EDITORIAL
Editor in Chief Ian Peate Editor/Associate Publisher Julie Smith [email protected] Chief Subeditor Sarah Kahn [email protected] Subeditors Daniel Davies [email protected] Vicqui Stuart-Jones [email protected] Commissioning Editor Sue Woodward Group Classified Director Rachel McElhinney [email protected] Circulation Director Sally Boettcher [email protected] Associate Publisher Andrew Iafrati [email protected] MedEd Manager Tracy Cowan [email protected] Classified Sales Executive Harry Nolan Production Manager Jon Redmayne Production Assistant Larry Oakes Editorial Make-up Kyri Apostolou Publishing Director Anthony Kerr Managing Director Jon Benson Chief Executive Officer Ben Allen UK PERSONAL SUBSCRIPTION RATES
Quarterly Direct Debit Annual Direct Debit Annual Credit Card 2yr Annual Credit Card 3yr Annual Credit Card
£43 £169 £178 £303 £427
Subscribe online: www.magsubscriptions.com, Subscribe by phone: +44 (0) 1722 716997 Contact [email protected] for institutional pricing MA Healthcare Ltd is part of the Mark Allen Group
www.markallengroup.com The British Journal of Nursing is published by MA Healthcare Ltd, St Jude’s Church, Dulwich Road, London SE24 0PB Tel: 020 7738 5454 Editorial: 020 7501 6716 Sales: 020 7501 6726 Email: [email protected] Websites: www.britishjournalofnursing.com
© MA Healthcare Ltd, 2015. All rights reserved. No part of the British Journal of Nursing may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. The British Journal of Nursing is a double-blind, peerreviewed journal. It is indexed on the main databases, including the International Nursing Index, Medline and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) The views expressed do not necessarily represent those of the editor or the British Journal of Nursing. Advertisements in the journal do not imply endorsement of the products or services advertised. ISSN 0966 – 0461 Print: Pensord Press Ltd, Blackwood, NP12 2YA Distribution: Comag Distribution, West Drayton, UB7 7QE Cover picture: iStockphoto.com The paper used within this publication has been sourced from Chain-of-Custody certified manufacturers, operating within international environmental standards, to ensure sustainable sourcing of the raw materials, sustainable production and to minimise our carbon footprint.
British Journal of Nursing, 2015, Vol 24, No 5
The cracks are showing: private healthcare providers
T
he winter, for the NHS, always brings with it sensational media headlines and this winter has been no exception. Strange, really, because winter comes every year, so how can we find ourselves in this state year-in, year-out? For example, the Royal College of Nursing (RCN) (2015) suggests that accident and emergency departments are in crisis and that the crisis is the result of a lack of government funding. The winter crisis is also being blamed for the decision by a private healthcare provider (Circle) to pull out of its contract to run one NHS hospital (Hinchingbrooke) in Cambridgeshire. The provider had been running the hospital since 2012, the first private operator of an NHS hospital—a franchise.The franchise was the first of its kind for the NHS and was seen by some as a potential way forward in financing some aspects of the health service. The National Audit Office (2012) deemed this so important that any future contracts to be awarded were to be improved and, crucially, based on lessons learned from the procurement process and early operational experience. The trust’s governance is derived from the Franchise Agreement and Intervention Order that was approved by the Secretary of State for Health. The provider found that running the hospital was no longer sustainable as a result of rising demand along with falling funding (Williams, 2015). Another contributory factor may have been that the financial targets that Circle (the provider) announced in 2012 were too ambitious. The National Audit Office was aware of these targets (National Audit Office, 2012), nevertheless the franchise was awarded. In January 2015 the provider said it could no longer afford to run the trust as a result of heavy demand for accident and emergency services and lack of care places for those patients who were awaiting discharge (Melton, 2015). This is a recurrent theme across the whole of the NHS and is exacerbated by the government’s failure to prepare for the winter crisis and to provide sufficient funding. Funding levels that have not kept pace with demand was cited by Circle as another contributory factor, stating that Hinchingbrooke’s funding has been cut this financial year. Circle also believes that inconsistent and conflicting regulatory regimes are compounding the challenges for acute hospitals (Melton, 2015)—this is in relation to a Care Quality Commission (CQC) assessment of Hinchingbrooke where the overall rating for the trust was ‘inadequate’ (CQC, 2015). The CQC inspectors found significant areas of concern during their inspection. They were concerned about patient safety,
