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Putting the NHS out to corporate tender isn't working

The rota developed more gaps than an exceptionally holey piece of Emmental cheese.

A few years ago, our out-of-hours service was put out to competitive tender. The existing co-operative run by local GPs narrowly missed out on the new contract, coming an agonisingly close second to a private provider that I call “the Big Beast of the North”. The Big Beast won the bid with promises of slick organisation and a swanky service redesign. Our clinical commissioning group (CCG) chairman announced a new era of corporate professionalism; the amateurism of the former service would be put to shame.

It didn’t work out like that. In the decade that the GPs ran the co-op, we never had a shift unfilled. Once the Big Beast took over, the rota developed more gaps than an exceptionally holey piece of Emmental cheese. Doctors had to be flown in from other parts of the country to provide a skeleton service. The formerly loyal staff of administrators, drivers and screen-watchers – whose jobs were transferred under employment protection rules – began leaving in droves; several told me they’d had enough of the chaotic, unresponsive new management.

The CCG tried to calm nerves, citing the inevitable turbulence that comes with change. Everything would settle down, we were told. It never has.

Admittedly, the Big Beast has long since given up the expensive business of flying in doctors from elsewhere – we have become habituated to a chronically patchy service in which our local out-of-hours centre is closed as often as it is open. Staff turnover has remained exceptionally high, with new recruits alienated by unanswered emails, mistakes over pay and the faceless management that is supposed to be running the show.

The Care Quality Commission inspected a few months ago; three years into the contract, the service still “requires improvement” in safety, effectiveness and leadership.

The big corporate providers that have sprung up in the wake of the Health and Social Care Act 2012 – which opened the NHS to unfettered private competition – are exceptionally adept at writing bids. They employ large teams specifically to manage the paperwork involved, and they know exactly which phrases will tick the boxes that commissioners use when scoring applications. But our experience illustrates the yawning gap between what is promised and what is delivered once the contracts have been won.

It has been a painful lesson, but the constraints of the Health and Social Care Act render the learning futile. The tendering process prohibits commissioners from taking account of the track record of an incumbent provider. Nor are they permitted to put a value on the strength of existing working relationships, or the goodwill of staff.

When our community trust’s contract was put out to tender earlier this year (it runs district nursing, health visiting, cottage hospitals, and so on), it was like Groundhog Day. The local bid lost out to a big corporation. I was working at our cottage hospital last week; the desk in each consulting room had two PCs on it. The old ones, belonging to the former trust, were now defunct. The shiny new ones beamed the corporate logo screen saver, but no one had a log-in, so we couldn’t use them. The only operational PC was at the reception; I had to jot down patient details on paper, disappear to conduct my consultations, and then return to the reception to type up my notes.

The nurses next door in minor injuries were similarly hamstrung. They had been issued with smart lanyards in the corporate livery, but insufficient software licences had been purchased to allow them to use their new computers. No one was manning the IT desk when they rang for help and, they told me, there had already been problems with their pay.

Doubtless this is the inevitable turbulence that comes with change, and we can look forward to a new era of slick organisation and swanky service redesign. But it has an awful feeling of déjà vu about it. 

This article first appeared in the 13 July 2017 issue of the New Statesman, The Maybot malfunctions

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Tackling tuition fees may not be the vote-winner the government is hoping for

In theory, Theresa May is right to try to match Labour’s policy. But could it work?

Part of the art of politics is to increase the importance of the issues you win on and to decrease or neutralise the importance of the issues your opponent wins on. That's part of why Labour will continue to major on police cuts, as a device to make the usually Labour-unfriendly territory of security more perilous for the Tories.

One of the advantages the Conservatives have is that they are in government – I know it doesn't always look like it – and so they can do a lot more to decrease the importance of Labour's issues than the Opposition can do to theirs.

So the theory of Theresa May's big speech today on higher education funding and her announcement of a government review into the future of the university system is sound. Tuition fees are an area that Labour win on, so it makes sense to find a way to neutralise the issue.

Except there are a couple of problems with May's approach. The first is that she has managed to find a way to make a simple political question incredibly difficult for herself. The Labour offer is “no tuition fees”, so the Conservatives essentially either need to match that or move on. But the one option that has been left off the table is abolition, the only policy lever that could match Labour electorally.

The second, even bigger problem is that it it turns out that tuition fees might not have been the big election-moving event that we initially thought they were. The British Electoral Survey caused an earthquake of their own by finding that the “youthquake” – the increase in turn-out among 18-24-year-olds – never happened. Younger voters were decisive, both in how they switched to Labour and in the overall increase in turnout among younger voters, but it was in that slightly older 25-35 bracket (and indeed the 35-45 one as well) that the big action occurred.

There is an astonishingly powerful belief among the Conservative grassroots, such as it is, that Jeremy Corbyn's NME interview in which the he said that existing tuition fee debt would be “dealt with” was decisive. That belief, I'm told, extends all the way up to May's press chief, Robbie Gibb. Gibb is the subject of increasing concern among Tory MPs and ministers, who regularly ask journalists what they make of Robbie, if Robbie is doing alright, before revealing that they find his preoccupations – Venezuela, Corbyn's supposed pledge to abolish tuition fee debt – troublingly marginal.

Because the third problem is that any policy action on tuition fees comes at a huge cost to the Treasury, a cost that could be spent easing the pressures on the NHS, which could neutralise a Labour strength, or the financial strains on schools, another area of Labour strength. Both of which are of far greater concern to the average thirtysomething than what anyone says or does about tuition fees.

Small wonder that Team Corbyn are in an ebullient mood as Parliament returns from recess.

Stephen Bush is special correspondent at the New Statesman and the PSA's Journalist of the Year. His daily briefing, Morning Call, provides a quick and essential guide to domestic and global politics.