I\’m looking forward to the narrative on Hinchingbrooke

I mean, someone on the left is going to comeup with a story about why this is a very bad thing indeed.

Hinchingbrooke Hospital in Cambridgeshire, previously described by ministers as “a clinical and financial basket case”, released its latest performance data yesterday. In just six months, waiting times had been turned around – from the worst in the region to the best. Patient care had improved; satisfaction ratings were higher than ever. Money was no longer being wasted. Staff morale was up. Even the unpopular car parking fees had been scrapped.

I expect to see a number of ideas floated.

Doesn\’t matter that it\’s got better because that\’s just a post code lottery now? It was all lies it wasn\’t that bad to start with? The budget has been increased (never mind whether it has or not) showing that it\’s all about resources? It\’s all Goldman Sachs money being poured in to make this first one go well?

Most of these attempts will sink without trace but there will emerge some contortion from somewhere about why this doesn\’t actually show what it does show. That private provision within a state financing system can and does (sometimes!) do better than state provision.

It\’s going to be interesting to see how they manage to fit reality into their world view.

 

37 thoughts on “I\’m looking forward to the narrative on Hinchingbrooke”

  1. If you live to the east of it, the real trouble with Hinchingbrooke is that you have to use the A14 to get to it. So you can’t be confident of getting to an appointment on time, the A14 being notoriously prone to blockages.

    ……. Now there’s an idea.

  2. Interesting that the Hinchingbrooke news led the R4 Today programme news all yesterday morning, and yet not a single article in the Guardian.

    Nor, even with 24 hours reflection, is there any article today.

    Almost as if it doesn’t fit the all-privatisation-is-bad agenda.

    I wonder what Danny Boyle makes of the Hinchingbrooke news.

  3. the great redacto

    And the people like it, whereas they didn’t like the old Hinchingbrooke, which had a reputation locally as an abattoir. The fact of the them liking it is the best corrective to any bent commentaries on it. The chief exec of Circle was on the radio yesterday explaining that they had saved millions by sourcing stationery more efficiently and had cut cleaning in the on-call rooms so they could increase it in the wards. More please.

  4. Depressing to see that, upon hearing the improved service figures, the first reaction of the local Unite halfwit was to claim “staff morale is low”. Typical response; the needs and rights of the worker above those of the patient and the taxpayer.

  5. Further additional comment on the “Staff morale is low” line from the Unions – I’m betting it was sky high when the trust was broke and failing!?

    Great news – and it’ll be interesting to see how the Gruaniad spin it!

  6. “I wonder what Danny Boyle makes of the Hinchingbrooke news.”

    I was curious about his opinion of “Black Wednesday”.

  7. There was a bit on R4 news at some point where apparently Unison had said that staff were stressed because they were worrying about job losses. But that appeared to be the best they could do…

  8. Simple – if its a success they will studiously ignore it in the hope no-one will notice, if there are any problems, however minor, they will jump on them and exaggerate them to the max.

  9. Worrying about job losses when doing far better than the organisation had before…… nope, I wouldn’t be.

  10. I’ll be pleased if Circle has come up with a better way to run hospitals. But I’m inclined to be cautious about it:
    – as the BBC story hints, you’re comparing Circle’s boasts about how well it’s doing with the government’s description of how poorly the previous management was doing. Both are motivated to make the comparison favourable to Circle.
    – the patient satisfaction report is based on a response rate of “almost 15%”. With such a low response rate, it’s easy to manipulate the result by encouraging selected patients to participate in the survey. (This survey w0uld not persuade me to choose to be treated at Hinchingbrooke in preference to Cambridge)
    – time will tell whether and to what extent the new management is outperforming the old. But it’s a comparison of (allegedly) the worst of the NHS with the best that Circle can provide – Circle will have put its best people on this project, and they can do that for only one hospital at a time. So the outcome may not be applicable to other hospitals.

