That this doesn't sit comfortably with me?

[savageswimmer]

I was sitting at the bus stop at my local hospital the other day and I kept noticing normal yellow and green ambulances with sirens going past but with 'Elite ems' on the side, I thought this was strange so I googled it and it appears that they are a private company being contracted to provide emergency response ambulance services. I had a look at their website and it doesn't sit right with me, quotes such as they 'exceed nhs standards' and calling patients 'clients'. Aibu that this is a slippery slope into privatisation that has the potential to descend into receiving an ambulance quicker if you have the means to pay? Should our emergency services really be being contracted out?

I remember after i think it was some sort of terrorist attack in London that first on the scene were some sort of private ambulance/ emergency service that the rich Jewish community in the area paid for.

I love the NHS and believe we really don't know how lucky we are - but Any one who thinks the rich don't get better health care is naive. We have a Tory government FFS and so privatisation of the NHS is being actively driven- it's not through the back door at all.

The whole point of contracting out is that someone makes money.

Think about it. You need a cleaner, you can employ him/her direct on £10 an hour or you can go through an agency and pay £12. The middleman makes £2.

All these services that are being contracted out by the NHS, someone (probably some fat cat Tory pal) is making money out of it.

And the fact that various services are so fragmented is a real problem when a medical issue needs joined up thinking and input from a few different sources. My experience of contracted out services are that they lack expertise and are one size fits all done on the cheap.

We have a mix of public and private healthcare in Ireland and one of the most unequal systems in Europe. Other countries like Germany can manage both quite well but not in Ireland. Be careful what you wish for.

This has been going on for years. Things like hip replacements and cataract removal are put out for tender and are provided to the NHS by private providers. Cleaning and maintenance the same. Hospitals were built using PPI finance. It all began under the Blair government.

link

I honestly can't see the problem with outsourcing.

My ds who has complex needs has had.... physio, OT, Speech therapy, community paediatric service and continence service via Virgincare since 2016....he lost therapists, we have had to travel further distances, communication is appalling, we have struggled to get certain medications, and equipment, referrals have been lost, communication between nhs services and Virgincare services are non existent and he has been discharged from services other professionals have said he needs. In a professional capacity (I work with disabled children in early years) I have seen waiting lists grow, criteria for referral, equipment and services change and a high turnover of therapists.

They do have a lovely shiny new building called a hub though. Oh and apparently they are running a more financially efficient service (this may be easier when there are fewer children being seen)

I discovered this when I needed to book a private ambulance for a hospital transfer for DH. That's another story but the upshot was that I couldn't get one locally. They were all doing NHS work.

A friend of mine has recently run several projects where a private company has taken over particular NHS services. At first I was very tight lipped about it but the more I hear from her, the more I think that this could be a good thing. The waste and corruption she comes across in the NHS is incredible. In one trust consultants routinely took on private lecturing jobs that clashed with their NHS clinic appointments meaning that either the clinic appointments were cancelled or the hospital had the work and expense of finding and paying locums - whilst still paying the consultants who hadn’t turned up. Under the private system my friend helped implement if the consultants didn’t attend the clinic (or arrange and pay for suitably qualified locums out of their own pockets ) they didn’t get paid by the NHS. Obviously the consultants are furious that they no longer get paid twice for the same hours but it has improved their attendance so patients see the same consultant regularly instead of different faces and is saving that one trust thousands and thousands of pounds a month.

In another example of waste she started work at a trust that had ordered Blackberry smart phones for hundreds of administrative staff because they were less expensive than alternative makes completely overlooking the fact that they had been reduced in price because Blackberry were withdrawing support for the software. By the time the phones were eventually delivered they were obsolete and literally went straight from a delivery truck to a skip without even being unpacked. She managed to resell them to a developing world hospital (obviously at a massive loss) so a small amount of the loss was recouped and the resources weren’t wasted but it was such a waste of money.

