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A model for joint working

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A private healthcare provider has taken over a floor at London’s University College Hospital. Jo Hartley finds out how nurses from the two sectors are sharing their skills

When 30 or so private oncology nurses set up shop within the walls of a prestigious London teaching trust towards the end of 2006, it signalled the start of a unique public-private experiment.

Today, the collaboration between University College London Hospitals NHS Foundation Trust (UCLH) and Hospital Corporation of America (HCA) is being hailed a ‘mutually beneficial’ success, and one that both the company and the trust believe could be replicated in other NHS organisations.

It all started back in 2005 when USA-based HCA, which owns six hospitals and a clinic in the capital, was casting around for a suitable location to establish an acute facility for haemato-oncology and sarcoma patients as part of an expansion of its cancer care services, which at the time were limited to day care at The Harley Street Clinic, London.

At the same time, only 10 minutes down the road, UCLH had just put the finishing touches to an impressive new 19-storey, PFI-funded building and was looking for an independent healthcare company to take over an entire floor, built specifically for private use.

The trust had previously run a private oncology ward at University College Hospital (UCH) itself, but decided to lease out the new floor, together with use of its hospital facilities, as a way of helping pay back the cost of the building.

HCA won the tender and on 27 October 2006 ‘Harley Street at UCH’ was born. ‘This is the first of its kind,’ enthuses Sarah Fisher, chief operating officer for cancer at HCA. ‘We were delighted to be selected by UCLH, not just because we could continue to extend and expand our cancer portfolio, but also because we could pair up with an NHS trust. We believe this is a model of the way the public and private sectors can work in the future.’

Harley Street at UCH takes up the whole of level 15 and is being rented on a five-year lease with the option to extend. Service level agreements, which are reassessed every three months, mean staff have access to all the trust’s in-house facilities such as pathology, imaging, critical care, cleaning and security.

The floor comprises two 12-bedded wards and a five-chaired day unit that offers chemotherapy and day patient procedures. One of the wards is reserved for haemato-oncology patients, including those undergoing bone marrow transplant, while the other is a mix of oncology patients, specifically sarcoma sufferers and people requiring major operations such as maxo-facial procedures and pancreatectomies.

Conveniently located just upstairs on level 16 is UCH’s own main haematology and oncology floor. The two facilities mirror each other in design, are serviced by the same medical teams and offer an almost identical model of care, according to Claire Johnson, senior clinical manager for oncology at HCA.

‘They are all new wards in the hospital with nice separate rooms for bone marrow transplant patients. The NHS facilities and ours are the same. Our model is very reflective of what transplant patients go through in the NHS,’ she explains.

In terms of nursing, she says staff have come together to form a strong collaborative approach to clinical care to ensure that all patients being treated at the hospital, regardless of whether they are NHS or private, receive the same high quality of care.

‘At first there were differences in policy, so initially there were variations in the way we did things – not better or worse, but different,’ reveals Stephen Rowley, lead cancer nurse at UCH. ‘So, we had to ensure that we had the same way of doing Hickman lines for example. Both procedures being used were safe, but looked quite different, which worried any patient who moved between the NHS and private floors.’

Some patients move floors, he explains, if for example their medical insurance runs out while they are in hospital, or if they are first treated on an NHS ward as an emergency before their private insurance kicks in.

Realising the importance of partnership working early on set the tone for the future relationship between the two organisations, and now they not only adhere to the same clinical standards, procedures and trust-wide policies such as infection control, but are pooling their nursing resources too.

While setting up level 15, HCA decided it needed to recruit a bone marrow transplant coordinator on a part-time basis. So it agreed to fund a post within the already established NHS team, thus gaining its transplant service while the trust gained an extra pair of hands. The position has been so successful that HCA is now stepping in to fund a clinical nurse specialist (CNS) in sarcoma, who will work predominantly with its patients, but will still be part of the NHS team helping out when needed.

‘It just makes sense,’ Mr Rowley says. ‘All the CNSs sit in the same office, have the same clinical skills and there is no difference for them when doing administration, liaison and ward rounds.’

Ms Johnson agrees: ‘I think these posts work very well because the nurses benefit from each other’s expertise. We all want to ensure that the nurses have as much experience in the field, and across both sites, it is mutually beneficial for the trust, HCA and the patients.’

With regard to the ward nurses on both floors, Ms Johnson says they all get on extremely well and there has been no animosity between them in terms of pay, working conditions and basic resources. She says: ‘They will come down and say ‘can I ask you about this’ or ‘can I borrow that’ and it is a reciprocal arrangement. We were all invited to level 16’s Christmas do!’ she adds.

In fact pay and working conditions are comparable between the two, when you take into account holiday entitlements and training opportunities. As if to underscore this point there has been no shift in staff between the two floors, despite an initial recruitment ban on HCA from poaching NHS nurses being lifted and there being vacancies at both sites, Mr Rowley reveals. ‘It’s maybe something about seeing yourself either as an NHS nurse or a private nurse. Nurses often don’t want to move and so people stay put.’

Overall everyone agrees that the scheme’s success boils down to three key ingredients: it covers a defined medical speciality, there was a desire by all parties to do business and there was a meeting of two like-minded organisations when it came to delivering first-class care.
If it had been a surgical model, which took valuable theatre time away from NHS patients when it was trying to meet 18-week waits, then it simply wouldn’t have worked, says Ms Fisher. ‘It works because it is a medical model and we can deliver the majority of care in one location and pool our resources where it makes economic sense for both parties.’

A more business-minded approach from UCLH, in leasing out the floor, has also helped as it has removed some of the previous barriers to how the NHS can make money.

Additionally, HCA’s presence on level 15 means more patients can be treated at the hospital.

As Mr Rowley explains, many of the patients on level 15 could well have been admitted to the hospital’s NHS wards anyway. This is because having inpatient facilities for haemato-oncology and sarcoma patients is a new specialist area of care for the private sector, so in the past, even those with private medical insurance would likely have been dealt with by the NHS.

And not only is UCLH able to cater for more NHS patients, it also receives a good income from the hospital facilities it leases out. As Mr Rowley says: ‘It’s a win-win situation – I do not see why this set-up couldn’t happen more and more.’

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