Tag Archives: privatisation

The real victims of the Hinchingbrooke hospital scandal: A special report

Image: The Poke

Image: The Poke

This month the only private company to run an entire NHS hospital threw a tantrum and stormed off. Circle Health pulled out of its 10-year contract to manage Hinchingbrooke hospital in Cambridgeshire after just two years, leaving the hospital’s survival in doubt. A Guardian editorial said our first concern should be with the patients, for whom “uncertainty allied with ill health is a terrible combination.”

I disagree. The real victims are not the patients. The real victims – the ones we must all pull together to support – are the journalists, commentators and even politicians who hailed Circle as a “miracle cure” for the NHS, and have cruelly been made to look like fools.

Circle, to all appearances a PR company that also runs hospitals, took over Hinchingbrooke in 2012. It immediately began grooming innocent and credulous journalists to do its bidding. Some were even trafficked to Cambridgeshire for “exclusive access.”

But when the hospital inspector, the Care Quality Commission, paid Hinchingbrooke a visit, Circle knew the game was up. Just hours before the release of the Commission’s report, the company announced it was walking out. It was soon clear why – the inspectors rated Hinchingbrooke “inadequate” for safety, “inadequate” for leadership and, for the first time ever, “inadequate” for patient care. The hospital was put into special measures.

We must now do all we can to care for the victims of this calamity, those vulnerable, impressionable opinion-formers that Circle mercilessly used, as they learn to live with that least curable of conditions – reality. Let’s take a closer look at how they were deceived.


Case study 1: The newspaper

The Daily Mail is Britain’s best-loved and most respected newspaper, renowned for calm, responsible and fair journalism. Regrettably, it has allowed its usual high standards to slip on the subject of Circle. It must have been duped.

Last May the paper ran a long feature article beginning with this description of Hinchingbrooke:

“Just imagine an NHS hospital whose standards match those of a top-quality hotel, with a welcoming reception area, polished floors, tasteful artwork on the freshly-painted walls, and menus inspired by a Michelin-starred chef. A public hospital where the doctors and nurses – and even porters and cleaners – are free to decide what’s best for the patients.”

“It sounds like a pipe-dream,” the article observed, correctly.

The piece ended by calling on David Cameron to “champion wide-scale franchising” of hospitals. In doing so he would be “saving” the NHS.


Circle’s flight is very embarrassing for the Mail. Perhaps, then, we can cut the paper some slack for it’s unfortunate response, which conjured a conspiracy theory: “The hospital was the victim of a stitch-up by opponents of private enterprise in the NHS.” How was this stitch-up stitched up? “The Mail understands that at least one of the 35 inspectors is a member of campaign group Keep Our NHS Public and may have been unfairly critical.”

Who knew that Keep Our NHS Public was so powerful? Who suspected the grass-roots campaign had sleeper cells at the heart of the NHS establishment? And who guessed that the Care Quality Commission – a body chaired by ex-Tory MP David Prior, who has previously called for 30 hospitals to adopt the Hinchingbrooke model – is actually a left-wing militant organisation?

But let’s not mock the Mail. You can sense its editors are perplexed. After all, as they plead in their defence, “The hospital had been hailed as a ‘miracle cure’ for the NHS.” And it’s true; it had been hailed as a “miracle cure.” Whoever made up this “miracle cure” claim has a lot to answer for, misleading such a cherished newspaper. I felt moved to help the Mail by finding out who coined the phrase. Eventually, I traced it to… The Daily Mail.


Case study 2: The journalist

Camilla Cavendish is a Murdoch journalist best known for being on that episode of Question Time with Russell Brand, when she accused him of using the “kind of language that led to the rise of fascist parties” in the 1930s. She said this on a panel that included Nigel Farage.

On the same show, weeks before Circle’s undoing, Cavendish defended the company’s Hinchingbrooke foray (at 38 minutes). To call it privatisation was “so misleading” because privatisation was “not happening,” she argued, relying on that strict government definition: “Privatisation /ˈprʌɪvətʌɪzzeɪʃ(ə)n/ noun Something we don’t talk about.”

