Nurses at the first NHS general hospital to be run by the private sector risk shouldering the burden for deep financial problems that are out of their control, the Royal College of Nursing has warned.
Private company Circle was awarded a 10-year contract to run Hinchingbrooke Health Care Trust in November. Last week it unveiled a 16-point plan for turning round the financially troubled Cambridgeshire trust, with a major focus on nursing. The trust is in the red by around £40m (see box).
The widely publicised plan included devoting two thirds of nurses’ time to contact with patients, a culture of “complete transparency” around patient harm, reducing rates of preventable falls and pressure sores to the lowest in the region. Staff will also be subject to “360 degree” performance reviews, with assessments from both their peers and line managers.
In addition, staff will be organised into “clinical units” each run by a nurse, a doctor and a manager. The three will have authority to take all decisions about a patient’s care and have responsibility for their own quality measures and costs.
But RCN director of policy Howard Catton warned that Circle’s “public relations strategy” was placing too much responsibility on nurses for overcoming the hospital’s huge financial challenges.
“Nursing could lead improvements, but it’s beyond nursing’s control to turn around all the cost pressures and [find] a £40m saving,” he told Nursing Times. He said: “What we’ve had this week is nursing and the workforce standing on their own at the front of this PR strategy.”
Mr Catton said the RCN wanted to see the same level of “transparency” expected of nurses placed on the work of Circle’s management team and the returns expected from the company’s shareholders.
The strategic health authority cluster NHS Midlands and East has published the contract signed with Circle, but has removed details of what share the company would take of any surpluses made by the trust.
Karen Webb, RCN Eastern regional director, said: “I heard [media reports] about how they were going to make sure nurses spend two thirds of their time with patients, but I would suggest they spend two thirds of their time with patients now. It’s old wine in new bottles to me.”
She argued that, while the trust clearly had major financial problems, clinically it was not a “basket case”. She said: “It will be wonderful if Circle improve what is already very good at Hinchingbrooke, but it’s not some lame duck hospital where people were getting poor care.”
NHS Midlands and East director of policy and strategy Stephen Dunn said last week that without the franchise Hinchingbrooke’s future could have been “uncertain”. “With the challenges the NHS now faces, new solutions are needed so services can be provided how and where patients want them, but at a cost which taxpayers can afford.”
The Department of Health insisted when it signed the Hinchingbrooke contract, that the same “model” was not being considered by other financially struggling trusts. However, Nursing Times’ sister title Health Service Journal has learnt that a partnership with an independent provider is on a shortlist of options under consideration by George Eliot Hospital Trust in Warwickshire.
Mr Dunn, whose team is currently working with George Eliot, said: “George Eliot’s board is considering the Hinchingbrooke plans and process to understand what benefits might be available.”
In a statement announcing the Hinchingbrooke plan, Circle chief executive Ali Parsa said: ““Like John Lewis, Circle are employee co-owned, and have a track record of creating best in class hospitals by devolving power to the clinicians and staff who are closest to patients. We are confident that we can do it again in Hinchingbrooke”.
History of the Hinchingbrooke franchise deal:
- March 2008: Audit Commission raises “serious concerns” about projected £40m deficit at Hinchingbrooke. The trust had built a £22m private finance initiative treatment centre just as the NHS switched focus to community care.
- July 2009: Department of Health and Treasury give green light for plans to franchise Hinchingbrooke to foundation trust or private company
- December 2010: Circle selected as preferred bidder to take over management of Hinchingbrooke
- November 2011: Government signs 10-year deal franchising Hinchingbrooke to Circle
- Feb 2012: Circle takes over management of the trust