Hinchingbrooke Hospital is to lose the private firm that runs it. Photo: YouTube screengrab
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The NHS privatisation experiment is unravelling before our eyes

As Circle Holdings, the first private firm to manage an NHS hospital, looks to leaving its contract, we have a depressing example of how privatisation can go badly wrong.

What a difference (less than) a year makes. In a press release back in February last year, private healthcare company Circle Holdings spun that it had, “transformed services at Hinchingbrooke”. The hospital, it boasted, “is now secure for the future”.

Which would make the news today that it was walking away two years into a 10-year contract to run Hinchingbrooke – the UK’s only privately-run NHS hospital – a shock, were it not for the sheer, abject predictability of it.

The fact that Circle is dumping the contract on financial grounds, citing a lack of funding and pressure on the casualty department, is certainly no surprise to many, not least the National Health Action Party founding member and Save Lewisham Hospital veteran Dr Louise Irvine.

She says: “This is exactly what we warned and predicted would happen and illustrates the folly of private sector involvement in our NHS. When the going gets tough, the private sector gets going - and dumps NHS patients. The privatisation experiment has lamentably failed”.

It isn’t unexpected, not least because in September last year, when Health Service Journal obtained a damning report by the Care Quality Commission (CQC) in which a litany of shocking failings were revealed, the writing was on the wall.

It was a miserable list. The CQC found, “little internal or clear external oversight of how the trust managed risks to the quality of care”; a lack of “clarity or coherence” over who was “responsible for the oversight and scrutiny of the trust’s quality agenda”; poor hygiene standards; “poor care provided to patients”, and, perhaps most damning of all, a “blame approach, rather than that of a supportive and patient focused approach”.

Circle had been held up as a shining example of a private company stepping in to triumph where the NHS had failed. It’s impossible to see how this rhetoric can be maintained with any integrity given this monumental failure; the privatisation experiment is unravelling before our eyes.

And what’s striking about this example is that it is not only a failure of patient care standards, but in hard-nosed economics as well. As I pointed out in October, one of the many severe consequences of marketisation – one totally overlooked in Simon Stevens’ big rescue plan – is that when private companies bin their contracts with the NHS in such a self-serving fashion, it is the trusts’ time and precious taxpayer funds that end up being wasted on picking up the pieces.

What cost will Circle’s walking away be to Cambridgeshire and Peterborough? I shudder to think. And, thanks to the Health and Social Care Act, the next chapter in this woeful saga will have to be another gruelling and costly tendering process, administrated by the trust.

And it goes full circle – if you’ll excuse the pun. Why are A&E departments in crisis? It’s extremely complex, but it would help if the limited resources trusts are being asked to survive on weren’t wasted in such gross examples of false economics, and privatisation going so drastically wrong.

Benedict Cooper is a freelance journalist who covers medical politics and the NHS. He tweets @Ben_JS_Cooper.

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Erdogan’s purge was too big and too organised to be a mere reaction to the failed coup

There is a specific word for the melancholy of Istanbul. The city is suffering a mighty bout of something like hüzün at the moment. 

Even at the worst of times Istanbul is a beautiful city, and the Bosphorus is a remarkable stretch of sea. Turks get very irritated if you call it a river. They are right. The Bosphorus has a life and energy that a river could never equal. Spend five minutes watching the Bosphorus and you can understand why Orhan Pamuk, Turkey’s Nobel laureate for literature, became fixated by it as he grew up, tracking the movements of the ocean-going vessels, the warships and the freighters as they steamed between Asia and Europe.

I went to an Ottoman palace on the Asian side of the Bosphorus, waiting to interview the former prime minister Ahmet Davu­toglu. He was pushed out of office two months ago by President Recep Tayyip Erdogan when he appeared to be too wedded to the clauses in the Turkish constitution which say that the prime minister is the head of government and the president is a ceremonial head of state. Erdogan was happy with that when he was prime minister. But now he’s president, he wants to change the constitution. If Erdogan can win the vote in parliament he will, in effect, be rubber-stamping the reality he has created since he became president. In the days since the attempted coup, no one has had any doubt about who is the power in the land.

