33 comments on “Timmy elsewhere

  1. Let me guess how the responses will go:

    Polly will scream about cherry picking,

    Ritchie will claim that the provision of health care is important but so is equity, in fact more so,

    The Unions will claim that the provision of health care is just one of the many jobs hospitals do such as forward planning and preparation for nuclear attack,

    The Guardian will say that the hospital is a capitalist stooge of the Americans and besides, it lacks sensitivity to Muslim patients,

    And Julie Bindel will accuse the hospital of heteronormativity and claim the only way to cure Britain’s health problems is compulsory homosexuality for all. Except trans-sexuals. Who ought to be gassed.

  2. @SMFS
    ‘The Unions will claim’
    @ SE ‘By their silence will ye know them’

    From the BBC piece about the hospital (which is rather buried away, unlike stories of privatised involvement in the state which go wrong):

    Unison could not be reached for comment.

  3. Actually, I’ve just gone there again and Unison have now made a statement. They are complaining that the original £40 million debt, run up under state control, has not yet been paid back, and are cross that the hospital is this far merely breaking even.

    That sounds to me like damning the state system with very faint praise, and if it’s the best they can do…

  4. Isn’t Hinchingbrooke the one that Dr Eoin used as an example of all that was wrong with privatisation?

    I seem to remember pointing out on his blog a while back that he was using data from when it was NHS-run to criticise the private operator; of course he didn’t allow my comments through.

  5. And another long-term Hinchingbrooke employee, Jenny Williams, said: ‘Under the NHS routine you have to go through a particular supplier. I remember being told if I wanted a new dishwasher it would cost £5,500 — I’m not kidding.

    ‘Now I’ve been allowed to find one myself — for £99. All I need is something which gets up to 100 degrees and kills germs. I don’t need something which can give me the time in three different languages.’

    I’ve recently built a system for the public sector. Most of my clients have security requirements that read “use the default security of the XYZ framework”. Everyone knows those rules, they’re effective (e.g. letters and numbers). You just plug the thing in and it’s done. Takes maybe a day or so.

    Public sector? Well, no. The rules are completely adhoc – someone just wrote what they thought was required. Some of them are not good, old rules that no-one uses now. And because it all had to be custom-built, took about 10 times as long.

    (lumbering private sector companies are about as bad, but at least you have markets that can destroy them).

  6. Lefty mate of mine insists this sort of thing (the washing machines) is just pointless anecdata. But there are a thousand and more anecdotes, and they really do add up to something.

    Chap I know is a detective who trains other detectives.

    – Wait for Mr Ecks to spit, then move on. –

    He was recently given a new intake of a dozen trainees and told to provide them with a certain course textbook, x00 pages thick, costing over £100 apiece from the constabulary’s preferred supplier.

    He found identical second-hand copies on eBay or Amazon in perfect nick, for £15 a go.

    Was told under no circs could he buy them.

    He bought them anyway, on the basis that if they sack him for it they’ve got a bigger problem than he has.

    Just as UKIP and the EU can be boiled down to one central point – you can’t kick the bastards out – the public sector can be boiled down to one central point: People spend other people’s money differently to how they spend their own.

  7. To be fair re the £5k dishwasher thing, you have to factor in that while it may be cheaper to buy umpteen different products from umpteen different suppliers, in a large organisation there can be considerable savings to be made in back office function if all items come from one supplier, one bill, one payment per month.

    That being said I doubt that the average NHS trust is understaffed in the finance office, and could very well operate a much wider number of suppliers with no extra cost.

    And there is always the possibility that kickbacks are in place higher up the organisation – put in place a ‘Buy only from this favoured supplier’ policy, get a nice little cash sum every month.

  8. @ Jim
    In the private sector there is a variant on “put in place a ‘Buy only from this favoured supplier’ policy, get a nice little cash sum every month.” which is ” ‘Buy only from this favoured supplier’ policy, get a nice discount on nominal price: it actually gives both sides a better deal (increased volume with no added salesmen more than makes up for the lower gross margin to the supplier) if done properly. I am fairly sure there are examples in the public sector as well. The dishwasher quote above illustrates the gross incompetence of the NHS Trust running Hinchingbrooke by employing a

  9. No I didn’t press enter, let alone “Post”
    by employing a supplier that did not actually supply the desired range of goods – in this case a basic hygienic dishwasher – rather than corruption. [I have no knowledge as to whether there was any corruption, but we do know that the NHS Trust was incredibly incompetent]

  10. “And there is always the possibility that kickbacks are in place higher up the organisation – put in place a ‘Buy only from this favoured supplier’ policy, get a nice little cash sum every month.”

