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OPINION

Thriving, not marooned

Heike Guilford, head of nursing for an independent hospital, believes myths about independent nursing need to be debunked

Around one in five (17%) nurses who left the NHS felt ‘marooned’ and uncomfortable working for independent treatment centres (ITCs), according to a Nottingham Business School study published in Sociology of Health and Illness.

Although the study focused only on ITCs, there are misperceptions about independent healthcare providers which the Nottingham Business School study reinforced.

So, I feel it’s only fair to emphasise the benefits of working for an independent healthcare provider. In my case it’s Care Principles which runs my place of work - Cedar House, a low-secure facility near Canterbury, Kent, for people with learning disabilities and mental health problems.

I very much appreciate that my employer encourages its nurses to pursue professional and personal development. More than NHS-run services do, at least in my experience. For example, one NHS service I worked for specified that only F-grade nurses could enroll on mentorship courses. In contrast, here at Cedar House all clinical nurses, whatever their grade, can enroll. There’s a feeling that more value is placed on continuous professional development and support is given to all nurses to take part in training opportunities.

What about career progression? I, for one, believed my managerial potential was not picked up on by the NHS. But Care Principles saw it and nurtured it. I came to Cedar House as a clinical team leader - the equivalent of a ward manager position. I was able to progress into a charge nurse role and am now head of nursing. Cedar House not only enabled me to develop further my managerial skills on a practical level, the hospital also supported me in gaining a formal Diploma of Management Studies from Canterbury University. There’s no way I could see myself having this career progression in the NHS. I’ve heard other independent provider nurses say the same.

What about clinical care for patients? The field I work in - secure care, in which many patients are detained under mental health law - is highly regulated and monitored. Rightly so. At Cedar House there is a strong emphasis on clinical governance. Audits - whether they relate to clinical quality, such as seclusion, CPAs, MDT records or environmental issues - are acted upon more quickly and action plans are implemented. It feels like clinical governance is very much alive. This was certainly not the case at one of my previous NHS employers, also a low secure facility, where a lot of ward staff did not appreciate the significance of clinical governance. 

As the Nottingham Business School study noted, nurses have expressed concerns that profit is being put before patient care. Every independent provider is different, but had the study’s researchers talked to Cedar House nurses I am confident they would have received different responses. I’ve never heard a staff member here say they would not implement a necessary clinical intervention - for example enhanced observations - for a patient because it would eat into the company’s profits.

Independent providers - not all - are said to be more efficient. This is positive. For example, I remember one NHS-run service which had a violent patient who would injure a member of staff every day. He needed to be transferred to a medium secure service. But it took months for him to be assessed and moved on, by which time more staff members were hurt. Independent providers - again not all - can often be quicker to act decisively in such situations.

There are many concerns about the government’s NHS reforms, and the opening up of opportunities for more independent sector provision. But, when it comes to clinical care and nursing, my experience has been nothing but positive. Definitely thriving, not marooned.

Heike Guilford is head of nursing at Cedar House, a low-secure hospital near Canterbury, Kent, for people with learning disabilities and mental health problems.