  11. @ PaulB
    Up to a point, Lord Copper
    A 15% response rate is relatively high for a survey and disgruntled patients are more likely to respond to a survey than contented ones.
    Tim and the Telegraph are *not* comparing “the worst of the NHS with the best that Circle can provide” – they are comparing one particular hospital run by the NHS with its state after *just six months* of management by a half-way house between John Lewis and capitalism when many of the reforms are still bedding in and so well below peak financial performance and, very probably, below peak clinical performance.
    One point that you could have picked on is waiting times – historic poor performance may have discouraged patients from choosing Hinchinbrooke so the low waiting times may simply be down to underutilisation of capacity.

  12. Big savings on stationary? Great! Involving medical/nursing staff in major decisions? Jolly good. Improved patient satisfaction? Lovely!

    Except that ‘patient satisfaction’ ratings can be a pretty misleading indicator of clinical acuity and casemix. Circle run very small (& generally loss-leading) boutique hospitals, providing tickbox elective stuff for stable patients. The NHS is underpinnning their profit model (especially in terms of acute care, ‘blue-lighting’ & workforce training) – even as it gets slagged off! And their media PR barrage can be pretty disingenuous – e.g. Circle outfits & NHS hospitals compared in broadsheet puff pieces, as if they are providing the same range of services (there’s a pretty big difference between daycase surgery & full-on A+E/ITU provision, for gawd’s sake!) .

    In short: I don’t trust Ali Parsa one bit. Hinchingbrooke is a stalking horse – and there’s some pretty convoluted financial engineering going on behind the cosy brand. The linked article is the usual Daily Mailograph froth… the very fact that Circle is held up as some kind of redress for the sins of G4S is – frankly – laughable!

    Tim adds: OK, so, so far you’ve got frothing indignation with a bit of obfuscation.

    As I’ve said above, I’m interested in the story that is going to be settled upon as well as watching the passsing parade of attempts at said story.

  13. frothing indignation with a bit of obfuscation.

    Tim, I work in emergency surgical admissions in a major city hospital. I have a pretty good idea of how this is being gamed by Circle. You know Bath, iirc: why not ask Ali why his small loss-leading hospital cherry-picks elective activity from the RUH – thereby effectively being subsidised by the NHS?

    Dismiss my views if you like, but don’t ask me to take this kind of Daily Mailograph stuff seriously. It’s a ridiculous article: why the overblown G4S/Circle angle – except for the sake of a rather lame ‘point’ about the private sector? And I have nothing against the private healthcare sector, btw – as long as we are being quite clear about who is shouldering the messy stuff. And it ain’t Circle.

  14. And I have nothing against the private healthcare sector, btw

    So why is pretty much everything you say on here a rant about the appalling predation of the private sector on the gleaming perfection of the NHS communitarian spirit?

  15. SE,

    Characterise my posts however you like – I simply take exception to some of the soundbites from Circle’s oh-so-soothing PR machine. I don’t claim that the NHS is gleaming perfection – not by any means: I see the best and worst of it, everytime I work a shift. Nor will I slag off private healthcare supply/provision where it is adding genuine value & innovation.

    But…. Circle are playing a long game. And I don’t much care for the bullshit involved. Ali Parsa never misses a chance to decry the ‘broken system’ – I’d have a good deal more respect for him if he admitted just how much he depends upon it.

  16. I have to say, point to a comment on here – or anywhere else – where your reaction to private health care hasn’t been one of:

    a) cherrypicking;
    b) evil capitalist bastards hiding things until they can slaughter the x-rays, burn the nurses and rape the beds;
    c) we hates them, we does, precioussss …

  17. Nor will I admit that private healthcare…

    Tis but thy name that is my enemy… nah, a job properly jobbed is just that – regardless of sector.

    As the name implies, Circle are good at spinning. That is what I object to.

  18. Sorry SE – a cross-posting moment there & a moment of bafflement while I ponder how to slaughter x-rays… 🙂

    we hates them, we does, precioussss

    I don’t! Anymore that I would routinely berate a GP, abuse a medical rep or sabotage multiple supply lines – but I remain deeply suspicious of healthcare providers who disguise the fact that they are dependant upon NHS acute capacity, infrastructure, workforce training, etc.