Cavendish has in the past “gushed” about Circle in the Times. “Hinchingbrooke,” she wrote, “is an innovation that should be applied to at least 18 other hospitals.” Circle’s secret, she said, is a “relentless focus on the patient.” But the Care Quality Commission found patients were told to “soil themselves” rather than wait for call bells to be answered.

For Cavendish the stakes are high. She has “spent five years looking at the NHS”; she’s even on the board of the Care Quality Commission itself. Yet, with true magnanimity, she now insists “the blame game is pointless” – a remarkably charitable view, given that Circle’s retreat has made her look a bit silly.


Case study 3: The broadcaster

BBC Newsnight lives on its reputation for never shying away from a difficult story. In August 2012 Circle gave the programme “exclusive” access for what the company thought would be a puff piece. The result was the finest corporate promotional film ever made by a state broadcaster – or so it seemed.

In fact, the package was intended as satire. To the sophisticated viewer the sight of reporter David Grossman repeating corporate mantras (“reactive, motivated staff treat patients better; happy, well-fed patients heal better”) was genuinely funny, although a radical departure for Newsnight.

The lack of any balancing view to the assertion “We need to get over the idea that patients and profit don’t mix” was surely a giveaway. If this was straight journalism there would have been searching questions about how Circle planned to make £311 million of savings in 10 years, and whether that would mean job cuts of the kind that resulted in a single nurse caring for 21 patients on a ward.

Unfortunately the film became a victim of its own success. It was too good; too dry. Believing it was genuine, many Newsnight viewers are now unable to comprehend Circle’s failure. Unhappily, it may have destroyed their faith in the rigour of BBC journalism forever.


‘You can fool all the media all of the time’

In presenting these case studies I in no way seek to diminish the pain of Circle’s many other media victims. We must reach out to all the journalists affected. By sharing experiences we can identify common lapses, and understand how Circle’s PR machine worked.

Take, for example, Circle’s ‘stop the line’ policy, which allows staff to halt a procedure if they spot something amiss. It impressed the Telegraph’s Charles Moore, an expert on Hinchingbrooke having spent an entire morning there. He recounted an operation stopped by a nurse who realised a swab had been left “inside the patient.” But wait a minute! Newsnight also talked about the “junior scrub nurse” who pointed out there was a swab “inside a patient.” And the Mail referred to a nurse who “spotted that a swab was missing… inside the open wound.” Lucky escape! Could have been a real swab story.

Circle wanted everyone to know about ‘stop the line.’ Moore duly reported that staff were “encouraged” to use it. “Someone stops the line in Hinchingbrooke most days” – although not, apparently, on the days when the Care Quality Commission was there. According to the Commission’s report:

“Staff told us that they had been actively discouraged by managers from calling a ‘stop the line.’ When we found a significant failing the matron was unwilling to call ‘stop the line.’ Even during the discussion of this issue with the CEO, it was the Care Quality Commission who called a ‘stop the line,’ not the Trust.”

Circle, the snakes, had pitched them all the same guff! Moore and co should be outraged. How are our finest journalists supposed to do their work if they have to constantly cut through spin?

Another example: Circle likes to present itself as the John Lewis of healthcare, run by its staff. The Sun; the Times; the Mail; even the Financial Times have indulged it, the latter calling Circle “a John Lewis-style partnership.”

It isn’t true. Power rests with the majority shareholder, Jersey-based Circle Holdings, owned by six venture capital and hedge funds (whose founders have, entirely coincidentally, donated fortunes to the Tories).

Yet nearly all of Circle’s victims reported that the key to its success was the empowerment of its staff. “Hinchingbrooke has become a model hospital in which clinical staff make decisions,” wrote columnist Alex Massie. But a survey showed that staff actually “felt bullied and harassed by managers.” One ‘empowered’ nurse told inspectors, “We are always told to do incident forms, but who has the time and nothing changes, therefore we don’t do them.”

Circle is a pound shop John Lewis. But the media couldn’t see it. They were spellbound by Circle’s PR wizards who could magic a string of fawning pieces in the Telegraph with the wave of a wand, or conjure from our newspaper of record (still the Times, at the time of writing) otherworldly editorials saying: “The heartening example of Circle is a glimpse of the only way the NHS in its current form will be sustainable.”