 

City of melancholy

The view from the Ottoman palace was magnificent. Beneath a luscious, pine-shaded garden an oil tanker plied its way towards the Black Sea. Small ferries dodged across the sea lanes. It was not, I hasten to add, Davutoglu’s private residence. It had just been borrowed, for the backdrop. But it reminded a Turkish friend of something she had heard once from the AKP, Erdogan’s ruling party: that they would not rest until they were living in the apartments with balconies and gardens overlooking the Bosphorus that had always been the preserve of the secular elite they wanted to replace.

Pamuk also writes about hüzün, the melancholy that afflicts the citizens of Istanbul. It comes, he says, from the city’s history and its decline, the foghorns on the Bosphorus, from tumbledown walls that have been ruins since the fall of the Byzantine empire, unemployed men in tea houses, covered women waiting for buses that never come, pelting rain and dark evenings: the city’s whole fabric and all the lives within it. “My starting point,” Pamuk wrote, “was the emotion that a child might feel while looking through a steamy window.”

Istanbul is suffering a mighty bout of something like hüzün at the moment. In Pamuk’s work the citizens of Istanbul take a perverse pride in hüzün. No one in Istanbul, or elsewhere in Turkey, can draw comfort from what is happening now. Erdogan’s opponents wonder what kind of future they can have in his Turkey. I think I sensed it, too, in the triumphalist crowds of Erdogan supporters that have been gathering day after day since the coup was defeated.

 

Down with the generals

Erdogan’s opponents are not downcast because the coup failed; a big reason why it did was that it had no public support. Turks know way too much about the authoritarian ways of military rule to want it back. The melancholy is because Erdogan is using the coup to entrench himself even more deeply in power. The purge looks too far-reaching, too organised and too big to have been a quick reaction to the attempt on his power. Instead it seems to be a plan that was waiting to be used.

Turkey is a deeply unhappy country. It is hard to imagine now, but when the Arab uprisings happened in 2011 it seemed to be a model for the Middle East. It had elections and an economy that worked and grew. When I asked Davutoglu around that time whether there would be a new Ottoman sphere of influence for the 21st century, he smiled modestly, denied any such ambition and went on to explain that the 2011 uprisings were the true succession to the Ottoman empire. A century of European, and then American, domination was ending. It had been a false start in Middle Eastern history. Now it was back on track. The people of the region were deciding their futures, and perhaps Turkey would have a role, almost like a big brother.

Turkey’s position – straddling east and west, facing Europe and Asia – is the key to its history and its future. It could be, should be, a rock of stability in a desperately un­stable part of the world. But it isn’t, and that is a problem for all of us.

 

Contagion of war

The coup did not come out of a clear sky. Turkey was in deep crisis before the attempt was made. Part of the problem has come from Erdogan’s divisive policies. He has led the AKP to successive election victories since it first won in 2002. But the policies of his governments have not been inclusive. As long as his supporters are happy, the president seems unconcerned about the resentment and opposition he is generating on the other side of politics.

Perhaps that was inevitable. His mission, as a political Islamist, was to change the country, to end the power of secular elites, including the army, which had been dominant since Mustafa Kemal Atatürk created modern Turkey after the collapse of the Ottoman empire. And there is also the influence of chaos and war in the Middle East. Turkey has borders with Iraq and Syria, and is deeply involved in their wars. The borders do not stop the contagion of violence. Hundreds of people have died in the past year in bomb attacks in Turkish cities, some carried out by the jihadists of so-called Islamic State, and some sent by Kurdish separatists working under the PKK.

It is a horrible mix. Erdogan might be able to deal with it better if he had used the attempted coup to try to unite Turkey. All the parliamentary parties condemned it. But instead, he has turned the power of the state against his opponents. More rough times lie ahead.

Jeremy Bowen is the BBC’s Middle East editor. He tweets @bowenbbc

This article first appeared in the 28 July 2016 issue of the New Statesman, Summer Double Issue