    Tim is right in one respect: the developing story is an interesting one. And on that note, I’ll leave it. 🙂

  19. @Lost Nurse: what are your comments on this little bit of special NHS ‘care’:

    http://www.dailymail.co.uk/news/article-2181669/Royal-Liverpool-University-Hospital-Student-dies-staff-told-friends-ambulance-despite-50-yards-away.html

    That was in an A&E dept that you keep telling us is the envy of the world, could not possibly be replicated by the private sector etc etc. Ironically if such behaviour was shown by a private business they would all probably in court for criminal negligence.

    Personally I would sack all the staff, bulldoze the hospital and sow the ground with salt pour encourager les autres.

  20. @Jim,

    Eh? I’m not going to excuse that kind of fcuk-up, except to note that any kind of respiratory arrest is going to require the kind of kit, O2, & immediate treatment that paramedics provide – hence getting an ambo to the patient should always be a priority (instead of driving in – although it sounds like they didn’t have a phone). I don’t entirely understand the receptionist’s attitude (roving crash team should have been alerted, though I don’t know the hospital), but it sounds like it might already have been too late – even by the time a resus team had been scrambled.

    Besides, none of this has any bearing on Circle’s strategy – indeed: they conspicuously avoid the tricky stuff, although you wouldn’t guess that from the PR campaign.

  21. BTW, Ali’s media frenzy & repeated insistence that his model be rolled out across the NHS: surely it’s nothing to do with combating the fall in Circle Holdings’ share price?

    Oh, and let’s compare:

    Daily Mailographhttp://www.telegraph.co.uk/health/healthnews/9443682/Hinchingbrooke-hospital-turned-around-by-Circle-in-six-months.html

    Health Service Journal:

    http://www.hsj.co.uk/hsj-local/acute-trusts/hinchingbrooke-health-care-nhs-trust/loss-making-hinchingbrooke-may-require-loan/5047838.article

    Keep on spinning, Ali…. perhaps we could install him in a hamster wheel & run the generators off that.

  22. “I’m not going to excuse that kind of fcuk-up”

    What would be your reaction if a privately operated A&E facility acted in such a manner? Would you be (rightfully IMO) spitting tacks about corporate manslaughter and demanding the management be hauled in front of the courts on criminal charges, or would you be saying ‘Nothing to see here, move along please’, as appears to be the NHS reaction?

    Can you not see that the NHS seems to have zero accountability? When these things happen (and they happen increasingly often -cf the case of Kane Gorney) why does everyone involved in the NHS circle the wagons and pretend everything is wonderful, nothing could possibly be better under any other system, and nothing must change one iota?

  23. @ lost nurse
    Are you by any chance a disappointed investor? The people who lost out in Southern Cross and several previous attempts to introduce capital from third-party private investors into nursing homes were the investors, not the patients. Even the left-wing King’s Fund admits that self-funded individuals in nursing homes are subsidising the local authority-funded ones. Mr Parsa’a spinning is aimed at gullible investors who will be asked to invest alongside medical staff when he launches an IPO.
    Tim’s point was more that the Grauniad and other fellow-travellers are hiding any good news about privatisation than the almost incredible improvement in Hinchinbrooke’s reported results (it should not be possible to improve that much in the first six months even if staff are entitled to a modest share of profits). OTOH just taking control away from NHS professional managers and listening to doctors and nurses is almost bound to result in significant improvements – such as making cleaning the wards a priority over cleaning offices. The stupidity of NHS bureaucrats has to be seen to be believed. My local NHS and Social Services departments each employ a team of accountants whose sole purpose is to recharge costs from one taxpayer-funded organisation to the other; when taking my sixteen-year-old son to A&E (oh no the school couldn’t do that despite their culpable negligence – they had to ‘phone me to rush over with the concomitant delay) I was required to have the correct change for a parking meter (no notes or credit cards accepted just correct change): so I had to find a residential street a few hundred yards away and carry him (just as well I was working from home that day as my wife cannot carry him). I’m not going even to mention my top two gripes.

  24. Jim,

    Can you not see that the NHS seems to have zero accountability?

    That’s a pretty major distortion. If you actually believe that, take same time to attend a hearing: http://www.nmc-uk.org/Hearings/Attending-a-hearing/.