    It’s not that there’s kickbacks – it’s that the systems are designed to ensure good tendering but ultimately end up with a fantastically complicated system that cost more than petty corruption. And you then get different sorts of corruption like large consultancies donating to political parties to ensure that more, big, complex tendering happens so they get more money.

    I’ve worked in private sector companies with “approved suppliers” and I remember one time that we needed a modem. It wasn’t just below the spec of what you could pick up in PC World, it also cost twice the price. And we had to wait weeks to get it.

    The only thing that works is trusting employees to be fairly decent and honest. If you’ve got an HR manager (which seems to be this woman’s job), you’re already trusting her to run the HR department properly. Why aren’t you trusting her with the cash for dishwashers and PCs? Even if she treats herself to a case of champagne out of it, who cares? It’ll still be cheaper than all the bureaucracy to try to stop that.

  11. It’s not so much corruption and kickbacks which is the problem with preferred suppliers. It’s more that to become a preferred supplier a company has to jump through dozens of largely pointless bureaucratic hoops, which it then charges for later; and the fact that once they are on the suppliers’ list, they only need to compete with others on the list, not the general market. And they know full well nobody will do a comparison between the approved suppliers and the general market once they are added to the list.

  12. When I worked for a large UK plc they had a preferred supplier for travel services, which we had to use to arrange travel, hotels, etc. Generally, if we shopped around we could get better deals ourselves, but the company went to great lengths to make sure we couldn’t do that. The argument was that the company got a nice bulk discount from the supplier and the actual discount rate depended on the volume of business. Of course the discount accrued to the department negotiating the contract (nice bonuses there!) whereas we had to pay the higher prices out of our own budgets. This is probably universal in large organisations.

  13. @ Tractor Gent
    The difference between big and small companies – I worked for a small consultancy in the ’90s and it had a preferred travel agent who knew who we were so we could ‘phone up and make a booking for a flight when we needed it. The firm paid the bills but since the lady who dealt with all the invoices was married to the largest shareholder we relied on her to ensure that no-one was trying to rip the firm off.

  14. why isn’t everyone trumpeting this from the rooftops?

    Give me strength – a froth-piece by Lawson for the Daily Fail, covering the results of an awards-dinner run by a Capita-owned consultancy firm… this is what the ASI cites as “evidence” for glib assertions about a competitive market in healthcare? If you are going to print PR bollox as the gospel truth, why not dispense with blogging – and simply repeat Circle’s press releases wholesale?

    No mention in that article of DOH’s generous indulgence towards the franchise, or how Circle is wholly reliant upon NHS acute capacity & workforce training, or how the cosy “staff co-op” image disguises some pretty opaque financial engineering. If the NHS is so unredeemingly shite, how come Circle are very careful to site their, y’know, boutique surgical centres in close proximity to NHS emergency/critical care facilties? They studiously avoid the messy stuff, and simply reap the benefits – it’s got less to do with competition, and more to do with freeloading.

  15. Ah, good old lost_nurse has turned up to tell us because the NHS does emergency care pretty well (and it does, mainly because you have to be on the ball in such areas, because the bodies start piling up rapidly if you’re not) the rest of the NHS must also be run as a centrally run monolith.

    Which of course is bollocks. There’s absolutely no reason why each town in the UK couldn’t have a State funded (and run if necessary) emergency medical facility, around which a number of privately owned and run medical businesses could cluster. Vast swathes of NHS treatment are perfectly suitable to be hived off to the private sector – having a hip operation is no real different to buying a new car really, same sort of cost, its important, but not hugely time critical, so the individual is completely able to research the options, visit the facilities and choose the best one for themselves. All without a single NHS bureaucrat to decide whats best for them in sight.

  16. @ lost_nurse
    Perhaps it might help if you read the piece before ranting at right angles.
    Circle Healthcare is not making a fabulous profit by free-riding – it gained an award for Quality of Service to patients. So all your allegations are utterly irrelevant to the discussion.

  17. john77: to be accurate, it gained the award for its performance in a set of care quality statistics, as selected after the fact by a consultancy in the business of providing “solutions” for monitoring care quality statistics.

    As I’m sure you’re aware, poor performance in these measures is a sign of problems, but the best performance is easier to achieve by pursuing the statistic rather than by concentrating on providing the best patient care.

