Hospital inspectors have written to the first 'franchised' NHS hospital warning them of serious concerns. And up the road, the NHS has won the largest single service tender yet - but only after having to waste a million pounds fighting off the private sector.
Patients at privately run Hinchingbrooke NHS hospital are being treated in an “undignified and emotionally abusive manner”, the Care Quality Commission alleged last week. Some patients who “lacked the capacity to consent” are being sedated. Hygiene is poor in some areas, the letter went on. There are significant staffing problems.
Speaking to local newspaper the Cambridge News this week, a staff member at Hinchingbrooke said
“There’s nothing in the CQC letter that comes as a surprise.
“The wards are often short-staffed and there aren’t enough nurses on the wards due to a reduced number of frontline nurses.”
Circle's balance sheet is a mess. It had claimed that they would make an astonishing £311 million of savings over 10 years. Campaigners had warned from the outset that savings of this magnitude could be made would be through the loss of staff and services.
Within months, the National Audit Office warned that the controversial and secretive decision to hand the hospital to Circle hadn’t factored in the risks properly, and that the level of savings projected were unprecedented.
Shortly before the NAO report, in September 2012, Circle renegotiated its cleaning contract, halving the number of cleaners to 24 and reducing night shift cleaning was cut from 11.5 to 6 hours.
Next, almost 50 posts frontline nurses and workers were cut. Hinchingbroke’s defence was that these were mostly agency staff or reduced hours. But An RCN report of May 2014 highlighted the results, including that on one ward in Hinchingbrooke, a single nurse was allocated 21 patients.
As staff told the local press this week: “People are afraid to speak up and when they do nothing is done about it.”
The CQC said much the same in its letter to Hinchingbrooke chief executive Hisham Abdel-Rahman. It highlighted the “lack of recognition of the level of concerns when raised with yourself and the length of time taken to grasp the seriousness of the situation for patients”, that the organisational culture did not enable nursing and caring issues to be easily raised, and that there Circle Hinchingbrooke had a “blame approach, rather than…a supportive and patient focused approach.”
The CQC was also damning on governance, alleging a “lack of robust challenge of the executive team through the governance system”,“little internal or clear external oversight of how the trust managed risks to the quality of care”; and a lack of “clarity or coherence” as to who was responsible for scrutinising quality.
So much for the much vaunted ‘John Lewis Partnership Model’, in which Circle claimed that staff were owners of the hospital jointly and would be at the centre of decision making. This model, which collapsed completely last year, never really existed in any meaningful sense. Most ‘shares’ are owned by the venture capitalists of Circle Holdings.
Circle are very good at PR, though - so much so that their two former Communications Directors now advise David Cameron and Jeremy Hunt, respectively.
Sometimes the PR obsession with appearance goes overboard. The popular and dedicated ‘Friends of Hinchingbrooke Hospital’ had raised millions for the hospital but they were kicked out from running the shop. They were told they did not fit in with Circle’s desired corporate image. They were replaced by Costa Coffee. More recently they have introduced a new uniform that sees porters wearing waistcoats and black shoes.
But the gloss can’t cover the cracks. The head of Circle, Ali Parsa, paraded as the future for the NHS, left only 6 months into the franchise deal following a highly critical report from the National Audit Office.
Parsa was hauled in front of the Commons Public Accounts Committee where the Chair, Margaret Hodge MP noted:
‘Somebody sacked you Mr Parsa to walk away with a £400,000 pay-off, most of which comes from the taxpayer’
Swiftly afterwards, the Chief Executive of the hospital resigned too. His stated reason - ‘early retirement’ at the age of 50 - must have come as a blow to healthworkers who had just been told by government they had to ‘work longer, pay more and get less’ as a result of NHS Pension Scheme reforms.
In June 2013, Circle closed a specialist elderly trauma and orthopaedic care ward, and merged other units, as part of a move to ‘streamline’ services and supposedly develop closer links with community services and an integrated care model. At the time, they were bidding for the £800 million community-based ‘adult and older people’s services’ contract for Cambridge and Peterborough. They walked away after seeing key financial data, realising that they would not make a profit.
The issue of financial instability has never gone away. Circle has continued to rely on public money. They have consistently fallen short of their financial savings targets and the losses have built to such an extent that they are now only £150,000 from the £5 million ceiling which could see the contract terminated. They blame the local NHS bosses, citing unfair payment systems and a ‘challenging’ environment. Whatever the case, this leaves the hospital in a perilous situation and facing an uncertain future.
Had this been an NHS run hospital, the government would have called in the Trust Special Administrator (TSA). Instead they have continued to throw money at Circle as if it failed, it would be a major blow to the Tory NHS privatisation agenda.
Circle and it's ilk have not had it all their own way in Cambridgeshire. This week, it was announced that a controversial £800 million tender had been awarded to an NHS consortium bid, ‘Uniting Care Partnership’ (UCP).
The contract was the largest of its type to be tendered in NHS history and the initial bidding stage attracted the usual suspects. Circle, Capita, Serco, Virgin Care, United Health UK all hoped to cash in on lucrative contracts.
Bidders - though not the public - saw the key financial data. Realising how underfunded it was, a number walked away.
Meanwhile, campaigners lobbied, demonstrated, spoke at meetings and collected over 5,000 names on a petition opposing NHS privatisation.
Questions still remain as to why the CCG embarked on such a process in the first place, rather than carry out a service review working jointly with existing NHS providers as campaigners had suggested from the outset.
Even bigger questions remain as to why the main existing NHS provider - Cambridgeshire Community Services NHS Trust was the only bidder excluded (despite being in line for a ‘Trust Provider of the Year’ award and judged one of the best NHS employers in the country) - while Virgin Care and Care UK were short-listed.
The whole process cost at least £1 million. A spokesperson for the campaign said
“ The competitive procurement process was both unnecessary and highly wasteful. The aim of achieving a more integrated service for older people’s care could have been achieved by taking steps for existing NHS providers to work more closely together without exposing the service to the risk of privatisation, as we have stressed right from the outset.”
Campaigners are calling for a public inquiry into the process.
Hinchingbrooke and the Cambridgeshire NHS tender both highlight the failure of NHS privatisation. The award of the £800 million contract for Cambridgeshire to the NHS shows sustained campaigning is effective.
For ‘Hands Off Hinchingbrooke’ the fight continues. They have warned since being established 5 years ago that the sums did not add up and that it was only a matter of time before problems would arise. The fears Circle have dismissed as ‘scare-mongering’ have proved to be correct.
Their fight will carry on until Circle are kicked out and the hospital is brought back into the NHS.
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