referring a number of patients to the local authority safeguarding team. Private providers need to know that this is what it is like in the NHS—there are unprecedented accident and emergency attendances, there are not enough care places for healthy patients awaiting discharge and cuts in funding are a regular occurrence. Clearly, the answer is not to sell off the NHS. Instead, it is about working with those who use the services and those who work in and provide services, and acknowledging that the provision of a world-class health service is expensive and as such appropriate investment is what is needed to ensure sustainability. In 2012 the takeover of a hospital by a private provider made that a test case for the future of other NHS hospitals, and the outcome of the now defunct relationship is a matter of serious concern not only for the people of Cambridgeshire but for the whole nation. Are the cracks beginning to show in this current administration’s obsession with privatisation? The National Audit Office needs to be true to the words uttered in 2012 and needs to consider the evidence concerning the effectiveness of Circle’s approach before this model is considered for use elsewhere. The financial targets at Hinchingbrooke were extremely ambitious and the challenges experienced even greater than the National Audit Office and Circle could have expected. Let the NHS truly be an organisation with a memory.The financial pressures experienced by Circle could not have been borne without some impact on patient care—nursing posts at Hinchingbrooke were removed and the risk of damaging patient care is a reality (RCN, 2012). Removing nurses from the numbers should never be seen as the default position BJN for any trust when it strives to save money. Care Quality Commission (2015) Hinchingbrooke Health Care NHS Trust. Hinchingbrooke Hospital Quality Report. http://tinyurl.com/ q245lsw (accessed 4 March 2015) Melton S (2015) A statement on Hinchingbrooke. 9 January. http:// tinyurl.com/lgafg8w (accessed 4 March 2015) National Audit Office (2012) The franchising of Hinchingbrooke Health Care NHS Trust. Executive summary. http://tinyurl.com/m2ay5a4 (accessed 3 March 2015) Royal College of Nursing (2012) RCN comment on report into Hinchingbrooke Hospital. 8 November. http://tinyurl.com/ouxfr2k (accessed 3 March 2015) Royal College of Nursing (2015) RCN responds to winter A&E figures. 6 January. http://tinyurl.com/osfsc74 (accessed 3 March 2015) Williams C (2015) First private operator Ian Peate of NHS hospital pulls out amid cuts. The Editor in Chief Telegraph (online). 15 January. http:// British Journal of tinyurl.com/no4klj7 (accessed 4 March Nursing 2015)
255
British Journal of Nursing. Downloaded from magonlinelibrary.com by 165.123.034.086 on November 29, 2015. For personal use only. No other uses without permission. . All rights reserved.
Editor in Chief Ian Peate Editor/Associate Publisher Julie Smith [email protected] Chief Subeditor Sarah Kahn [email protected] Subeditors Daniel Davies [email protected] Vicqui Stuart-Jones [email protected] Commissioning Editor Sue Woodward Group Classified Director Rachel McElhinney [email protected] Circulation Director Sally Boettcher [email protected] Associate Publisher Andrew Iafrati [email protected] MedEd Manager Tracy Cowan [email protected] Classified Sales Executive Harry Nolan Production Manager Jon Redmayne Production Assistant Larry Oakes Editorial Make-up Kyri Apostolou Publishing Director Anthony Kerr Managing Director Jon Benson Chief Executive Officer Ben Allen UK PERSONAL SUBSCRIPTION RATES
Quarterly Direct Debit Annual Direct Debit Annual Credit Card 2yr Annual Credit Card 3yr Annual Credit Card
£43 £169 £178 £303 £427
Subscribe online: www.magsubscriptions.com, Subscribe by phone: +44 (0) 1722 716997 Contact [email protected] for institutional pricing MA Healthcare Ltd is part of the Mark Allen Group
www.markallengroup.com The British Journal of Nursing is published by MA Healthcare Ltd, St Jude’s Church, Dulwich Road, London SE24 0PB Tel: 020 7738 5454 Editorial: 020 7501 6716 Sales: 020 7501 6726 Email: [email protected] Websites: www.britishjournalofnursing.com
© MA Healthcare Ltd, 2015. All rights reserved. No part of the British Journal of Nursing may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. The British Journal of Nursing is a double-blind, peerreviewed journal. It is indexed on the main databases, including the International Nursing Index, Medline and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) The views expressed do not necessarily represent those of the editor or the British Journal of Nursing. Advertisements in the journal do not imply endorsement of the products or services advertised. ISSN 0966 – 0461 Print: Pensord Press Ltd, Blackwood, NP12 2YA Distribution: Comag Distribution, West Drayton, UB7 7QE Cover picture: iStockphoto.com The paper used within this publication has been sourced from Chain-of-Custody certified manufacturers, operating within international environmental standards, to ensure sustainable sourcing of the raw materials, sustainable production and to minimise our carbon footprint.
