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.

I'm not knowledgable enough on public v private sector arguments to comment on the main stream of this thread, but I will say that I gave birth at Hinchingbrook in March last year. I was diverted there because the all-singing, all-dancing birthing unit at Addenbrokes was closed to new patients due to staff shortages. The midwives at Hinchingbrook told me it was a regular occurrence.

I can't fault the care DD and I were given during our 72 hour stay and I'd worry enormously about the impact on services in the area if Hinchingbrook were to close.

TBF, Cornettoninja, healthcare can be a profit-making sector as long as you only try to treat cheap stuff, or the punters put a lot more money in.

It's only if you try to run a universal service on a low payment-per-head that you can't make a big fat wad out of it.

We use Hinchingbrooke and Kettering Hospitals, and the changes Circle have made at Huntingdon are nothing short of amazing. It used to be awful, really awful. The difference in care between Hinchingbrooke and the other local hospital are easy to see, and given a choice I would have chosen Huntingdon over Kettering whatever CQC say. I'm not surprised that they can't run at that standard for the same money as a less polished/patient and visitor focussed hospital can. It will be a great shame if it reverts to the local management system they had before.

Granted there are some areas of healthcare that can indeed produce a profit - elective treatments and procedures. My layman observation is that there is a reason the likes of BUPA have never attempted to provide emergency or ITU care (I'm sure there are other areas), profit doesn't translate particularly well to hospital care (amongst other areas)

I cannot even begin to explain how incorrect and ill-advised the premise of your OP is, Theoreticician

Healthcare will never be a profit-making undertaking, unless the service caters only to the rich and cherry picks conditions it choses to treat.

Circle pulling out due to concerns about quality?
You are having a larf, aren't' you?!

I am not one to excuse the many flaws and faults of the NHS, but god help us all when health care gets privatised.

Comparative findings of Commonwealth Fund

Plus, the fact that 'some' procedures can be delivered profitably is the crux of the problem; they're only profitable because the complex patients (poor, old, vulnerable, mad) are taken on by the public sector, thereby subsidising the trivial, predictable, relatively simple elective operations that the private sector likes so much. And if you happen to arrest during your operation, or there are complications? You get transferred to an NHS hospital to deal with it.

The business model of private healthcare providers in the UK is like that of Kwikfit; specialise in a couple of simple jobs, pile them high, sell them cheap and let someone expert clean up the consequences. Unfortunately, years of Daily Mail propaganda has actually convinced people that the superficial customer service 'improvements' in private hospitals reflect real clinical care.

Momb, your comment that,

'We use Hinchingbrooke and Kettering Hospitals, and the changes Circle have made at Huntingdon are nothing short of amazing. It used to be awful, really awful. The difference in care between Hinchingbrooke and the other local hospital are easy to see, and given a choice I would have chosen Huntingdon over Kettering whatever CQC say'

Is terrifying in its ignorance. Do you actually understand the implications of a damning CQC report? A hospital may look clean and shiny, but your risk of contracting a life-threatening infection are much higher, the level of care will be worse, the likelihood of drug errors is higher and your chance of leaving alive is much lower.

I write this as someone who runs hospitals for a living (private and NHS). I've privatised services, and I've taken others back into public hands. Ideology aside, I'm certain which I'd rather my loved ones were treated in.

Yes, agree completely Cornettoninja and Babycham.

Someone can make profit if they cherry-pick. But that's not running a health service.

The mantra of privatised public services is: privatise profit, socialise risk.

Ideology aside, I'm certain which I'd rather my loved ones were treated in.

Yes, me too.

I'd happily have a simple procedure, say a knee arthroscopy, done privately: it would probably happen quicker and I'd have a certain degree or being able to plan it around my other obligations.
If I or one of my loved ones was seriously ill I'd want to use the NHS without a shadow of a doubt.

YABU. Your logic is completely bonkers.

Well yes maybe that's the solution. Privatize what you can take the profit off them and reinvest to run emergency services and services that not safe privately run.

Haven't read the whole thread, so apologies if repeating stuff already said. I think private hospitals do care about the standard of their care, because it's their edge over the public system. I've worked as a nurse in both and been a patient in both here in Oz. I would actually have to say that while the hand holding/ cup of tea type care was much better in the private sector, the actual clinical care was better in the public. Much better and more up to date. The way a cardiac arrest was dealt with in the private hospital ( which did some large surgery, hip replacement etc) was to call an ambulance! Neither private where I am has an ICU or A and E.

Meg, just how do you propose to "take the profit" off privatised companies?

And given the private companies are being paid from the public purse in the first place, where do you think that money is coming from to be "reinvested"?

Umm, have you seen the CQC report OP? Fairly significant compromise in quality, id say.

And the reason nhs managers don't walk away from their jobs when the financial situation becomes intolerable, is because there is no one else to do it. The services need to be provided. If everyone walked out when it got tough what would happen?