Just remembered another example of waste - she oversaw the relocation of services and staff from an NHS site to a new privately run site. Even though this had been in the pipeline for several years the NHS site managers had carried on as if it would never happen and arranged for a refurb of the kitchenettes to take place two weeks after the NHS site closed. Amongst other things she was responsible for selling on or donating or disposing of all the furniture and equipment left on the old site. When she arrived one day at the nearly empty old premises some of the white goods for the new kitchens had been delivered. Dozens of packaged fridges and microwaves piled up in the foyer of a building scheduled for demolition. No one had thought to cancel or redirect the orders.

Your examples just indicate that the NHS need sorting out Winbinin not that we need to hand over part of the budget to private people.

I agree there is massive waste in the public sector: our local primary school had a lovely shiny new dining hall built. And two years later they knocked down the whole school and rebuilt it all.

There’s a real problem with joined up thinking on the management and admin side. For example I bet the trust was forced to buy those Blackberries because they tendered on cost alone.

DH used to tender to the NHS. Often they bought inferior poor value stuff because it was cheaper. More savvy buyers tailored the tender requirements to eliminate these problems. For example, the Blackberry buyers should have had it written into the tender that any phones bought must be supported for x number of years.

Virgin invited me for a healthcheck now i'm 40 years old on the NHS's behalf

I've worked in private sector providers of NHS services, NHS provider Trusts, and in NHS commissioning (the people who have the money and award contracts.) I can assure you that private providers are always held to at least equal standards, and often much higher ones than NHS providers. In one job I had (private secure mental hospital) I had monthly contract monitoring meetings with a particular pair of commissioners. Even they were embarrassed to admit that they came to me every month and spent two hours inspecting the ward and patient room, going over quality indicators, incidents, care plans, and everything else - even menus - with a fine tooth comb for one patient on whom they were spending around £25k a month when they didn't step foot in their local NHS Mental Health Trust from one year's end to the next despite spending £200 million a year there.

It would also take something quite remarkable for a contract to be awarded to a private provider which did not offer equivalent or better value for money given the level of scrutiny these things attract from not just those charged with oversight, but from unsuccessful bidders too. When a public service contract is let on the basis of "most economically advantageous tender" the contracting authority MUST award it to the best value bid - and this is often the private sector. Trust me, no properly-advised NHS contracts manager is ever going to award a contract otherwise for fear of legal action, not if they have any sense.

Where private sector NHS contracts have fallen apart, in my experience it is usually because the assumptions the NHS made when letting the contract, for example on volumes of activity or casemix, have turned out to be wildly inaccurate, or the goalposts move significantly (usually because the NHS tries to impose a price cut).

There are a number of reasons for inviting the private sector to tender for NHS contracts. Often it's purely about efficiency. Sometimes, it's because there is a large capital requirement that the NHS cannot commit to but the private sector can; the trade-off of course is that the providers of capital expect to be able to make a profit. Why would anyone let you use their money if they couldn't make a return on it?

More recently, and cynically, I've seen a lot of contracts put out to tender where the contract value on offer is less than the salary cost of the staff expecting to TUPE-transfer across - that is to say that redundancies are needed and they want the incoming private provider to both swing the axe and foot the bill.

For those who think "creeping privatisation" is a Conservative ideologically-driven policy - think again. It was Alan Milburn (SoS for Health under Tony Blair) who rapidly expanded private provision of NHS services under the Growing Capacity programme in 2002-03. I know, because I was heading the NHS business unit of one of the largest private providers in Britain at the time. Milburn wanted the private sector to provide 15 per cent of NHS acute servies; in fact the figure has never gone above 5 per cent.

On the question of "client" or "service user" versus "patient", you'll find the former terms much more prevalent in mental health, addiction and in particular learning disability services. This is to avoid the stigma attached to being a "patient" in one of these areas and it appears to be becoming more mainstream in acute health.

I've been around the block in UK healthcare, and I'd take a private provider of NHS services over the NHS itself every single time.

Group4 run our 'taxi ambulances' round - why would you pay a qualified paramedic 40K per annum to suffle people from care home to clinic and back again, operating what is effectively a taxi service ? Thats a waste of moeny. So you have trained first aid drivers instead on half the money, working a 7 till 3 service rahter than shift work.

