The first private healthcare provider to take over an NHS hospital just over three years ago is pulling out of its contract today, claiming it is “‘no longer sustainable under current terms’ because of rising demand and falling funding.” You can picture the foam forming around the mouths of hungry public-sector supporters and Burnhamites; in this ultimate battle to keep UK healthcare not only free at the point of use, but in public sector control, they’ve been craving a golden piece of evidence against the private-sector.
But Circle's contract termination isn't quite that.
Circle’s involvement with Hinchingbrooke Hospital is far from a traditional private sector model. Hinchingbrooke did not become a private hospital, but rather a privately managed hospital, that was still under the jurisdiction of NHS bureaucracy and, more importantly, dependent on public funds for its operations. Furthermore, there was nothing particularly competitive about the market, and while Circle did have an incentive to make some profit if it made a surplus, not much of its own money was at risk.
Circle’s contract with the government dictated that the hospital would be supported with public funds, give or take up to £5m worth of payments from Circle if public funds weren’t sufficient to provide necessary support for Hinchingbrooke.
Within a few years of taking over Hinchingbrooke Hospital, Circle Holdings took a failing hospital that “consistently ranked near the bottom of the 46 trusts for waiting times” – and that would have been shut down if it hadn’t been sold – and turned it into “one of the highest (ranked hospitals) for patient happiness”. Circle also corrected waiting time failures, leading the hospital to “(top) the list for short waiting times, seeing 98.2 per cent of patients within the required window”.
From ASI Fellow, Tim Evans:
Circle massively improved this hospital and the government should now do two things – 1. Recognise what a good job they have done and re-negotiate the contract to keep them on board - barring another company taking it over. 2. The government should announce that is wants more - not less - private and employee ownership of hospitals, clinics and other care facilities.
It is definitely the case that Circle brought to the table a much better management system and improved healthcare significantly for the hospital's patients. But these triumphs for both the hospital and its patients didn’t necessarily reflect a sensible business strategy. In fact, choosing to muddy the waters between public and private care under NHS supervision was a risky decision indeed.
From the ASI’s Dr Eamonn Butler:
I was very surprised that any private firm took on an NHS hospital. I spoke to private providers throughout the 90s and they all rejected the idea. An existing hospital comes with current buildings, equipment, procedures, personnel and above all culture. In schools a new head teacher can turn around a school, though there will be a lot of redundancies and redeployments along the way. In the NHS that is even more unthinkable, given the strength of the employee unions, including the doctors' trade unions, and the ease with which any changes can be dramatised as 'cuts'.
“Hinchingbrooke’s funding has been cut 10.1pc this financial year”, and having already spent £4.84m of the required £5m of its own funds, Circle claims it can no longer run the hospital in a successful, effective way.
More from Eamonn:
What we need is more private, voluntary or charitable groups providing healthcare services on their own terms, in facilities that they themselves create and with staff that they pick by hand because of their skill, dedication and commitment to the enterprise.
Circle’s improvements to Hinchingbrooke Hospital should not go overlooked, and the Circle experiment should not be dubbed an example of private healthcare gone awry. Real privatisation puts the risk and responsibility on healthcare providers and those who hold equity - ideally including doctors, nurses, and hospital staff members - and then allows for public choice to dictate the winners and losers in the field. It's not backed up or heavily regulated by public funds.
If Circle's experiment has shown us anything, it's that private healthcare providers need more stake and control in their endeavours to produce good results.
More from Tim:
We have to move to 100% independent provision of hospitals through genuine ownership and property - not time bound and counterproductive government contracts.
In reality, Circle’s flirtation with public healthcare was not an experiment in the privatisation of the NHS, but rather an experiment to determine if public funds and oversight were compatible with private sector management. And in the case of healthcare, it looks to be a bust.