  18. @ PaulB
    Paul, there is no law against being more pedantic than I, possibly because no-one ever thought that one was necessary! Will you be satisfied if I add the quotation marks that I thought were implied by capitalising Q and S? The award was for “Quality of Service”.
    Regardless of whether the criteria were selected with hindsight, that an award could be given demonstrates a massive improvement in service to patients compared to the old NHS Trust. The post by lost_nurse ranted on about profits, which are a different topic – and implied that Circle had relocated Hinchingbrooke hospital to be closer to a separate NHS A&E department (very Douglas Adams, but not practicable at an affordable price with current technology)..

  19. implied that Circle had relocated Hinchingbrooke hospital to be closer to a separate NHS A&E department

    No I didn’t – although Hinchingbrooke doesn’t have to deal with the full spectrum casemix of a major city hospital. I was referring to Circle’s general operating strategy, with particular reference to their elective surgical beds. They might not be turning fabulous profits (indeed, their finances have often looked rather shaky – e.g. http://nhsvault.blogspot.co.uk/2012/07/circle-bath.html ), but that doesn’t remove from their reliance upon the NHS, even as the NHS gets slagged off.

    I have nothing against the private sector – what I object to is the smoke & mirrors PR, and how the likes of Lawson, Tim & Guido repeat it as soundbite “evidence”.

  20. @ lost_nurse
    Firstly that is *still* completely irrelevant to the improvement in the “Quality of Service” at Hinchingbrooke.
    Secondly, if you don’t like “soundbites” why do you not do as I do, struggle to write a paragraph explaining stuff?
    Thirdly, Tin is not denouncing the existence of a NHS but how it is run. Most of us would welcome a state-provided network of A&E units (as saving massive admin costs relative to an insurance-funded one) while still backing privately-managed hospitals and nursing homes: my last hospital visit was caused by a faulty kerbstone – in the USA there could have been litigation costing several times the costs to the NHS (and the “victim” could have claimed monetary compensation for “distress” on top) but in the UK everyone (including the totally innocent individual who partially cushioned my fall and totally overlooked his bruises to worry about the extent of my injury) tried to minimise injury and ignored money. If there was no NHS I should subscribe to an insurer, as people do in other countries and I should have been able to access similar treatment – possibly quicker – at lower cost than the sum I pay for the NHS via income tax, but not only would the overall cost/benefit for thew whole country be worse in money terms but also the attitude of bystanders and in my case the innocent, but not badly hurt, victim, could be expected to be less sympathetic.

  21. It isn’t irrelevant in the slightest – it’s how Circle are gaming things right across the board. It underpins both how they operate, and their future expansion plans.

  22. ” It isn’t irrelevant in the slightest – it’s how Circle are gaming things right across the board. It underpins both how they operate, and their future expansion plans.”

    Its whether patients are getting a better deal that matters, not whether Circle (or any other private provider) are making a killing. You remember patients? The people who are supposed to be the focus of the NHS, but currently come a distant third after the staff and the suppliers.

  23. Its whether patients are getting a better deal that matters

    If you think patients are “getting a better deal” via Circle running Hinchingbrooke as a loss-leader, then you have a somewhat simplistic understanding of what is actually happening on the ground.

    You remember patients?

    I do. I’ve just finished a run of four long days (12.5 hour shifts) in five, on a very busy emergency surgical admissions unit – all patients (some of whom were extremely unwell) properly cared for, as is specified in my job description. But thanks for the lecture.

  24. @ lost_nurse
    I have a very simplistic understanding. Under previous management patients suffered disgracefully bad treatment e.g. http://www.ciao.co.uk/Hinchingbrooke_Hospital__Review_5394622
    Under new management the hospital has been given an award for “Quality of Service”
    Going from really bad to good meets the OED definition of “better”.
    Your views on the economics of Circle’s other operations are irrelevant to patients at Hinchingbrooke.

  25. I have a very simplistic understanding

    You said it. And if you are going to start googling for stuff, then perhaps you could investigate: (1) why Hinchingbrooke had problems in the first place (2) the somewhat-selective generousity extended by DOH to what is most certainly a pet project & (3) Circle’s decidedly-shadowy behind-the-scenes financial engineering. Let’s be clear about this: the hospital was awarded a QoS “award” by a Crapita-owned healthcare consultancy, for maintaining services whilst reducing a deficit. That is being twisted into ‘best hospital in the country’-type bollox by all mannner of ill-informed commentators – whether it be the naïve extrapolations of Andreas Whittam-Smith in the Indy (” Hinchingbrooke did exceedingly well to come first out of such a distinguished list”) to the downright idiotic ramblings of Ann Widdecombe in the Express (“I was last a patient in an NHS hospital in 1963… In 1963 nurses fetched bedpans and cleaned up sick…Hinchingbrooke has shown the way.”). But Hinchingbrooke’s CQC stats aren’t especially stellar, and for a supposed employee co-op, their staff engagement record is pretty dire. Moreover, it’s being mentioned in the same breath as major city hospitals which have to take on a far more acute casemix (for which read: messy, complex, expensive… like is in no way being compared to like). The whole thing is being milked for maximum PR – and subsequently swallowed wholesale by clueless interner bloggers.

