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A local public-private partnership

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Sue Hayward.

Critical Care Manager, BUPA Southampton Hospital, Hampshire

The NHS Plan sought to end 'ideological and institutional barriers' between the public and private sectors working together to provide health and care services (Department of Health, 2000).

The NHS Plan sought to end 'ideological and institutional barriers' between the public and private sectors working together to provide health and care services (Department of Health, 2000).

The Government suggested that, by constructing the right partnerships, the NHS could harness the capacity of the private and voluntary providers to treat more NHS patients.

To this end, a concordat was set up with the private sector in November 2000, allowing NHS patients to be treated in independent hospitals, paid for by the NHS (BBC, 2000).

In some areas, NHS and independent hospitals were already co-operating on a local basis before the concordat, and since it was formalised, many new schemes have developed. For example, in December 2001 BUPA opened the first independent diagnosis and treatment centre (DTC) at Redhill in Surrey. The Redwood DTC is dedicated to the treatment of NHS patients and focuses on particular procedures including joint replacements and endoscopy. A combination of BUPA and NHS nursing staff care for patients.

Nurse rotation scheme
One partnership arising from the concordat is a nurse rotation scheme set up by BUPA Southampton Hospital with Southampton General Hospital.

Critical care nurses from each hospital have been working together in each others' environments since June 2002. Nurses from the hospitals' critical care units (CCUs) can rotate between the two sites, which are only 100 metres apart, to develop skills and experience.

BUPA Southampton Hospital is a 78-bed acute hospital, able to treat a wide variety of conditions. Last year it treated over 28 000 patients. Its 24-hour CCU mainly treats cardiac patients - although the unit is capable of offering treatment for most critical medical conditions.

The CCU comprises four intensive-care beds and three high-dependency beds. The larger Southampton General Hospital holds 49 critical-care and high-dependency beds.

Links between the nurses of the two CCUs began to develop more than three years ago.

Staff met at regional critical care network meetings. When discussing their work and roles, the issues that had traditionally been seen as barriers between the NHS and the independent sector, particularly recruitment, seemed less significant. This was because nurses in both settings were working towards the same goal - the highest standard of care for patients, regardless of which sector they worked in.

Before the concordat, the working relationship between BUPA and the NHS was narrower and typically comprised 'spot-buying' at the end of the NHS financial year. Thus work involving NHS patients was sporadic and limited.

The development of a rotation scheme was the next logical step in diffusing any remaining perceived barriers.

Each nurse's rotation will vary depending on their individual development needs. The rotation may be for just a few days but can last some weeks as the scheme can work around personal career goals.

Each nurse is paid by his or her employing hospital.

Today, new recruits to BUPA's critical care unit visit the Southampton General Hospital as part of their induction.

Relieving the pressure
In addition to providing training and education for the nurses involved, the scheme alleviates some of the pressures that burden the two units, such as shortages of staff and beds. It is also possible to transfer patients between the two hospitals if high-dependency beds in either CCU are full.

Benefits for nurses
Significant differences between the two units mean they can offer nurses a range of experiences. Southampton General Hospital has a fast turnaround of patients because of its accident and emergency department, so its nurses handle a high volume of patients.

Those working at the BUPA hospital usually know in advance the type of patient cases they will work with and the type of care that they will require. The basic nursing skills used by the nurses are the same, yet there are a variety of other skills that differ, which can be exchanged.

The NHS nurses recognise that they can learn valuable management skills by spending time at BUPA Southampton Hospital. For example, E-grade nurses can expect to develop their skills in project management, participate in formal teaching sessions and take charge of a shift. These are among the skills necessary for nurses who want to progress to an F-grade position.

Nurses at BUPA Southampton Hospital have less chance to experience a large, unpredictable environment in their own workplace. The rotation scheme allows them to experience the ward system and learn how to overcome the challenges that size and turnover produce.

The scheme has helped with staff retention, as during 'quieter periods' within BUPA Southampton, nurses can maintain a high level of personal development and progression. Critical care nursing is highly specialised, and the opportunity to share knowledge and experience is vital.

The scheme has provided nurses with the chance to learn new skills in practice and management. It has also encouraged the nurses at both hospitals to learn how different working environments require different social and interpersonal skills. The chance to learn how to adapt quickly to changing working situations has been an invaluable experience for all involved.

Many critical care nurses from both hospitals also belong to a regional critical care nurse bank. Their rotation experiences have helped to reduce induction times for bank nurses and foster team spirit. Nurses being recruited for short periods through the bank often now know the other nurses on a personal level.

Staff and patients can be assured that temporary nurses are as familiar as the permanent members of the team with critical care, the structure and system of practice.

Both hospitals are discussing the feasibility of extending the rotation programme to other departments.

In the future we may even have job partnerships where nurses spend a certain amount of time within the NHS and the rest of their time in the independent sector.

BBC News Website. (2002) Milburn Strikes Private Sector Deal. Available at:

Department of Health. (2000)The NHS Plan. London: The Stationery Office.

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