Hinchingbrooke – where next for franchising?
The news today that Circle is going to pull out of the Hinchingbrooke franchise will no doubt lead to the normal range of NHS 20/20 hindsight judgements on the failure of the private management of Hospitals but has the whole scheme been such a failure?
Hinchingbrooke was a trailblazing pilot and this early termination should not automatically signal the end of similar franchises or management support arrangements. The Dalton review shows that intense management support should be one of the options for supporting trusts. It may well still be a realistic alternative to formal insolvency/TSA, which has its own challenges. What would be a (typically) wasteful NHS response would be to throw out the idea of any management support structures altogether (whether they are called franchises or not).
The NHS cannot ignore the reality that despite “buddy trust” arrangements and the Dalton proposals finding capable management teams to turn round hospitals is a huge challenge in the NHS, and so closing down any future use of private skills would be very short sighted, even if (temporarily) politically popular
It is a truism of management theory that you can learn as much, if not more from failure as you can from success Novel and contentious contracts like this in the NHS often have challenges, especially when they are so constrained to stop any hint of private sector profiteering that their flexibility to adapt to changed adverse conditions is limited. Learning the structuring and contracting lessons would be really valuable for the NHS provided all parties can resist the temptation to “spin” the conclusions to suit their wider agendas, irrespective of whether a future management contract was awarded to an NHS or private provider.
Equally since the Hinchingbrooke franchise was let it has become even clearer that delivering affordable sustainable services improvement and change is not an overnight task and it needs significant continuing and sustained financial as well as management support. Arguably the Hinchingbrooke deal took so long to negotiate that it was fatally flawed from the outset because so many of the original assumptions as well as the external conditions had changed (adversely and significantly) by the time the deal was finally approved. It should also not be forgotten that at the time (before acute trust deficits were as common as they are now) Hinchingbrooke had one of the largest deficits for an NHS Trust in England, a deadweight that would have drowned many management teams.
Lastly while no one can ignore the quality failures exposed by CQC – it is hardly the case that Hinchingbrooke is the only NHS Trust with quality problems. Part of the real challenge for Circle was that it was always at the eye of the storm in terms of interest and scrutiny. While quality failures may have been contributory to the final decision by Circle to pull out, it should not distract anyone from the real lesson that this was not primarily a failure of private sector management, but more a reflection of the sheer scale of the challenges facing many NHS trusts, a challenge in which we need to keep all our options open including future management franchises.