To think "failure" of a privately run hospital proves all hospitals should be privately run

[Theoretician]

Article in the Telegraph this morning saying that private operator Circle is pulling out of running Hinchingbrooke hospital. They say that outputs (demand for services) have increased and inputs (government money) have decreased, therefore it is no longer viable for them to be involved.

What would an NHS-run hospital do in the same circumstances? Try to cut quality of care in ways that aren't too obvious or noticeable to the public, I think. The sort of thing that, in the most extreme cases, results in the kind of neglect we've seen in some recent scandals.

I suppose it's not inevitable that a private operator would have the integrity to pull out when politicians promises and health funding diverge. But at least there's a chance. I'm not aware of any cases where a NHS hospital manager has turned round to the government and told them to fuck off, because they're asking for the impossible. If they did, it would make no difference, they'd just be replaced by someone willing to pretend that targets were achievable. And it wouldn't be a news story.

Strictly speaking, it's not being privately run that makes this case different, it's being run at arms-length from the government by an organisation that won't compromise on quality, and regards any divergence between funding and demand as someone else's problem. (Which it is. Specifically it's for politicians to reconcile the two.) So truly independent trusts, who prioritise quality above everything else, might do just as well.

[MaidOfStars]

I've read this a couple of times and I just want to be clear... The situation in Hitchingbrooke is one of an NHS hospital run by a private company? Circle are not a private healthcare provider?

[WonkoTheSane42]

I think you're pretty naive to think a private company priorities patient care over profit. Private companies in the healthcare business will do it for as long as they can make a profit at it. The NHS doesn't have to worry about making a profit, so can spend all its money on patient care.

[Teeste]

Motivated by integrity? Lack of profit, I should think. And that's always the problem with privately run healthcare firms, they need to do everything the NHS does AND make a profit, so they cost more and will also cut back on stuff people might not necessarily see when funding is an issue. They will also pretend targets are achievable to protect their own profit margins. Privatising everything else didn't work either.

So aren't you arguing for better empowered and funded NHS trusts and not private ones? Which I'd agree with.

[Hobbes8]

What makes you think the private sector won't compromise on quality?

[Lilymaid]

CQC preliminary report on Hinchingbrooke back in September was damning. Full report expected soon. The current national A&E problems have provided Circle with a good opportunity for an excuse to get out before report is published.

[paxtecum]

Sorry, you are very deluded and or naive for the reasons stated by others above.

Think about G4S and that privately owned company that was paid millions to get the unemployed back to work and they had all sorts of scams on the go - sorry name escapes me, but was owned by a woman.

[Theoretician]

What makes you think the private sector won't compromise on quality?

In this case they haven't. In other cases the might. But in every single case, an NHS-run hospital will compromise on quality. So at least this way there's a chance of a better outcome?

[Theoretician]

OK I was wrong to talk about the integrity of a private company. Let's assume they couldn't let quality slip because they were being independently monitored. We've still had (as I see it) a better outcome here than if this hospital had been NHS run.

[elastamum]

Hinchingbrooke had huge problems before Circle took it on - and I am amazed they even considered it could be viable privately run. If it was part of an NHS trust it would be running a deficit, as many are, i.e. making a loss. that isn't a long term option for a privately run company.

Circle cant solve the problems and cant keep a loss making business going indefinitely so they are bailing. Entirely predictable. It amazes me when people go on about the threat of privatising the NHS that they haven't considered that most private companies wouldn't touch most of it as it is not a profit making venture and wont run as such. It isn't a viable business model, far too risky.

The only bits at real risk of privatisation are defined peripheral services, which can be run profitably. These are mostly being tendered by GP consortia to companies owned by - guess who - GPs

[MaMaMarmoset]

As an American, I think YABVVVVVU.

And talking poo.

[MegCleary]

There is no way to make a profit running an NHS hospital. The NHS was not designed with profit in mind. What may need to happen is a discussion on what can & cannot be provided by the NHS, but good luck trying to have that.

[Hobbes8]

The NHS can't let quality slip because they are being independently monitored. That's what the CQC do. Obviously that system hasnt been working perfectly, but the idea that the private sector would automatically do better is flawed, at best.

[dogscatsandbabies]

Oh god, where to start? As has already been said here, private companies do whatever they do to make money. In this case, they provide healthcare. And I don't doubt that there are employees within these companies that have integrity and want to provide high quality care but (trust me on this one) their intentions are ALWAYS trumped by the accounts.

To suggest that the NHS cuts quality to meet targets is... simple wording for a massively complicated truth. Everyday is a compromise between what we have to do according to our contracts, what we want to do for the patient in front of us, and what physically can be done when there is too much work with too few resources. Something gives, it has to. Don't ever think that any of us who are covered by this huge 'NHS' descriptor are comfortable with it.

It is lack of profit that has led this health care provider to pull out. At least my management can't throw the towel in when it all gets a bit tough.

[elastamum]

FWIW I don't think hospitals should be privately run because so much of the work of an acute trust is unpredictable that the business model is not viable.

