The recent news that England’s first privately run NHS hospital was to be placed into “special measures” by healthcare regulator the Care Quality Commission has sparked a fierce and rather ugly political debate.
As The BMJ first reported on 12 January, Hinchingbrooke Health Care NHS Trust in Cambridgeshire—managed by Circle Healthcare—was subject to the action after a CQC inspection highlighted serious failings with the hospital’s emergency and medical care services.
The report was published just hours after Circle announced plans to withdraw from its contract to run the hospital after declaring that soaring emergency attendances, funding cuts, and a lack of care in place for patients awaiting discharge had made the contract unviable. The decision was also influenced by what Circle called the “unbalanced” findings of the CQC report.
Whilst some on the political left say the case demonstrates why the private sector should not run NHS organisations, government supporting newspapers The Sun and the Daily Mail have defended Circle and Hinchingbrooke—and accused the CQC and local commissioners of being involved in a Labour orchestrated plot to discredit the hospital for political gains.
Matt Limb’s feature for The BMJ, sidesteps the smears in favour of a more considered approach by asking health policy experts to examine the longer term impact of Circle’s withdrawal from Hinchingbrooke.
In the piece, King’s Fund chief executive Chris Ham tells Limb that he believes the Hinchingbrooke case may spell the end of private sector companies taking on management franchises of NHS organisations. But Nick Bosanquet, professor of health policy at Imperial College London, warns it would be a “great mistake” if the case was taken as a warning against all such collaborations in the NHS.
In a separate head-to-head debate also published on thebmj.com, Stephen Collier from the NHS Partners Network argues that the problems at Hinchingbrooke are “not a reason to decry the role of the independent sector in the NHS.”
But in the opposing corner, public health doctor Gabriel Scally argues that Hinchingbrooke is “a failed experiment” that proves private providers cannot be trusted to run NHS hospitals.
In the interest of representing every side of the story, The BMJ has also published a letter from the consultant doctors of Hinchingbrooke in response to the CQC report.
Whilst acknowledging that “there are areas of the hospital that do need improving,” the letter says that the rating was unfair, “As doctors, it is our professional opinion that Hinchingbrooke provides safe, high-quality care for the vast majority of our patients,” the doctors argue.
It is true that there are limitations to what a two or three day inspection can reveal about the quality of a service, and it is not easy to convey the nuances of a complex organisation in an inspection report. Circle has signalled its intention to appeal against the findings, and the regulator will decide if there is a case to answer.
But the tabloid claims of a “stitch up” by the CQC jar with my own recent experience of shadowing an inspection team in Kettering.
I observed doctors on the inspection team forensically scanning notes and medical data as well as conducting anecdotal interviews with staff and patients. They were thorough and professional throughout.
The inspection reports are compiled collaboratively and are typically based on the input of 30 or more people. Whilst the discussions are facilitated by a chair and a lead inspector, reports are produced using input from inspectors, consultants, junior doctors, and patients.
The chances of one or two people being able to influence the outcome of an inspection to the extent claimed appear to me to be very slim.
Above all, it is insulting to those involved to dismiss the CQC team’s findings so readily in favour of unsubstantiated innuendo.
Alas, we may have to get used to these tactics between now and May.
Gareth Iacobucci is news reporter for The BMJ.