The Hinchingbrooke fiasco proves privatisation is not the way to fix the NHS
Healthcare company Circle has walked away from its contract with Hinchingbrooke Hospital. Circle was the first private provider to take over management of an NHS hospital, but has now called the arrangement "unsustainable," describing "unprecedented increases in accident and emergency attendances, insufficient care plans for patients awaiting discharge, and funding levels that have not kept pace with demand." Welcome to the NHS.
There should be no surprise that Circle has struggled. Unlike established private hospitals where pre-planned operations and consultant led clinics take place at the expense of the patient, Hinchingbrooke played an integral part in the acute, emergency, and 24 hour care of the general population. It is an NHS hospital, where patients are unpredictable, and difficult or unprofitable cases cannot be ignored or sent elsewhere.
Under Circle's management, Hinchingbrooke became the first NHS hospital to be rated as "inadequate" for caring, and placed under special measures by the Care Quality Commission. An experiment in privatisation created a poorly led, unsafe organisation.
Hinchingbrooke's takeover was supposed to be a flagship for the Health and Social Care Act, Andrew Lansley and Jeremy Hunt's great gamble with the NHS. The unprecedented and swift legislative changes made by the government are based on a blinkered idea that market forces can create a leaner, more efficient NHS. Section 75 of the Health and Social Care Act allows for "competitive tendering," where private companies can bid to provide NHS services, as long as they are capable to do so.
With Hinchingbrooke, the government's gamble demonstrably failed. Circle proved incapable of providing an equivalent service, and instead took a struggling hospital and made it worse.
But Circle is not wrong about unprecedented attendance rates, inadequate community care or plummeting levels of funding. A private profit led company sees these challenges and runs a mile, but the problems persist, regardless. Bad care is not some abstract fiscal worry for shareholders. Failing hospitals cause needless suffering.
It all comes back to A&E. There has been a reluctance to accept that people go to A&E for things other than accidents and emergencies. NHS 111, ‘Not Always A&E’, and other campaigns to highlight the alternative ways people can get health advice make only a small dent in the ever increasing numbers presenting to hospital. There is a perceived dearth of other options, and the always open doors of hospitals mean you will get to see a doctor eventually.
A&E waiting times are now the worst in a decade. Many people in emergency rooms do not need to be there, but can wait for hours in a corridor before being told they can go home. Or worse, they are admitted to hospital for no good reason. The junior doctors who make up the bulk of A&E staff are usually only one or two years out of medical school. Some patients are inevitably admitted unnecessarily, just in case something is missed. Better to be cautious than cocky.
This has a knock on effect across the whole hospital. An overnight stay costs two to three hundred pounds. More occupied beds mean less time per patient for nurses and doctors - there may be more patients, but there isn't more staff.
Fix A&E and you fix the NHS. Despite being encouraged to seek help elsewhere, people are treating A&E departments like their GP - so let's put GPs in A&E.
Labour now wants to "encourage local areas to place GPs in major A&Es" as part of their solution to the NHS crisis. This short statement belies the infrastructure required to make it work properly. We already have a limited amount of GPs working alongside A&E doctors, but numbers are small, in part because GPs are more expensive than A&E juniors. The occasional GP in a few hospitals is not enough. The quantity of patients who need seeing requires, in effect, a fully staffed GP surgery to be placed within an A&E department.
Without doubt this needs investment. But with the right system in place, A&E could siphon off the patients who need to see a doctor but don't need a trauma team. There will always be people who see a GP and end up needing to go to hospital anyway - just as patients who see their usual doctor sometimes get referred. But primary care physicians have years more experience than A&E junior doctors, and should be able to keep patients out of hospital who never needed to be there.
We should learn from Circle's failure with Hinchingbrooke. The radical reforms needed in the NHS have nothing to do with the private sector. The coming election is an opportunity to take stock, and make our health service work for patients, not profiteers.