But the NHS has never had paramedics doing taxi duty ambulances.

It would also take something quite remarkable for a contract to be awarded to a private provider which did not offer equivalent or better value for money

That’s just not true. Our company sold technology to the NHS. We dealt with a lot of scientists and clinicians who were deeply pissed off that they had to use equipment that was simply the cheapest rather than the best for the job. The more savvy ones would basically write the tender spec to fit our products and eliminate the crap ones.

Unfortunately that didn’t always work. Think of the Sam Vimes boots situation so beloved of mumsnet. You can ask for boots that do x, y and z. And that brief can be filled either by cheap rubbis h boots that are uncomfortable and fall apart after a year or lovely well made boots that fit perfectly and will do sterling service for five years, but cost twice as much.

Currently the NHS will get the equivalent of the cheap boots. The opinion of the person using the boots will not be taken into account.

winbinin Some of the consultants are piss-takers in the trust I work in too... cancelling clinics at very short notice (think 12 hours) and just buggering off to do something more attractive (paid for conference abroad for example). Then 'offering' to clear the backlog of patients on the waiting list by running weekend clinics at weekend rates of pay (time and half or even double time).

Tinkly I take your point - especially about the appalling specs you see in some NHS contracts - but we're not really talking about the same thing here.

A district nursing service is a district nursing service, regardless of price. When it is contracted out to the private sector the exact same staff transfer across to the new provider. The only real variable is the productivity of the staff which manifests itself in things like response time and length of appointment, which even NHS managers can work into a specification.

Other In our area orthotics has been contracted out. My young adult children have orthotics and if they are not correctly fitted their whole quality of life is affected.

The contracted out service only fits orthotics in one specific way that does not work at all for my children’s issues. Basically pushing your foot into a mould. Takes 5 minutes. Anyone can do it.

They point blank do not do it in the more skillfull and time consuming way that the NHS were previously able to offer: manipulating the foot into the optimum position, casting with plaster of Paris, So my children cannot now get decent orthotics on the NHS. We have had to go private at a cost of hundreds of pounds.

I cannot speak for your district nurse service, but I would strongly suspect there is a district nurse service and a contracted out district nurse service. Even if it is the same staff there will be new cost constaints.

Tinkly I understand and share your frustration, I really do, but the problem there is the way the new service has been commissioned and specified, not an intrinsic privatisation problem.

The one-size-fits-all (literally!) approach will have been imposed on the current contract to drive costs down. The NHS would have been welcome to bid against the same specification.

As pps have pointed out, the NHS is subject to procurement law the same as any public sector entity. Because of its own structure (ie having 'commissioning' bodies) it needs to outsource certain contracts - awarding these contracts is subject to procurement rules. Private sector bidders have a good shot of winning due to access to resources which can (at least on paper) give better services and drive down costs. It spans across everything from ambulances, to health visiting, to sexual health services and so on, and there's likely more out there than people realise because the staff don't necessarily change as they are subject to TUPE transfer.

The NHS can't simply give the contract to a public sector bidder despite the fact they may want to, and if they ignore or attempt to circumvent procurement law in order to do that then the private sector bidder that loses out is well within its rights to throw the money it has into suing the NHS and getting a very considerable payout (of public money) through either an out of court settlement or award by the court. Even if the NHS body decided to just restart to process in order to avoid a contract that goes against the relevant principles and legislation and therefore avoid litigation, running a procurement exercise is a bloody expensive task and takes months and months to do, so it's not a decision they would take lightly.

They aren't just handing contracts to the private sector because they want to (often they are very opposed to the concept), it's because the private sector tender was better than the others in the context of responding to the questions they were asked. If the winning offering is terrible it's generally because either the procurement process was designed poorly and did not ask the right questions of the bidders, or the other offerings (which may be good in practice) were terrible on paper. 'Most Economically Advantageous Tender' doesn't simply mean the cheapest. Price and quality are both normally taken into consideration and given more or less weight than other depending on the importance to the procuring body, so they need to get that balance right.

