right) says: ‘I have always worked closely with our union colleagues and I recognise the benefit of working collaboratively. Our relationship with the RCN has gathered momentum and we are working hard to focus on a new direction.’ Many nurses struggled with the news last month that Circle was withdrawing, says Ms Fowler, who praises their ‘energy, resilience and loyalty’ and their determination to get back to a state of equilibrium. ‘There was huge disappointment and shock, but that was equal to, if not surpassed by, the news that we were going into special measures – that is what nurses were reeling from,’ she says. Because she was aware of the findings of the CQC report before it was published, Ms Fowler had already taken steps to explore the concerns and make sure all nursing care was safe. In addition, she invited a safeguarding team from Nottingham University Hospitals NHS Trust to review provision at the hospital and is acting on its recommendations. These include a training audit on issues such as the Mental Capacity Act. ‘We have accepted the CQC report but we did have concerns about the proportionality of it. We recognise there is always an opportunity for improvement but we should also remember that more than half of the report was positive,’ she says. The trust will invest £1.2 million to recruit more nurses because it recognises the weight of evidence that links a fit-for-purpose nursing workforce with positive patient experience, Ms Fowler adds. Nurses are being encouraged to come up with a range of initiatives to restore the confidence of patients and boost staff morale.
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