    As for the economics of Circle’s other operations not having a bearing on the performance of the loss-leading Hinchingbrooke.. are you having a laugh? Circle studiously avoid the heavy-lift of acute/complex care, and that goes a long way towards accounting for their “performance”. Now, the thought of a PE-backed private firms taking over PFI-distressed NHS hospitals might get Tim all moist and excited, but speaking as nursing grunt of nearly two decades, I take a dim view of how this being presented – long exposure to faecal matter gives one a fine nose for bullshit.

  26. @ lost_nurse
    “As for the economics of Circle’s other operations not having a bearing on the performance of the loss-leading Hinchingbrooke.. are you having a laugh? ”
    If you had rested your eyes long enough before switching on your computer, you might have been able to read what I actually posted, to wit “Your views on the economics of Circle’s other operations are irrelevant to patients at Hinchingbrooke.”
    Tim’s original post and most comments, apart from your own, are concerned with patient care. Yours are about profit margins and denouncing Circle’s pretensions to being a healthcare version of John Lewis. No, I am *not* having a laugh when I say that your comments are irrelevant: they are.
    Why did Hinchingbrooke have a problem in the first case? Nobody who knows is going to give me an honest answer (I am not a Catholic priest attending deathbed confessions). The standard lefty complaint that it must have been down to Margaret Thatcher (e.g. for paying nurses a relatively decent wage – relative to Wilson and Callaghan) wears a bit thin when the disastrous performance occurred during a second-/third-term Labour government more than twenty years after she resigned. Have *you* been given an honest answer? Andy Burnham, when Secretary of State for Health described it as a “failing hospital”; the private sector was invited to tender in 2009 by a government led by, er, Gordon Brown. The Daily Mail omits to mention this when applauding so-called “privatisation” which is merely a piece of temporary sub-contracting. I discount DM reports including their 85% approval but you need a massive discount to 85% to sink towards the approval under the NHS Trust.
    I did google but the idea that all Hinchingbrooke’s troubles are because Mrs Thatcher reckoned that Huntingdonshire needed less funding per head than Hackney when the MP for Huntingdon was PM for more of Hinchingbrooke’s operating existence than the MP for Finchley and all its problems (or all those that have emerged arose under New Labour) are ludicous. Were you having a laugh when you asked to google them?
    “Hinchingbrooke’s CQC stats aren’t especially stellar,” – but prior to Circle’s appointment it was not even CQC approved.
    Any stat above the mohorovicic discontinuity layer level is a major improvement.
    I tangented from your suggestion and Googled “complaints Capita award to Hinchingbrooke” expecting some organisation to complain that it was unfair. There were none (it seems that no hospitals are run by football managers). CHKS is owned by Capita but that does not guarantee that its judgements are flawed and corrupt

  27. your comments are irrelevant

    If you don’t don’t grasp how/why Circle are stumping up the cash to run Hinchingbrooke as a loss-leader, or how reliance upon NHS infrastructure/workforce training/acute capacity enables them to do so, then we’ll just have to differ. The fact remains: the CHKS “award” story is being inflated way out of proportion – and is being used as some kind of justification for privatisation by all the usual suspects, without substantive merit. Circle’s PR agenda is laughably obvious to anybody at the actual clinical coalface, and the Fail-type media copy is, IMO, disingenuous to say the least. Perhaps we could have some scrutiny of Circle’s byzantine financial structure, instead.

    As for Hinchingbrooke and its history – I’m certainly no defender of NuLav. The disastrous ConDem reforms are merely an extension of the pseudo-market nonsense set in train by the previous government. They also went batshit crazy with PFI, thereby helping to land hospitals like Hinchingbrooke in deep trouble. Fast foward to the present day, and those same distressed hospitals are – increasingly – the target for takeover by private firms. It’s not cause for celebration, whatever Tim might think.

  28. Yes we obviously shall have to differ because *I* believe that the purpose of the NHS is to treat patients.

  29. *I* believe that the purpose of the NHS is to treat patients.

    Indeed. And the purpose of bullshit media spin is to sell Circle’s brand.

  30. As is pointed out in the latest issue of Private Eye, Crapita (owners of CHKS) and Circle are partners in a joint venture to bid for NHS contracts… what a surprise!

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