I work in NHS, lots of our senior managers are due to retire in the next 5 or so years. They are spending their last few years trying to redesign a service without management because they know that when they go they won't be replaced. Or annual budget is in the region of 500 million, we've got about 4000 staff and we have 6 senior managers. The place will fall apart when they go, there's no forward planning with respect to management, because their funding will have to go to savings.

nhsworker15 - agree totally. That's my experience too.

Anyone still thinking that private providers are a good idea, Google Serco in Cornwall and see how they compromised patient care and fiddled the figures in order to meet targets and make a profit.

(Though the PCT/CCG could have discovered it much sooner than they did if only they had the brains to ask the right questions....)

There's a massive exodus of senior/experienced doctors in their late 50s due to the unilateral reduction of their pension allowance by the government. The money was there to cover everybody's pensions but was taken.

This is not a moan about pensions (although I do think it was unfair) but just to say not only will senior management be depleted, but medical staff with experience and expertise too.

Ah wait, there will be the famous 3000 or 50000 (depending on which speech you listen to). Except there won't because they are not even in training yet.

I have one word for you right now - railways.

pausing could the NHS not charge & run the rest of the service on the income. As I said earlier I have no fix but am utterly saddened by the state of the institution I truly believe is one of the greatest endeavours of a civilised society.

My GP surgery was taken over by a private provider a couple of years ago and the service is appalling. I needed a CT scan aand had to wait 4 months because the GP said only a consultant could decide whether I needed a scan.

When i saw the consultant 8 weeks later she was surprised why I had to see her as she said the GP could have referred me for a CT scan himself then under her breath I heard her say I bet he didn't want to pay for it.

Then I had to wait for another 8 weeks to get a scan. Private providers are only interested in the bottom dollar

There's a massive exodus of senior/experienced doctors in their late 50s due to the unilateral reduction of their pension allowance by the government. The money was there to cover everybody's pensions but was taken

That's not true, really. NHS pensions are funded out of current taxation - there is no pension "pot". And I find it hard to feel any sympathy for individuals on six figure salaries funded by the public pot (which also funded their education) who supplement said salaries with lucrative private work.

I'm only a user, not an insider, but in my view the NHS is over managed and over administered. Front line staff are under valued and under paid. That's where I'd like to see the funds go.

great posts from Babycham, Pacific & others. OP you are stretching the neoliberal delusion about private markets to the utmost. The reality is that healthcare (like other essential public services like roadbuilding) simply won't ever be attractive to private companies because their inherent nature is unpredictable and costly and there are no ways of ensuring enough of a return on "investment". They are never profitable private enterprises without massive state subsidies. Just look at rail and transport - supposedly privatised but in reality taxpayers give nearly £5bn a year to private transport companies in capital subsidies, without which privatised transport isn't remotely viable.

(Next time anyone says we can't afford to pay for students to go to university for free bear in mind that the entire HE teaching budget before the new tuition fees came in was about £3.9bn - less than the taxpayer subsidy that is doled out as a matter of course to private companies like Railtrack etc.)

Healthcare likewise like transport isn't remotely viable as a private concern without massive taxpayer subsidy. So why not just run it direct with taxpayer money rather than some of that being creamed off in profit?

I don't understand what anyone means by profit for health provision. It costs money to provide healthcare. That money comes in taxation or charges from the population. Who profits? Shareholders of a private company at the expense of the sick?

I'll admit this OP wasn't my most considered post on here. However there was a point in there that I'm holding onto for the time being.

And the reason nhs managers don't walk away from their jobs when the financial situation becomes intolerable, is because there is no one else to do it. The services need to be provided. If everyone walked out when it got tough what would happen?

If managers pretend they can do an impossible job, they are colluding in a lie, which leads to poor care. I'm not suggesting a co-ordinated mass walk-out, merely that every organisation should draw a line in the sand and not allow themselves to be pushed into compromising standards.

I heard of a computer programmer who put a somewhat passive-aggressive message to his bosses on a sign balanced on top of his monitor. "Fast, cheap or good: pick any two."

If can't have everything, you have to pick something to sacrifice. In the NHS it's most likely that something will be "good", because that's the hardest thing for the public to measure. Second most likely is "fast". Remember waiting lists? I would like the something to be "cheap."

I want a system that doesn't compromise and try to cope, to make do and hold itself together with duct tape, when the going gets tought. I want a structure where hospitals can say to their customers, the politicians "this is what we do, this is what it costs, if you want more supply, give us more money, otherwise fuck off."

(Actually, maybe the emergencies declared in various hospitals this week are example of NHS managers behaving they way I want them to? Maybe the NHS has evolved the structure I want? But will it last if it makes politicians look bad?)

If managers pretend they can do an impossible job, they are colluding in a lie, which leads to poor care. I'm not suggesting a co-ordinated mass walk-out, merely that every organisation should draw a line in the sand and not allow themselves to be pushed into compromising standards

I'm assuming you don't work in the public sector, or in a caring/educational job? Or a job at all, from some of the things you've "theorised"? Those of us who work under heavy workloads and care can't just walk away.

YABU and dangerously naïve