Keep our NHS Public: Health Warning – A mutual may be heading our way

Jan Ainsley from Keep our NHS Public writes:

Michael Scott, Chief Executive of Norfolk & Suffolk NHS Foundation Trust (NSFT), was “delighted” to be able to write to staff with good news. NSFT has been successful in its application to investigate becoming a mutual in the government’s “Mutuals in Healthcare Pathfinder” initiative. Sounds cuddly doesn’t it? Who could be against mutuality?

Evidently the initiative is all about changing the ownership of the Trust for the benefit of staff and, in turn, the care of patients. The Trust has been listening and has heard that many staff are disengaged, disempowered and demoralised – and that can’t be good for the quality of care provided can it?

Here are a few starter questions for the Trust, staff, patients, carers and local people to consider:

1. Have we, the people who already own the NHS, been consulted about a change of ownership?
2. What is a mutual? The letter refers to the John Lewis model but there is no single definition of a mutual. If the emphasis is on shared ownership, then it is wide open to interpretation. The government include Circle in its list of recognised mutuals. Circle is 50.1% owned by hedge funds (Circle Holdings plc) and 49.9% owned by Circle Partnership (senior executives and consultants). If this was the chosen model, the private sector could be involved right from the beginning as “partners”.  Curiously, Circle do not seem to be a very good example of either high levels of staff satisfaction (falling in the bottom 20% in the latest national survey) or in high standards of patient care (shortly to be confirmed in the latest CQC inspection) at Hinchingbrooke Hospital.
3. No matter which particular model is selected, NSFT would be severed from the NHS. In the event of a future financial or care crisis, it is likely the mutual would have to be sold or wound down. We all know what happened to the mutuals in the financial sector- they were demutualised. Given the Trust’s current financial and care crisis, is this a good time to explore a major risky change of organisation, when so many urgent issues need to be resolved?
4. Mutuality is not just about a “business” organisation. It can also refer to workplace democracy and decision making within an organisation. Does NSFT have a workers’ co-operative in mind?
5. Since 2008, 29 health organisations have been established as mutuals. In addition, since 2010, 91 mutuals have been created in other parts of the public sector. Where is the evaluation of their successes or failures in delivering their goals? No-one would want to see further experimentation based on flimsy or anecdotal evident, would they? Norman Lamb and Francis Maude are touting heavily as evidence an “independent” report by Chris Hams of the King’s Fund, “Review of staff engagement and empowerment in the NHS” (2014). Given the government’s highly selective use of independent reports it is worth looking closely at what this one has to say. Of the three core recommendations, only one actually refers to the mutual option. The other two recommendations, that NHS organisations should redouble their efforts to engage staff and that there should be greater devolution of decision-making within the NHS, do not seem to have attracted much government attention.
6. As mutualisation is about greater staff involvement, what engagement took place across the trust between July and September to make the decision to apply for membership of the mutual pioneers? Were patients, carers, staff, unions, governors, members of NSFT and the wider public consulted at all?
7. Could the £100,000 to be spent on management consultants investigating mutualisation have been better spent on providing mental health care to the public?

Since the passing of the Health and Social Act, creeping privatisation has accelerated throughout the NHS. So far it mainly consists of selling off health services to private companies. But the government is only too aware of growing public concerns about profit hungry corporations. Now under the cover of mutualisation, privatisation is taking a new turn. No matter what form mutualisation takes, the Trust would be moving out of the public sector into unexplored new territory. In case there is any doubt about where mutualisation will lead, the government provide the answer:

“public sector mutuals are organisations which have left the public sector”

Watch this space for more about mutualisation!