Hospital takeover stirs hope of healthier outlook

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Hisham Abdel-Rahman, medical director of Hinchingbrooke NHS Trust, knew his hospital had turned a corner the day the roof fell in.

Weeks earlier Circle Health – a private company in which staff hold 49.9 per cent of the shares – had assumed control of an institution facing closure, with debts of £40m.

When rain dislodged some roof tiles, the classic response of staff steeped in top-down NHS culture would have been to pass the problem up the line.

But when Mr Abdel-Rahman, a consultant gynaecologist, arrived to assess the damage, “I found 10 people around the room from the estates, from the clinical staff – nursing or doctors – from the specialities that we may need to use to shift some of the patients, and the whole thing was done and dusted in less than an hour. That never happened before in the NHS.

“The way they did it and the way they co-ordinated with each other – that was the lovely bit. There was no management to sort it out for them. They knew they had to sort it between them.”

For advocates of Circle’s takeover of Hinchingbrooke, this is an example of the cultural change that private sector involvement can bring to the NHS. But critics seized on Thursday’s revelation that the first £2m of any surplus generated by the hospital will go to Circle.

Ministers have played down the likelihood of further such deals. However, the clinical results achieved since the company took over three months ago seem to point to the transformative potential of what Massoud Fouladi, Circle co-founder, calls “dispersed and mandated leadership”.

Jennifer Dixon, director of the Nuffield Trust, a think-tank, says the philosophy, which has its roots on the factory production lines of companies such as Toyota, offers an effective model for a cash-strapped health service whose focus must be on “productivity and staff motivation”.

“It’s all about giving power to those on the shop floor who see the mistakes, who see the waste, to reduce it because it can’t wait to be handed five layers up to the top and then come down as some sort of edict,” she says.

The question is whether Hinchingbrooke can serve as a template for the rest of the NHS.

Its achievements so far are eye-catching. The accident and emergency department, once the lowest performer in the region, has topped the Cambridgeshire league table for 10 weeks.

Its orthopaedic unit has reduced average length of stay for patients undergoing hip and knee surgery from just over five and a half days to three and a half. Overall, the number staying more than 10 days has fallen from a persistent average of 120 to between 60 and 70.

This matters because reducing the time patients stay in hospital delivers the biggest cost reductions as well as improving outcomes. The shorter stays in orthopaedics alone are contributing to savings of £1.5m over the course of a year.

Circle has both investors and the Department of Health to impress and the evidence to back up the claims came from the hospital’s own data centre.

Yet clinical staff unselfconsciously use the word “empowerment” when they discuss the new regime. Nurses on one ward cited a small but telling change: the “estimated discharge date” on a patient’s chart has been renamed the expected discharge date. The effect has been to embolden them to act as advocates for their patients.

Diane Pryce-Dyer, ward manager, said: “It gives you more confidence to actually challenge when things aren’t working or aren’t moving along as fast as you would expect them to.” That trusting staff, and publicly hailing their achievements at monthly staff meetings, should produce such profound changes may be as much a reflection on the deficiencies of NHS culture as the advantages of Circle’s. Its £10m a year annual savings target remains incredibly tough.

But something is happening at Hinchingbrooke – and it may be hard for the wider health service to ignore it.

Dr Dixon says: “Are the staff at Hinchingbrooke and the patients at Hinchingbrooke any different to NHS staff or patients elsewhere? The answer’s got to be ‘probably not’. So if it can be done at Hinchingbrooke it can certainly be done across the health service.”

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