Are we privatising the NHS?

Last week we announced that following a robust and detailed competitive dialogue we have awarded a contract for our community and urgent care services in Whitby to Virgin Care. The response to this announcement has been fascinating….


We set out to get the best for Whitby. We spent much time developing a joint view with patients and the public and the local health staff about what we wanted….we warmed up the market, encouraging providers both local and national to participate.


We choose competitive dialogue because although we knew it would be a resource intensive thing to do it would give us the best chance to find the right provider for the job. What is competitive dialogue? Well rather than the process being mainly paper driven (providers simply supplying written answers to questions) and then holding a single interview, competitive dialogue is a series of detailed (four hour) face to face conversations with each of the potential providers developing within them the details of our joint ambitions for the services.


By the time we arrived at the decision making phase we had talked to each of the final two providers for 34 hours! We also assessed them through written submissions which included each provider answering a long series of questions marked by pairs of subject matter experts (37 in total) including a patient and public panel. We visited places where the organisations already provide services to talk to staff, patients and commissioners of those services. The visiting team included CCG staff both managerial and clinical, members of staff from the Whitby services, a member of the public and a local councillor. Those visits gave us the chance to triangulate information we had received in both written and verbal interactions with the providers. 70% of the marks were allocated to the assessment of quality of care including patient experience, with the remaining 30% covering financial capability.


How did we deal with conflicts of interest? We were told that our GP Federation had developed links with one of our potential providers therefore the GPs working for the CCG who are all members of a single federation were “conflicted” and couldn’t be part of the process. We held separate Senior Management Teams to cover the Whitby work which excluded them, and we brought in clinical advice from other CCGs where no conflict existed to support decision making. Although I have been a GP in this area for 26 years I no longer work in primary care so I was able to lead without issue.


In the end the process led us clearly and simply to the answer. One provider could offer us the best service for Whitby. They are ambitious. They have a track record which is strong for engaging and involving patients in everything they do and for empowering and developing staff to improve the quality of local services.
Are there challenges? Of course. When you do a job like mine you know what you are taking on. I am a public servant. I follow the rules laid down for my organisation by Parliament. I am also an individual with my own private views and opinions. I vote. As I do my job I am bound to reflect privately on issues that chime with or challenge my personal views. I learned a great deal through this process and yes, it challenged some of my personal views.

Whilst we were visiting the Virgin Care site in Surrey we asked staff what it was like to work for a private company. One of the nurses told me that she sees herself as an NHS nurse offering NHS care to NHS patients, employed by a private company. She commented one of her most challenging encounters had been with a GP. She thought that was a bit much considering that GPs are themselves private providers! It made me think….I see myself as NHS through and through, and yet as a GP partner in a practice for the last 26 years I have been a profit-making partner in a small private business, as all GP partners are and have been since the birth of the NHS. We made decisions week by week which affect how much of our money we invest in staff and services and how much we take home in our pay packet. It is profit/loss at the sharp end.

In conversations with Whitby staff someone said they were sad an NHS organisation wasn’t able to offer something as credible and ambitious as a private organisation. It made me reflect on our process and consider if we had done everything in our gift to stimulate and develop the market both private and NHS, and I am confident we did: we held several open events, made many conversations both formal and informal.

What about the staff? Our NHS staff in Whitby will transfer to the new provider with their terms and conditions of employment intact and will be able to stay in the NHS pension scheme. More importantly as they develop and progress and their roles and pay change and as new staff come they will also be able to choose between NHS terms conditions and pensions and those of Virgin Care. Staff at the site we visited talked enthusiastically about great opportunities to develop and progress they had been given since Virgin took over for all staff groups. A nurse told us that she had been dragged” kicking and screaming” to work for Virgin but she had had to eat her words because they were a good employer who cared about staff and patients.


It is easy, isn’t it; to somehow think NHS providers occupy an ethical high ground. But do they?

The Kings Fund, an respected independent UK Charity that works to improve and develop healthcare wrote recently on this subject they said:

"For-profit, non-profit and NHS providers can provide high-quality care and equally all sectors can fail to do so. Whether a provider (public or private) makes a surplus/profit from its trading with the NHS does not automatically mean that quality of care is compromised. The Fund’s view is that who provides the service is less important than the quality and efficiency of the care that is provided."

In conversations since the announcement people have quoted to me programmes and articles about the shortcomings of private providers. However, they are not alone. How many are there about NHS providers if you look for them? The system we work in isn’t perfect. Sadly there is poor performance in all sectors. We must and do strive to improve the quality of the services we offer our patients and we are committed to continuing to do that.

Will the political landscape and thus our framework change? Possibly. The private sector involvement in the NHS has been sanctioned by both major political parties when in government. Will it change? It may. It isn’t a certainty, but if it does we will manage that. That is our job.


So when people ask me, am I privatising the NHS ? my answer is a simple one. As a public servant my job is to improve the quality of our services and I use the framework given to me by Parliament to do that. I do not make policy. I am not a politician. So no, I am not privatising the NHS. I am doing my job.


We are confident the robust and clear process we have been through will lead to real improvements in services for patients in Whitby. We will to continue to work closely with the patients, public and staff as commissioners of the service to shape and develop services over the next 7 years. The proof of the pudding as they say will be in the eating…