    Just quickly – nope, not excusing anything. But I’m not going to comment on a case I know nothing about – except to say that a severe asthma attack needed paramedic attention in the first instance. The decision to drive was understandable, but culminates in her having a respiratory arrest in a carpark (& note the pathology report). A ‘receptionist’ (in what area? – are we talking about an A+E receptionist? It’s not unusual for members of the public to run screaming into areas that are some distance from A+E – if he/she wasn’t an A+E receptionist, they might well have believed that they were doing the right thing) who hadn’t clapped eyes on said patient told her friend she needed an ambulance – where are the waiting ambos parked up? I still don’t understand why she wasn’t directed to A&E, but if somebody collapses within a short distance of a hospital, it might well be that the nearest kit (+ O2 & drugs) is onboard a wagon. But by that stage, it was probably too late to save her – even if she had been carried straight into resus.

    I’m not excusing anybody: hospitals need a clear policy on medical emergencies within site grounds. But that doesn’t necessarily mean that arrests in shops, corridors, lifts etc are reversible – despite proximity to all that gucci kit . Above all, she needed an ambulance – & much, much sooner. In that respect, it doesn’t matter who is running the hospital.

    pretend everything is wonderful

    Believe me, I am not opposed to change where it means improved outcomes. My major concern about the ConDem Reforms is that fragmentation of services will result in even more overstretch on the frontline (we are already seeing this) – in other words, an ever greater potential for fcuk-up.

  25. Mr Parsa’a spinning is aimed at gullible investors

    Quite – and I don’t much care for mixing his poker games with NHS provision. A degree of orchestrated PR is being carried out at Hinchingbrooke. If Circle Holdings have to apply for a cash injection or bridging loans, there will come a point where the PR and the reality collide.

    just taking control away from NHS professional managers and listening to doctors and nurses is almost bound to result in significant improvements

    It’s true that the NHS is often hidebound by bureaucracy (much of it, natch, the result of successive Gov reform, not least the internal market fudge) – but recent months have seen talented managers cleared out, together with admin staff, in an unfocused Great Cull. It’s why the nascent CCGs are such a farce – with staff being fired & then taken back on to manage the transition. Furthermore, sure – nobody would dispute that Medical/Nursing staff are best placed to understand the clinical shopfloor – but that doesn’t necessarily make them great managers. As for cleaning – you don’t need to hand over mangement to Circle to achieve that. Indeed, my Trust managed it all by themselves (not least by bringing it back ‘in-house’).

    As for carpark charges, overpriced bedside TVs, etc – I agree entirely. But I suspect it will become ever more prevalent.

  26. @ lost nurse
    “talented managers”? ROFL
    Any talented managers would have stuck out like a sore thumb.
    “Great Cull” would be getting rid of more than 10% of staff which hasn’t happened – yet! After BT was privatised it got rid of FIVE layers of management in 2-3 years before my pal who worked in HR was given early retirement because clearing out so many bureaucrats meant they needed fewer HR people.
    I didn’t mention bedside TVs but one reason for improved patient views of Hinchinbrooke may be that they abolished car park charges. You have ducked the point – how far can you carry a 15-year-old boy (apologies for typo)? Only a moron or a NHS bureaucrat puts parking meters on access to Emergency services.

  27. “Believe me, I am not opposed to change where it means improved outcomes”

    But you oppose all changes in favour of the status quo. How can you know whether they will improve things until they are implemented and given a chance to work? We have tested the current system (throw money at it in the hope some of it sticks to the patients in form of better outcomes rather than staff wages) to destruction. There is no way of continuing on the current course. There has to be a different line of attack at the problem.

    Or are you just defending your own vested interests – the NHS being run primarily for the benefit of its staff rather than the patients?

  28. Only a moron or a NHS bureaucrat puts parking meters on access to Emergency services.

    Unfortunately, quite a lot of our older A&E hospitals are within walking distance of city centres or train stations. And there are some complete bastards who think that parking there is a reasonable way of saving money on their daily commute. As we aren’t allowed to hang them any more …

    Actually, the people I feel worse for are the lower-paid NHS staff – most trusts being completely incapable of running a competent “staff car park with badge” system. My friendly local orthopod cycles in to the mega-trust – not for fitness, cost or travel convenience but because the neds and sengas have easy access to the staff car park.

