Would NHS break-up really improve hospital safety?

By Savi Hensman

October 11, 2013

The type of problems at Mid Staffordshire NHS Foundation Trust in England – where care failings affected patient safety and dignity – would not have happened in an enterprise part-owned by employees, according to care minister Norman Lamb. Yet the drive to remove more health services from NHS control may seriously harm patients.

The government has launched a “review of NHS staff engagement” which “will consider options for supporting employee voices and their stake in organisations providing NHS services, and will assess a range of options, including models such as social enterprises and mutual organisations.” It will be led by Chris Ham of the King’s Fund

Giving staff a greater say is indeed important – indeed this was supposed to be one of the benefits of NHS foundation trusts. But major structural change is a different matter, and many employees as well as patients are less than happy at the thought.

“Public service mutuals are appearing all over the country because hardworking nurses, social workers, probation officers and other frontline staff want the freedom to do their jobs as they know best,” according to cabinet office minister Francis Maude. “We are in a global race and as government looks to support the next generation of innovative health mutuals, I’m excited to see what ideas are generated by the Panel.”

It is not certain that all the ex-NHS staff who formed not-for-profit mutual Central Surrey Health would agree. In 2010 Maude praised its staff for being able to “show that more can be done for less” and being “the experts who know what their patients want”. But it lost out to private provider Assura Medical for a £450m contract.

Perhaps he was thinking instead of Hinchingbrooke Hospital, which he visited in 2012. “Circle, a mutual joint venture which is 49 per cent employee owned, became the first company to take over management of an NHS hospital,” according to a government news release at the time. It failed to mention that Circle is largely owned by hedge funds, some of which are controlled by major donors to the Conservative Party.

In February 2013, the parliamentary Public Accounts Committee reported that "The company has not achieved the savings it expected in the first few months of operation and it has already parted ways with its Chief Executive, only six months into the project. We are concerned that Circle's bid was not properly risk assessed and that Circle was encouraged to submit overly optimistic and unachievable savings projections”, adding that the Trust is not “financially sustainable in its current form”.

To make the shift towards loss of public control of NHS services sound more politically acceptable, the supposed benefits to patients and staff are being emphasised. “At Mid Staffs you had bullying managers who tried to drive through some pretty irrational changes internally,” Norman Lamb told the health service journal HSJ. “You can’t do that in a mutual. It couldn’t happen as it happened in Mid Staffs.”

But bullying happens in all sectors and, as the Mid Staffs and similar inquiries have made clear, major restructuring can distract managers from patient care, with deadly results. What is more, a fragmented health service involving numerous contractors may not be well-equipped to deal with a major disaster or epidemic in a coordinated way.

Not-for-profit social enterprises and private firms which are part-owned by employees may have a valuable part to play in providing certain health services. But dismantling the NHS, while creating lucrative opportunities for some companies, is likely to cause grave harm to patients overall, especially those who are most vulnerable.

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(c) Savitri Hensman is a regular Christian commentator on politics, economics, society, welfare and religion. She is an Ekklesia associate and works in the equality and care sector.