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Nurses who leave NHS for private sector feel 'marooned'


Nurses who have transferred from the NHS to work in independent treatment centres feel “marooned” and worry about standards of care, latest research has revealed.

The study by Nottingham University Business School found some who made the move feared centres placed profit before patient care, while others “longed to return” to the NHS.

Researchers carried out in-depth interviews with 35 staff – 18 scrubs nurses, 10 operating department practitioners and seven theatre support workers – at two independent sector treatment centre (ISTC) day surgery units over two years.

A small number felt “abandoned by the NHS” while a significant proportion – 17% – felt “marooned” and were uncomfortable working in an environment they described as mainly driven by profit.

“We’re told all the time this isn’t the NHS. They expect us to do things differently, more ‘efficiently’ – that’s how they make their money,” said one nurse.

Another recalled a talk by an ISTC manager who told staff that the centre should “work like a car factory”.

Others strived to recreate the NHS in their new settings, while just 34% saw the move as an opportunity to enhance their careers by taking on new roles, provide better patient care and work more closely with other healthcare professionals.

The findings – published in the journal Sociology of Health and Illness – come amid concern over the government’s troubled NHS reform plan, which pledges to open up the service to “any willing provider”.

Lead researcher Justin Waring said plans involving the blanket transfer of NHS staff into the private sector overlooked the “profound implications” for nurses and others.

“For the clinicians involved it’s not always easy to reconcile change with established ways of working,” Dr Waring said.

“Many of them have reservations and even resentment. We need to find ways of easing the transition.”


Readers' comments (7)

  • I joined the private sector just over a year ago (having worked in the NHS for 22 years) to set up a Colorectal Cancer CNS post. I have been both supported and encouraged to strengthen links between the NHS and private sector and to mirror the excellent service provided by Colorectacl CNS's in the NHS. I have been allowed to undertake education to enable me to develop my role and to offer seamless care. I have been encouraged to actively take part in and been welcomed onto professional groups attended by NHS and private sector staff. When patients sometimes end up transferring care between the NHS and the private sector I believe that care provided should be of the same standard regardless of where it is given. I am fortunate to work for a company who also recognise the holistic needs of cancer patients and are striving to ensure that these can be met.

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  • surely it is up to NHS nurses to carry their standards to the private sector and maintain them!

    Actually, I have experience of the money driven bit when working in a well known care home and employed to take responsibility for nursing care there.

    I was severely reprimanded by the Head (an elderly SRN) for telling the family of a patient that we did not have sufficient facilities for caring for their relative with dementia safely - suitable room, adequate staffing levels to keep him under constant observation and prevent him for climbing over his bed barriers and causing injury and wandering off, etc. The reason given by the Head was that I should not say this to the family as we need to keep all the rooms occupied at all times otherwise we would make a financial loss! Sadly, for this and other policies and practices I did not like in this clinic and which ran against my professional and personal conscience, I did not stay long in that job.

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  • I totally agree with the post from anonymous above. I have had exactly the same experience, made worse by finding out that the manager [RN] who was pressuring me to take all sorts of clients in an unsafe mix, 'to fill beds', was on a bonus for % bed occupancy!!

    No conflict of interest there then!!!!!

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  • Me and my salary and bonuses first, patients second. I (with the very biggest capital I) come first, patients naturally second!

    or so it sometimes seems. It is very sad, in fact tragic where care for irreplacable human lives is concerned and equally tragic for those who hold such values of life. I must have been quite naive as working abroad in an excellent modern system with first class care this business of the reality of meeting targets (which I later discovered also applied to the care of patients in UK hospitals, practices, clinics, etc) was only brought home to me in the designer section of an upmarket department store in my home town in the UK and later working briefly in the NHS and the private sector where the collective attitudes of the staff shocked me to my very core.

    In the dept. store I was just looking through the rails of some rather chic and expensive clothes where one would expect good service and advice but totally ignored by two young and oblivious sales girls who were just chatting. Normally on the contrary the older sales people are all over you. I don't like other of these types of behaviour, as a customer I like my presence to be acknowledged but I also like a little freedom to browse otherwise I am totally demotivated to make any purchase and move on. I simply heard one of the girls boasting to the the other that she had met her targets for the month. I interpreted this as 'having met my targets I have made enough sales to get my bonus'. to me it sounds as if all this was without any effort and regardless of providing any sort of customer service beyond showing them where the changing rooms were and taking the payment and packing the goods. I imagine every sale was gleefully clocked up mentally as another point towards the target and the bonus and possibly even recognition from her manager as somebody who had done her job well.

