Study finds NHS staff unhappy when moved to private sector

Tired and stressed doctor on hospital corridor
12 Apr 2011 12:54:08.423
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NHS staff who have been moved to the private sector in the increasing transfer of health services say they feel ‘insecure and marooned’, according to a new study by the Nottingham University Business School.

The survey revealed that some clinicians who have been transferred to the private or third sector fear the new providers place profit before patient care and that new working practices adversely affect their NHS-acquired professional standards.

Many consider themselves ‘abandoned’ by the NHS, while others are determined to carry on safeguarding the ethos and work standards upheld in the public healthcare service. Only a minority see the move as a chance to reinvigorate their careers through new roles and relationships and improved quality of patient care.
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The study examined the attitudes of NHS clinicians who have been relocated to work in Independent Sector Treatment Centres (ISTCs). These were introduced by the Blair government during the health reforms of 2002. ISTCs allow private healthcare companies to deliver state-funded NHS care.

The findings will be of particular interest in the continuing controversy over the coalition government policies promising to create a ‘liberated’ NHS of ‘willing’ providers from the public, private and third sectors. Existing NHS services are expected to become increasingly managed and delivered through independent and private providers if the plans are pushed through.

The study claims the profound implications for the clinicians and other staff who have been subject to blanket transfers already, have been largely overlooked.

Leading the research, Dr Justin Waring, Associate Professor of Public Services Management, said: “The wholesale secondment of NHS clinicians to the private sector raises some important questions. For many, the NHS has been their primary place of training and career development. They’ve grown used to certain cultures and managerial practices.

“The NHS also represents a particular set of ideals and values around collective healthcare provision, such as care based upon need rather than an ability to pay.

“Not all workers support those values, but they identify with working in a public-sector NHS — which is why moving to the private sector has profound implications.”

Researchers carried out in-depth interviews with nurses, operating department practitioners and support workers at NHS and ISTC day surgery units.

Dr Waring said ISTC workers could be divided into three groups — ‘pioneers’, ‘guardians’ and ‘marooned’:

“‘Pioneers’ regard the move from the NHS as an opportunity to revitalise their careers by seizing the chance to help expand the new ‘mixed economy’ of service provision. ‘Guardians’ try to recreate the NHS’s ideals in their new settings, relying on traditional hierarchies and rebuilding relationships with their former colleagues.

“But the ‘marooned’ long to return to the NHS and are uncomfortable with working in an environment they perceive as driven mainly by profit and productivity.”

One nurse told researchers: “We’re told all the time this isn’t the NHS. They expect us to do things differently, more ‘efficiently’ — that’s how they make their money.”

An operating department practitioner (ODP) added: “It’s not what the NHS is about. Patients were treated because they needed care, and that was it. Now it’s about profit.”

Another nurse recalled attending a talk by an ISTC manager who, explaining the business’s approach, advised staff the centre should aim to “work like a car factory”.

A second ODP said: “All the time we’re told to work longer or quicker. Everything is about ‘efficiency’ and ‘turnaround’. That’s how they make their money.”

Other fears of a ‘numbers through the door’ approach included concerns about adding patients to full lists, using cheaper equipment and cutting team briefings.

One nurse said: “The concern is that I’m no longer part of the NHS. I believe in the NHS. It’s part of the national culture. I want to make sure we don’t lose that.”

Dr Waring said many of those interviewed for the research regarded the concept of ISTCs as “contaminating or eroding the principles and values of the NHS”.

He said: “These partnerships may harness ‘the best of both worlds’, but they reveal how healthcare is becoming increasingly commercialised, standardised and fragmented.

“For the clinicians involved it’s not always easy to reconcile change with established ways of working. Many of them have reservations and even resentment.

“It’s therefore important for policymakers intent on expanding the mixed economy of healthcare to consider how clinicians see themselves and their work.

“We need to find ways of easing the transition across sectors, because the present approach is unwittingly creating what may well prove barriers to change.”

— Ends —

Notes to editors: The University of Nottingham, described by The Sunday Times University Guide 2011 as ‘the embodiment of the modern international university’, has award-winning campuses in the United Kingdom, China and Malaysia. It is ranked in the UK's Top 10 and the World's Top 75 universities by the Shanghai Jiao Tong (SJTU) and the QS World University Rankings. It was named ‘Europe’s greenest university’ in the UI GreenMetric World University Ranking, a league table of the world’s most environmentally-friendly higher education institutions, which ranked Nottingham second in the world overall.

The University is committed to providing a truly international education for its 40,000 students, producing world-leading research and benefiting the communities around its campuses in the UK and Asia.

More than 90 per cent of research at The University of Nottingham is of international quality, according to the most recent Research Assessment Exercise, with almost 60 per cent of all research defined as ‘world-leading’ or ‘internationally excellent’. Research Fortnight analysis of RAE 2008 ranked the University 7th in the UK by research power. The University’s vision is to be recognised around the world for its signature contributions, especially in global food security, energy & sustainability, and health.

More news from the University at:

May Fest 2011 is on Saturday 7 May, 11am to 5.30pm, at The University of Nottingham. The University is throwing open its doors to the community – with heaps of free activities for all ages. The Physics Buskers, thunder and lightning on demand and brain games. Get a glimpse of some of the amazing things that are happening on your doorstep. Visit:

Story credits

More information is available from Dr Justin Waring at Nottingham University Business School on +44 (0)115 82 31275

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