British Journal of Nursing, 2015, Vol 24, No 5
The cracks are showing: private healthcare providers
T
he winter, for the NHS, always brings with it sensational media headlines and this winter has been no exception. Strange, really, because winter comes every year, so how can we find ourselves in this state year-in, year-out? For example, the Royal College of Nursing (RCN) (2015) suggests that accident and emergency departments are in crisis and that the crisis is the result of a lack of government funding. The winter crisis is also being blamed for the decision by a private healthcare provider (Circle) to pull out of its contract to run one NHS hospital (Hinchingbrooke) in Cambridgeshire. The provider had been running the hospital since 2012, the first private operator of an NHS hospital—a franchise.The franchise was the first of its kind for the NHS and was seen by some as a potential way forward in financing some aspects of the health service. The National Audit Office (2012) deemed this so important that any future contracts to be awarded were to be improved and, crucially, based on lessons learned from the procurement process and early operational experience. The trust’s governance is derived from the Franchise Agreement and Intervention Order that was approved by the Secretary of State for Health. The provider found that running the hospital was no longer sustainable as a result of rising demand along with falling funding (Williams, 2015). Another contributory factor may have been that the financial targets that Circle (the provider) announced in 2012 were too ambitious. The National Audit Office was aware of these targets (National Audit Office, 2012), nevertheless the franchise was awarded. In January 2015 the provider said it could no longer afford to run the trust as a result of heavy demand for accident and emergency services and lack of care places for those patients who were awaiting discharge (Melton, 2015). This is a recurrent theme across the whole of the NHS and is exacerbated by the government’s failure to prepare for the winter crisis and to provide sufficient funding. Funding levels that have not kept pace with demand was cited by Circle as another contributory factor, stating that Hinchingbrooke’s funding has been cut this financial year. Circle also believes that inconsistent and conflicting regulatory regimes are compounding the challenges for acute hospitals (Melton, 2015)—this is in relation to a Care Quality Commission (CQC) assessment of Hinchingbrooke where the overall rating for the trust was ‘inadequate’ (CQC, 2015). The CQC inspectors found significant areas of concern during their inspection. They were concerned about patient safety,
referring a number of patients to the local authority safeguarding team. Private providers need to know that this is what it is like in the NHS—there are unprecedented accident and emergency attendances, there are not enough care places for healthy patients awaiting discharge and cuts in funding are a regular occurrence. Clearly, the answer is not to sell off the NHS. Instead, it is about working with those who use the services and those who work in and provide services, and acknowledging that the provision of a world-class health service is expensive and as such appropriate investment is what is needed to ensure sustainability. In 2012 the takeover of a hospital by a private provider made that a test case for the future of other NHS hospitals, and the outcome of the now defunct relationship is a matter of serious concern not only for the people of Cambridgeshire but for the whole nation. Are the cracks beginning to show in this current administration’s obsession with privatisation? The National Audit Office needs to be true to the words uttered in 2012 and needs to consider the evidence concerning the effectiveness of Circle’s approach before this model is considered for use elsewhere. The financial targets at Hinchingbrooke were extremely ambitious and the challenges experienced even greater than the National Audit Office and Circle could have expected. Let the NHS truly be an organisation with a memory.The financial pressures experienced by Circle could not have been borne without some impact on patient care—nursing posts at Hinchingbrooke were removed and the risk of damaging patient care is a reality (RCN, 2012). Removing nurses from the numbers should never be seen as the default position BJN for any trust when it strives to save money. Care Quality Commission (2015) Hinchingbrooke Health Care NHS Trust. Hinchingbrooke Hospital Quality Report. http://tinyurl.com/ q245lsw (accessed 4 March 2015) Melton S (2015) A statement on Hinchingbrooke. 9 January. http:// tinyurl.com/lgafg8w (accessed 4 March 2015) National Audit Office (2012) The franchising of Hinchingbrooke Health Care NHS Trust. Executive summary. http://tinyurl.com/m2ay5a4 (accessed 3 March 2015) Royal College of Nursing (2012) RCN comment on report into Hinchingbrooke Hospital. 8 November. http://tinyurl.com/ouxfr2k (accessed 3 March 2015) Royal College of Nursing (2015) RCN responds to winter A&E figures. 6 January. http://tinyurl.com/osfsc74 (accessed 3 March 2015) Williams C (2015) First private operator Ian Peate of NHS hospital pulls out amid cuts. The Editor in Chief Telegraph (online). 15 January. http:// British Journal of tinyurl.com/no4klj7 (accessed 4 March Nursing 2015)
255
British Journal of Nursing. Downloaded from magonlinelibrary.com by 165.123.034.086 on November 29, 2015. For personal use only. No other uses without permission. . All rights reserved.