You need specialist centres for things such as major trauma and serious surgery / emergency medicine, which are very expensive and difficult to predict. In order to support the investment you need a caseload of routine work to justify the investment and staffing in a major hospital. Even if you contract out the routine stuff to a private provider you still need to keep the hospital investment to manage the difficult stuff. If you go down the privatisation route secondary care gets much more expensive - not cheaper

[bobthebuddha]

"The NHS was not designed with profit in mind. What may need to happen is a discussion on what can & cannot be provided by the NHS, but good luck trying to have that."

Can't disagree with that. It's worth noting that Hinchingbrooke was privatised under Labour, when Andy Burnham was Health Minister, however he may wish to ignore that fact. Nicely ironic that Circle has pulled out under the Tories though.

[BuggerLumpsAnnoyed]

They're not pulling out because they don't want to compromise on quality. Its because they're not making enough money

[SusanIvanova]

What ukip/tory nonsense.

Most private forays into public sector services go tits up, not because of integrity but because it's hard to make a profit.

Look at most PFI deals, G4S, Atos, any database they've tried to implement in the last 20 years and you'll see what I mean.

[Babycham1979]

OP, is your title wrong? It makes no sense at all. Circle have demonstrated that, despite all the fanfare, the Emperor has no clothes. NHS inefficiency was blamed for the failure of Hitchinbrooke, where the truth is that it's an unsustainable business model, made so by Government 'reforms' and insufficient funding in the context of growing demand. Surely it proves that no hospitals should be privately run, as they can't be. Only by cherry-picking certain procedures can private providers compete with the NHS. Some PbR (payment by results) tariffs are more generous than others, yet NHS providers don't get to choose what they provide.

Circle's story proves that the myth of private sector efficiency is just that. WHO and Commonwealth Fund studies have repeatedly sharon the NHS to be among (if now the) World's best for care outcomes versus cost. A third of the cost of the US system goes on profit and administration costs, as opposed to 7% in the NHS. Furthermore, the US system (even with Obamacare) doesn't provide cover for ten of millions of Americans.

Successive governments have sold us the lie that the private sector is automatically more efficient and effective than public. This is a lie, and it's told because so much of our political class has a personal interest in big private health providers.

[Lilymaid]

Hinchingbrooke is situated between two larger hospitals - Addenbrookes in Cambridge and Peterborough General. Back in the summer it was advertising on Cambridge buses for patients so presumably wasn't the hospital of choice for many.
The area is growing rapidly in population so there is justification for it to remain open particularly if the A14 upgrade is delayed even longer and the only way to get from the west of Cambridge to Addenbrookes is by helicopter

[nhsworker15]

Rubbish op. Private companies are pulling out because they can't make a profit. You just have to look at the state of private run nursing homes to see how much integrity these companies have in relation to patient care.

[CLJ52]

I'm with Elastamum.

Hinchingbrooke was a failing hospital when Circle took it over. It made huge improvements in clinical outcomes, employee satisfaction and waiting time reduction. These improvements didn't happen because Circle is a private enterprise; they happened because Circle put the patients and employees first. Our NHS has turned into a giant bureaucracy where patients and employees are an afterthought.

Just like many of our NHS hospitals, they have found the government constraints impossible to work under. People are being directed to A&E because there is nowhere else to go (no GP out of hours, very few home visits, long waiting times for appointments) and lack of social care means there are people in hospital who don't need to be there.

There's a real danger this turns into a public vs private failure argument. Our whole health service is imploding.

My ideal would be a purely publicly owned, publicly funded health care system that provided first class healthcare throughout the service. We are a long long way from that.

[bobthebuddha]

"There's a real danger this turns into a public vs private failure argument. Our whole health service is imploding. "

I'd add that this is already a Tories vs Labour argument, which is a false one. Labour constantly talks about 'our NHS' as if only they can run it properly but they've made some catastrophic errors which have contributed to the current implosion. The NHS is also a political football with patients, taxpayers, efficiency and value at the bottom of the heap. This needs to stop, but how??

[PausingFlatly]

The CQC don't agree that Circle put employees first, or patients:

Hinchingbrooke staff in CQC 'abuse' concerns 'fear bosses'
Staff accused of treating patients in an "undignified and emotionally abusive manner" at a privately-run NHS hospital in Cambridgeshire are victims of a "blame culture", a union said. The criticism was in a Care Quality Commission (CQC) letter to Hinchingbrooke Hospital ahead of a full report following a recent inspection.

[Cornettoninja]

They won't pull out. It's a massive game of chicken to get more funding. They'll have bid ridiculously low to win the contract and once that's in place can use this as a tactic to get more money to cover real costs and make a profit.

That's why government contracts always (pretty much) run over budget. Once a company is providing a service it's next to impossible to replace them without months and months of notice and planning.

All this proves is healthcare isn't a profit making sector. Unfortunately you get no medals for savings anywhere else in society but your own budget.

[PausingFlatly]

"advertising on Cambridge buses for patients"

Goody, that's clinical budget well spent, isn't it?