Many others now need our help

Circle’s manipulations stretched well beyond the media. It preyed particularly on the vulnerable who wanted to believe – like the corporate-funded, spontaneously pro-corporate ‘think tank’ Reform and its director Andrew Haldenby, of whom it made a true convert.

It coaxed influencers like Professor Paul Corrigan, adviser to Tony Blair, into demeaning public avowals calling Hinchingbrooke “an example of what the private sector could achieve if it were allowed to play a role.”

It showed no mercy towards its weaker victims. The local Tory MP in Hinchingbrooke, Jonathan Djanogly, was pitilessly used and then dumped, left in a state of utter confusion by Circle’s withdrawal, murmuring: “It seemed to work… As far as I’m concerned the model was a success. The particular contract didn’t work.”

Like a gangster, Circle compromised its opponents. How dearly Labour’s last health secretary Andy Burnham would love to rail against the Hinchingbrooke debacle, if only the contract hadn’t been tendered on his watch.

It sought out the influential and seduced them, like Sean Worth, David Cameron’s former special advisor on health (later a private lobbyist with clients including… Circle), lured into risking his career as a forward thinker by proclaiming Hinchingbrooke a “huge success story.”

Most disturbingly, it infiltrated parliament. Circle’s name appears again and again on the list of over 70 MPs with financial connections to private healthcare companies. It attracted allies like Chris Skidmore MP to trumpet Circle’s “victory.” It recruited – literally recruited, for £50,000 a year – Mark Simmonds MP, who said in 2012 that Hinchingbrooke was “at the frontier of the way healthcare is going to be provided in the future.” Well now it is the future and the Hinchingbrooke miracle is as illusory as flying DeLoreans.

Its spin-masters even infiltrated the inner sanctum of government. A former head of communications for Circle is Christina Robinson (née Lineen); she became a special adviser to health secretary Jeremy Hunt. Another former Circle head of communications is Nick Seddon, now health policy adviser to David Cameron.

Our prime minister never stood a chance. Circled by Circle, he was conditioned, indoctrinated, brainwashed to not only endorse the Hinchingbrooke scam last year in the Commons, but to take responsibility for it: “If we look at Hinchingbrooke hospital in Cambridge, it is now providing much better services because of the changes that we have made.”

Our only consolation: Circle’s downfall seems to have lifted the wool from his eyes – he’s not taking responsibility now.

N.B. Another possibility is they were all in on it.


This article is co-published with openDemocracy
Alex Nunns tweets at @alexnunns


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Going private? My reply to a job offer from a private health company

What the heck is this? I’ve been trying and failing to stop the government from privatising the National Health Service for years, and now a private healthcare company has contacted me about a job!

The email from Care UK says they are “seeking a Media Relations Executive for our Head Office based in Colchester and your skills and experience appear to be a good match.” Huh? They are offering a “competitive salary, 25 days holiday and corporate discounts.”

Here’s what I have replied:

Dear Laura,

Thank you for your unexpected email about the Media Relations Executive job with Care UK. I am very interested. Since Care UK is possibly the leading private healthcare company making inroads into the NHS, I would relish the opportunity to publicise what it does – indeed, this is precisely what I was trying to do in my previous job as information officer for Keep Our NHS Public (on a much smaller budget, I’m sure). That must be what you were referring to when you said my skills and experience are “a good match”.

As you can imagine, I am brimming with ideas. If you don’t mind, I would like to set them out here. First of all, I think much more needs to be done to let the public know what Care UK is. Hardly anyone realises just how big a chunk of the NHS you now run, from GP surgeries and walk-in centres to treatment units doing things like bunions. If I were your Media Relations Executor I would promote this aggressively to build the brand. I think the public has a vague idea about NHS privatisation, but they aren’t yet able to put a face to the name, so to speak. Care UK’s name could be that face. As a profit-making healthcare company owned by a private equity firm you are perfectly positioned.

I believe a key talent for any disrespecting Media Relations Executive is the ability to turn a negative in to something offensive. For example, it must have been a stressful time in the Media Revelations office when that tax avoidance story broke a few months ago – the one saying that Care UK had reduced its tax bill by taking out loans through the Channel Islands stock exchange. All this talk of tax havens and tax avoidance isn’t good in the current climate. But as your Media Relationship Executive I would have used a little reverse psychology, instead of denying it as your spokesman did. After all, this could put you right up there with the big boys like Goldman Sachs, Vodafone and Jimmy Carr.

