Flimsy evidence should not be used to generalise merits of ‘mutual’ NHS trusts
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Version 0 of 1. Why did Salford Royal NHS foundation trust score more highly for overall staff engagement than any other acute trust in the 2013 NHS staff survey? Is it because it has left public ownership and been turned into a mutual? No, that cannot be the reason, because it hasn’t. So is it because it hasn’t? If that’s your explanation you might struggle to explain why mid Yorkshire and north Cumbria NHS trusts came joint bottom of that league table. Somewhere around the middle – just below average, in fact – came Hinchingbrooke health care NHS trust, the only one to have been privatised but still presented by government ministers as though it proves that mutualisation works wonders. Let us leave to one side the fact that Circle Health, the company that has run Hinchingbrooke since 2012, is not really a mutual at all, since most of its shares are owned by a hedge fund and only a minority by its staff. More to the point is that its strengths and weaknesses – like those of Salford, mid Yorkshire and north Cumbria – tell us little or nothing in general about the relative merits of public, private or mutual control. What the experience of each can contribute to the debate about how to improve the NHS is in the detail of what they have or have not done to innovate in leadership, staff involvement and governance, and the values that have guided them. No research captures any experience exactly, but the annual NHS staff survey is the best guide we have to trends in staff engagement in the service, and its results matter because they correlate with care outcomes and reported patient experience. Yet Francis Maude appears to have paid it no attention at all before earlier this month, urging NHS trusts to reconstitute as mutuals. Like the government-commissioned King’s Fund report a couple of weeks earlier, which paved the way for Maude’s announcement with a flawed argument, Maude chose not to mention that Hinchingbrooke’s job satisfaction score in the latest NHS staff survey is in the bottom 20% of all trusts. Hinchingbrooke is also in the bottom 20% for: “effective team working”; “relevant training, learning and development”; appraisals and “well-structured appraisals”; “support from immediate managers”; staff “witnessing potentially harmful errors, near misses or incidents”; “fairness and effectiveness of incident reporting procedures”; staff “experiencing harassment, bullying or abuse” from other staff; “feeling pressure to work when unwell” and “equality and diversity training”. There are those who would conclude from that catalogue, perhaps linked with other data, that the Hinchingbrooke experiment is failing. Some would even base a general case against privatisation and mutualisation on that evidence. I would be more cautious, not least because in some of those categories Hinchingbrooke’s score is improving from a low base, while in others the hospital scores above average. But if it would be rash to base an anti-mutualisation case on Hinchingbrooke’s experience, it would be madness to conclude from it that mutualisation is the best route to improving staff engagement, clinical outcomes and patient experience. As the founder and managing director of a social enterprise, I believe in mutuals. I strongly believe that mutuals and social enterprises have an important role to play in the health and social care services of the future, and that they can provide lessons in innovation, service quality and improving working lives and productivity. Hinchingbrooke has much to contribute to our understanding of how to improve the NHS but, like Salford and mid Yorkshire, it will yield its lessons only if the debate moves on from making dubious use of flimsy evidence to make a general case one way or the other. Francis Maude should know better and we deserve better. Are you a member of our online community? Join the Healthcare Professionals Network to receive regular emails and exclusive offers. |