Trying to cut corners in order to award to an NHS body rather than run a process that risks giving a private bidder a contract ends up being more time consuming and expensive than just doing the job right and ensuring you are asking the right questions of the bidders. If it's important that bidders are able to work with other areas of the service, or that they provide a specific standard of care, and the NHS (or any public sector body when it's putting out a contract opportunity) doesn't ask bidders about their ability to do that, then they can't grumble afterwards when the bidder does exactly what it said in its bid and no more.

The procurement rules are in place in order to stop services just being handed out to the friends and family of the decision makers. Unfortunately the appreciation of the importance of procurement law is not always as robust as one would hope in the public sector. As Otherpeoplesteens pointed out, a well advised body won't award a contract improperly - the issue is most don't want to spend the (considerably less substantial than those for litigation or rectification of a poor service) legal fees to make sure that what they're doing is correct and defendable, and then end up either with a poor service, or needing to defend a claim once they're already up the creek.

The opinion of the person using the boots will not be taken into account.

That may be the case sometimes but absolutely not across the board. Evaluation panels need to be made up of people qualified to review the tenders and generally that does include representatives from the various user groups (better still, separate representatives for nurses, doctors, admin etc as appropriate) in addition to other decision makers. The rules are there, it's up to the public sector to follow them.

I'm not for one second saying the process is perfect, but when it's done properly it can be an incredibly valuable tool. Unfortunately it rarely is, and that's an issue within the public sector, not the private companies.

Sorry for the essay

The problem we have with orthotics is that Virgincare physio now no longer tie up with children's orthotics, so 8 year old ds is seen in adult orthotics, who seem to have a similar skill set of push child's foot into mould....."stop tensing your foot"......"he's 8 and has learning disabilities, he doesn't understand tensing, and he is crying because he thinks you are cross with him"

He used to be seen in a centre where physio and ortnotics worked together, with the OT in a specialist clinic for disabled childten. It was fantastic.

Over the last 2 years ds has had splints held together with gaffer tape, insoles which don't fit in any shoes, insoles cut so badly they have left sores on his feet and it has taken me hours of phonecalls and emails to contact a physio and get them to actually assess what support he needs. That's just his feet. That's one of the easier bits of his needs to address.

I've been around the block in UK healthcare, and I'd take a private provider of NHS services over the NHS itself every single time I may not have worked in healthcare but we've been around the block a bit too and I would take the NHS over the shit show we have now..

hazey you have articulated the problem so much better than I did.

Contracting out services might work for the rare health issue that is discrete and uncomplicated. But many, if not most, are not. They require an input from a range of specialists.

When my kids were small we would go to a clinic with a neurologist, a physio and an orthotics. Plus a nurse whose job was to act as the go to coordinator for kids with that medical issue.

I’m pretty convinced that this excellent early care has meant my kids have grown up with minimal issues and able to be active and therefore healthier. Presumably saving loads of money over their lifetimes. And sadly I do have a sort of control group for this because my sisters kids, with the same problem, were cared for in a reagional hospital with more fragmented services and have significant ongoing problems.

However now my lot are young adults this sort of service seem not to exist unless we pay for it.

Thankyou Tinkly.

The coordination of care for people with complex needs is so difficult to navigate, and when half of it is contracted out, it makes it even harder to coordinate.

I am going to a feedback forum on our local healthcare services, a lot of people seem completely unaware that huge swathes of health services (400+ and growing rapidly) are now under Virgincare. I think until you are directly involved you have no idea, even if it happening in your own area.

I also fear what will happen in 2 years when the contract for children's services come up again....

I love the NHS as much as the next Brit but there is SO much waste in the NHS.
Saw a post this morning about terrible patients wasting resources by ordering prescriptions they don’t need. As if it’s our fault there is waste.

Did a quick calculation about a med DD was prescribed as a baby. Because of the size of bottle, we ended up throwing the vast majority away. Pharmacy couldn’t supply it in smaller bottles. If you multiply this by all the babies who were prescribed it, this one medication alone was responsible for £5m per year in waste.