Similarly, you got some bad press when it was revealed that the wife of your former chairman John Nash gave £21,000 to Andrew Lansley’s office before the last election, when Lansley was shadow health secretary. But let’s view it from another angle – doesn’t this serve to highlight Care UK’s excellent political connections? And look how it turned out: Lansley is in power and he has passed the Health Act. He has opened the door wide to privatisation, and Care UK is already inside redecorating the place.  We thought Lansley wasn’t going to manage it for a while, when all those thousands of patients and doctors started protesting and June Hautot shouted “codswallop” at him in the street. But he pulled through, sacrificed his future public career for private gain, and God bless him for that. Care UK now stands to make a fortune. This is something to boast about, for Bevan’s sake! And all for £21,000, less than it would cost to employ a Media Relations Executive for a year. (Please confirm.)

You should play to your strengths. Care UK is a true pioneer in this privatisation drive. You were the first private company to run a GP surgery in Dagenham back in 2006. And the first to face enforcement action from the Healthcare Commission because of slack hygiene procedures at the Sussex Orthopaedic Treatment Centre in 2008. And who’s to say you weren’t the first to forget to process 6,000 x-rays at your ‘urgent’ care centre in North-West London in 2012? As a Mediocre Relations Executive, I would advise not mentioning those last two.

If there’s just one thing that Care UK knows how to do – and there is – it’s take money from the state. I would make a bigger deal of the fact that 96 percent of Care UK’s revenue comes from the NHS. That’s the kind of solid base that any company would envy – taxpayers’ money, minimal risk, easy profits. So shout about it! It shouldn’t just be left-wing NHS obsessives who hear about this stuff.

Take the Barlborough Treatment Centre. It’s a complicated story, but in the hands of a good Media Relations Excretion it can be turned into a wonderful example of the company’s strengths. First, Care UK was paid £21.9 million over five years to do orthopaedic surgery – hip and knee replacements, that kind of thing – but you only did £15.1 million worth of work. (The local NHS Medical Director saw the trick, complaining: “The problem we have got is that they cherry-pick; they don’t take any patients with complicated conditions”. I guess the joke’s on him.) The NHS eventually realised it was getting a bad deal, and things weren’t looking good for Care UK. But then the NHS bought the treatment centre from you for £8.2 million, a lovely gesture. And finally the NHS signed a new 30 year contract to run the centre with… Care UK! (As an aside, it is important from a media management perspective not to spoil this tale of triumph-from-the-jaws-of-lucrative-defeat with any reference to the several lawsuits brought by local patients claiming that their surgery went wrong.)

As an example of what I could bring to the company I would like to propose a new corporate motto: ‘Care UK – Providing less, for more’. These words came to me when I was thinking about Manchester, where last year the NHS paid you £2.7 million for work that was never done at your Clinical Assessment and Treatment Centre. According to a parliamentary report, the services you provide up there are between 7 percent and 12 percent more expensive than equivalent services in local hospitals. Providing less for more – it’s a record that really ought to be publicised.

And Care UK should be proud of its talent for cost-cutting, like the plan to use more nurses and healthcare assistants in your GP surgeries because doctors are too expensive. Your managing director, Mark Hunt, describes this as “workforce efficiency on skill mix”. As a Meddling Relations Executive I would advise him to ditch the jargon and tell it as it is. Patients might get a worse service, but at least the company is making more money and that’s good for the economy. We’re all in this together, as someone once said, in jest. I’m convinced that if Care UK followed my strategy it would solve the serious problem of patients accidentally opposing the private take-over of GP surgeries through confusion and surfeit knowledge, like when those blasted Keep Our NHS Public campaigners scuppered the Care UK health centre in Euston by threatening court action.

Be bold. Be proud. Be shameless. That’s the approach I would bring to the job, and I hope you like my initial ideas. Please be sure to let me know when and where the interview will take place (the formalities must be gone through, I understand). I trust that I will hear from you soon.

Yours sincerely,

Alex Nunns

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