As well as talking to Ali Parsa, I also spoke to Circle’s head of IT Gary Mudie on his plans for Hinchingbrooke.
On 1 February, the private healthcare provider Circle Partnership took over the management of Hinchingbrooke health care trust in Cambridgeshire. While not a privatisation – Circle has not taken ownership of the trust, and staff remain on health service contracts – the 10-year franchise represents a new level of private sector involvement in running an NHS organisation.
For Ali Parsa, chief executive of Circle, it also represents a new level of staff involvement. “The first thing we did is went in and said: ‘Never mind the business plan of the hospital, or what we will do in the bid; what really matters is what you as staff think you can do’.”
By the time of the takeover, more than 1,200 of Hinchingbrooke’s 1,700 staff had attended a four-hour meeting in their own time to discuss their ambitions for the trust’s future. The result is a 16-point plan, with the overall aim of becoming one of the top 10 district general hospitals in the country. There are targets on patient safety, patient experience, value for money and staff engagement.
Improvements are already apparent, Parsa says: “People used to say to us: ‘You’ve never run emergency before; how do you know can you run emergency?” But since the trust has taken over, the local strategic health authority confirms that it has moved from having the worst figure for four-hour waits of the three trusts in Cambridgeshire to the best.
Parsa adds that the average number of patients staying for longer than 10 days has fallen from 125 to around 75. “Some people should stay a very long time, irrespective of whether the hospital loses money or not,” he says, but he adds that some patients stay too long because of avoidable delays over treatment, tests and discharges. “It’s those processes that we are fixing. Anything you could do so quickly tells you there is a lot more to be done.”
He is particularly keen on the Stop the Line initiative contained in the staff-inspired plan: “We took it from the mining industry where, when there is an incident, all hell breaks loose.”
The trust’s chief executive, medical director and nursing director, as well as Circle’s medical director, must be informed within an hour of an event that is either life threatening or should never happen, regardless of time of day. They have to make an initial report to Parsa within 24 hours, permanent changes have to be made within 25 days, and an unannounced inspection is made within 30. “As a result of even just starting it, we have reduced serious incidents by over 50%,” says Parsa.
Circle recently led the response to a report on serious errors in bowel surgery, made before it took over managing the trust, promising to recruit two new surgeons: “We didn’t just hide it or go easy on it,” says Parsa. “We turned every stone.”
Parsa adds that there is less progress on “perhaps the most important” point in the plan: changing nurses’ work patterns so they increase time spent with patients from one-quarter to two-thirds. This will require changing paperwork and processes: some nurses already hand over to colleagues in front of patients, increasing contact time, while others do not.
Hinchingbrooke has an underlying deficit, and one of Circle’s tasks is to reduce it. “The contract says that if we don’t reduce the deficit, and we lose more than £5m, which is 5% of the revenue, which is almost where the hospital was last year, we have to give back the contract,” says Parsa. He adds that this will be achieved primarily through using Circle’s procurement experts to cut at least £1.6m from its annual spending and reducing its use of short-term staff, but also through attracting more patients.
Unlike other trusts, an application for foundation trust status is not in Hinchingbrooke’s plans – the NHS is treating Circle’s 10-year franchise deal as an acceptable alternative. Parsa is interested in working as consultant to help other trusts achieve and retain foundation status, but is not looking to the new Health and Social Care Act for assistance; interviewed a couple of days after the bill received royal assent, he was not aware it had become law, and points out that the deal with Hinchingbrooke was made under earlier legislation passed by Labour. He does not know what effects the new law will have, given it was so heavily amended: “I hope that in the rush at the end they [the legislators] didn’t mix it all up and create something which is unhelpful to everybody.”
Parsa says that the hospital’s staff have been “phenomenal”; he visits Hinchingbrooke each month for an open meeting, usually attended by 200 people. Employees will receive shares in Circle, which is 49.9% owned by its staff; the mechanism has yet to be worked out, “but we will do it by the end of the year”.
He says that local union representatives are also engaged: “Unions may have a national policy that says that they don’t like anything to be run by anybody but the public sector, but in reality people are most dedicated and committed to the success of their own hospital,” he says. “They are fantastic advocates of what is right, and they know that what we are doing here has the right intention.”
He has less time for those commenting on previous articles about and by him on the Guardian website. “I just find it unbelievable that we have people in the country who believe that the country has all these problems, and nobody has the ability to fix it apart from them,” he says. He wonders whether the anonymous critics would be willing to give up their careers if they failed to meet published criteria – which is how he sees Circle’s position if it fails at Hinchingbrooke.
Parsa recognises that some people oppose any private sector involvement in the NHS, but hopes to convince others. “There’s a lot of people trying to find out where is the catch,” he says, but there are, for example, no plans to increase private work at Hinchingbrooke. “Private is not one of the 16 initiatives we published, so it’s neither here nor there,” he says. “We’re not going to do anything we didn’t say in there. There really is no secret agenda.”
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