  29. @ SE
    This was nowhere near a station or City Centre – I don’t know how far since one has to take a different route from the school (or my home) to either of those or the hospital. We can assume that it was not likely to be used by commuters or shoppers, for whom there were extensive dedicated car parks.

  30. John,

    Agreed but once one does it (for vaguely sensible reasons) – and then has a little budget to buy better biscuits the next time the NHS Adminstrators’ round-robin sabat is chez them, the others will all do it. And some fuckwit appointee ex-politician chair of the board (who gets paid to take a taxi to and from the station or airport) will whitter on about “maximising our scarce resources”.

  31. @SE: my local hospital is on the edge of town (moved out under PFI about 10 years ago). There is absolutely nothing close by that would attract free loading parking. But you still have to pay to park.

    I repeat the NHS is run for the benefit of its staff, not the patients. It is not beyond the wit of man to devise a system, even in town centres where non user parking could be an issue, that solves the problem. It might take a bit of organising, but its doable. But our beloved NHS prefers just to make everyone pay. What an envy of the world it is.

  32. I repeat the NHS is run for the benefit of its staff, not the patients.

    That’s a nonsensical conclusion to reach based on NHS parking charges. NHS staff have to pay the charges too. There are, however, big discounts available to patients who need to attend for daily outpatient treatment.

    If free parking at hospitals means that demand exceeds supply, isn’t charging for it exactly the solution neoliberals should recommend.

  33. “If free parking at hospitals means that demand exceeds supply, isn’t charging for it exactly the solution neoliberals should recommend.”

    Yes in a free market. Which in the NHS is totally non existent. We are all already paying via our taxes for the NHS carpark, why should we all pay again to use it?

    Private retailers manage to provide free parking in town centre locations for their customers. They employ various methods to weed out (and charge) the free loaders, without inconveniencing the genuine store user. Why cannot the NHS do likewise?

    Mainly because its easier for the management (not necessarily the other staff I grant you) to just slap on parking charges. for all users. More money in from a captive audience, no organisation of an alternate (fairer) parking scheme required. Fat salaries and pensions all round!

  34. Or are you just defending your own vested interests – the NHS being run primarily for the benefit of its staff rather than the patients?

    I would dearly like you to follow us around at work.

    As for changes: no, I am not opposed to change where it means improved outcomes. But the ConDem reforms (and the PR antics of Circle et al) are doing nothing – I repeat, nothing – to help matters. Get set for increased chaos on the frontline.

    Only a moron or a NHS bureaucrat puts parking meters on access to Emergency services

    And don’t ask me to defend car park charges, FFS. I work for an inner-city Trust inwhich parking is near to impossible – I cycle to work. I also note that in some Trusts, car parking is effectively privately-run – as are most bedside TV units.

  35. @lost_nurse:

    You didn’t happen to get the share price conspiracy from Richard.Blogger?

    He has a pretty graph showing dramatic falls in Circle Holdings plc share price over the past 12 months.

    What he doesn’t mention is the significant share issues made by Circle Holdings plc over the past year (especially at the end of last May when they doubled the number of shares in circulation).

  36. You didn’t happen to get the share price conspiracy from Richard.Blogger?

    No, although his blog site ( http://nhsvault.blogspot.co.uk/ ) seems to have the general measure of Circle & their somewhat opaque finances.

    It’s more the general buzz that Circle’s PR effort is a fixed-grin bid to keep ’em afloat – not least given that the long-term issues at Hinchingbrooke are going to require more than just fiddling with the cleaning rota & cheaper printer paper. Their expansion plans (e.g. Reading) speak volumes: small hospitals undertaking elective procedures in close proximity to NHS infrastructure, acute capacity & expertise. In other words, a good deal of piggybacking on existing services. It’s why all this breathless Daily Mailograph pish annoys me so much.

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