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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Air pollution: 5 steps to vanquishing an invisible killer

A new report looks at the economics of air pollution. 

110, 150, 520... These chilling statistics are the number of deaths attributable to particulate air pollution for the cities of Southampton, Nottingham and Birmingham in 2010 respectively. Or how about 40,000 - that is the total number of UK deaths per year that are attributable the combined effects of particulate matter (PM2.5) and Nitrogen Oxides (NOx).

This situation sucks, to say the very least. But while there are no dramatic images to stir up action, these deaths are preventable and we know their cause. Road traffic is the worst culprit. Traffic is responsible for 80 per cent of NOx on high pollution roads, with diesel engines contributing the bulk of the problem.

Now a new report by ResPublica has compiled a list of ways that city councils around the UK can help. The report argues that: “The onus is on cities to create plans that can meet the health and economic challenge within a short time-frame, and identify what they need from national government to do so.”

This is a diplomatic way of saying that current government action on the subject does not go far enough – and that cities must help prod them into gear. That includes poking holes in the government’s proposed plans for new “Clean Air Zones”.

Here are just five of the ways the report suggests letting the light in and the pollution out:

1. Clean up the draft Clean Air Zones framework

Last October, the government set out its draft plans for new Clean Air Zones in the UK’s five most polluted cities, Birmingham, Derby, Leeds, Nottingham and Southampton (excluding London - where other plans are afoot). These zones will charge “polluting” vehicles to enter and can be implemented with varying levels of intensity, with three options that include cars and one that does not.

But the report argues that there is still too much potential for polluters to play dirty with the rules. Car-charging zones must be mandatory for all cities that breach the current EU standards, the report argues (not just the suggested five). Otherwise national operators who own fleets of vehicles could simply relocate outdated buses or taxis to places where they don’t have to pay.  

Different vehicles should fall under the same rules, the report added. Otherwise, taking your car rather than the bus could suddenly seem like the cost-saving option.

2. Vouchers to vouch-safe the project’s success

The government is exploring a scrappage scheme for diesel cars, to help get the worst and oldest polluting vehicles off the road. But as the report points out, blanket scrappage could simply put a whole load of new fossil-fuel cars on the road.

Instead, ResPublica suggests using the revenue from the Clean Air Zone charges, plus hiked vehicle registration fees, to create “Pollution Reduction Vouchers”.

Low-income households with older cars, that would be liable to charging, could then use the vouchers to help secure alternative transport, buy a new and compliant car, or retrofit their existing vehicle with new technology.

3. Extend Vehicle Excise Duty

Vehicle Excise Duty is currently only tiered by how much CO2 pollution a car creates for the first year. After that it becomes a flat rate for all cars under £40,000. The report suggests changing this so that the most polluting vehicles for CO2, NOx and PM2.5 continue to pay higher rates throughout their life span.

For ClientEarth CEO James Thornton, changes to vehicle excise duty are key to moving people onto cleaner modes of transport: “We need a network of clean air zones to keep the most polluting diesel vehicles from the most polluted parts of our towns and cities and incentives such as a targeted scrappage scheme and changes to vehicle excise duty to move people onto cleaner modes of transport.”

4. Repurposed car parks

You would think city bosses would want less cars in the centre of town. But while less cars is good news for oxygen-breathers, it is bad news for city budgets reliant on parking charges. But using car parks to tap into new revenue from property development and joint ventures could help cities reverse this thinking.

5. Prioritise public awareness

Charge zones can be understandably unpopular. In 2008, a referendum in Manchester defeated the idea of congestion charging. So a big effort is needed to raise public awareness of the health crisis our roads have caused. Metro mayors should outline pollution plans in their manifestos, the report suggests. And cities can take advantage of their existing assets. For example in London there are plans to use electronics in the Underground to update travellers on the air pollution levels.

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Change is already in the air. Southampton has used money from the Local Sustainable Travel Fund to run a successful messaging campaign. And in 2011 Nottingham City Council became the first city to implement a Workplace Parking levy – a scheme which has raised £35.3m to help extend its tram system, upgrade the station and purchase electric buses.

But many more “air necessities” are needed before we can forget about pollution’s worry and its strife.  

 

India Bourke is an environment writer and editorial assistant at the New Statesman.