    This simple anecdote also translates well beyond sales to provides of services, including healthcare where this inhumane system of targets and bonuses has taken priority over patient-centred care.

    Whereas our European colleagues are educated to a level where they can think laterally and evaluate and work guidelines, policies and regulations to their advantage to provide individualised care, in Britain everybody is so blinkered they have the tendency to follow everything to the letter without giving it much thought for fear of contradicting authority even thought it may be to the detriment of patients. Maybe an all degree profession will help provide a boader approach to care to meet patients' needs in the public and private sectors.

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  • I entirely agree with Anon 27 April - nurses have a responsibility to transfer and maintain high standards of care wherever they work. However, all too often nurses do not consider / realise the impact that such transfers can have on themselves and their careers;

    The PCT I was working for planned to transfer staff under TUPE regulations to a Social Enterprise (SE). I realised that my continuity of service with the NHS (37 years) in terms of redundancy rights would be placed in jeopardy if I chose to return to the NHS after one year employment with the new SE, as continuity of service can only be guaranteed whilst you remain with the SE (or remain in the NHS). On return to the NHS after this time the new NHS employer has the right to use their discretion whether or not to honour your continuity of any previous service (with the NHS or a private organisation that the nurse might be transferred to).

    Unfortunately, it could also mean that your continuity of service may not be honoured and your previous years service would effectively be dissolved. You would then have to re-build your continuity of service from zero on return to the NHS. You would then only be entitled to a redundancy payment after you have worked two continuous years back in the NHS (under AFC T&C's). In this current climate, with so many jobs at risk, it is highly likely NHS employers will not honour this right.

    I chose to remain in the NHS rather than transfer to the SE and secured another NHS post (at great relocation expense to me) before the transfer took place in order to guarantee my continuity of service. By doing this I maintained my freedom to transfer my years of service to any NHS organisation within the UK if I wished to relocate or seek promotion in the future. It also meant that I would continue to be entitled to a redundancy payment in the event that that was something I faced.

    Had I allowed myself to be transferred to the SE, my only choice after one year would be to remain with the SE for the duration of my working life in order to keep my continuity of service intact. This of course would deprive me choices of the aforementioned options (both professional and private).

    I felt so strong about this issue that I did in fact take the matter to an Employment Tribunal, where the Judge agreed that the PCT gave no justifiable reason why AFC Terms and Conditions should exclude the protection for continuity of service in terms of REDUNDANCY RIGHTS.

    Whilst the ruling at the Tribunal did not benefit me in any way personally, I was satisfied that the Judge did in fact acknowledge I was justified in raising this concern as it would have implications for many thousands of staff who would be disadvantaged in this way in the future.

    Unfortunately, any nurse who returns to the NHS after one year with a private company may in fact find themselves in a position where they may not be entitled to any redundancy payment as they will only be entitled to such payments after two years of service, if the new NHS employer decides to use their discretion not to honour previous service, as I feel sure many will do.

    Until such time that this unacceptable 'arrangement' is challenged and stopped, nurses will continue to be disadvantaged in a way many will find over the next year or two.

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  • i am a newly qualified mental health nurse and have been working in the private sector for 5 months. i have still not recieved my first aid or C N R training despite requesting it numerous times. i only accepted the job as there was nothing available in the NHS and this vacancy offered me a perceptorship. however the perceptorship has been a disgrace i havent recieved any feedback on my progress, supervision or support despite requesting it. i am stuck i want to leave but then i dont, i want to challange them but really dont know where to start the standard of care is appauling and difficult for me to change as the satff there including nurses are stuck in their old ways. and when i do challange them i get abuse and when i report this, make formal complaints absolutley nothing is done. i am determined to change the way this place is run, i believe this is my duty as a nurse to encourage a better standard of care and equal rights for all memebers of staff. but i have a totla lack of support from management. has anyone got any suggestions for me, as to where to start to challange ho the place is run?

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  • I have just returned to the NHS after 20 years in the private sector . Long hours lack of staff and continuous compromise between profit and standards , were the deciding factor . I have returned to the NHS 6 months ago and am extremely impressed with the high standards , and rightly so . However I am in the middle of a massive professional transition , and although I have a wealth of experience ,this is much more difficult than I expected . Has any one else encountered this and if so what was your experience .

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