Supplementary memorandum by UNISON (PS
33A)
The experience of private sector provision of
support services in the NHS has been one of failure. Private sector
provision has not improved the quality of services, it has broken
up the NHS team and created a two-tier workforce and it creates
obstacles to the provision of integrated services.
UNISON believes NHS support services should
be provided by directly employed NHS staff and with sufficient
training and investment on in-house workforce can deliver high
quality support services complementing clinical care.
The failure of privatisation is evident from
the government April 2001 audit of cleaning standards in the NHS
(the only support service which has been audited according to
agreed national standards). This was a general audit of the hospital
environment focusing on cleaning and shows that where services
are contracted out they are more likely to have failed. 20 out
of 23 of these hospitals which did not pass the cleaning audit
are contracted out compared to an estimated 50 per cent of contracts
contracted out overall. Subsequently by September 2001 all hospitals
which failed had improved their standards thanks to the efforts
of staff, extra investment and NHS management support. UNISON
welcomes this.
A list of the hospitals, which failed in April
2001, is attached identifying the contractors concerned, (including
four of the first wave PFI). See Appendix. UNISON does not wish
to single out any particular contractors, as this would not be
justified. UNISON believes that in many cases there are a number
of causes for the problems as well as privatisation.
The historic process of market testing and the
constant cost cutting pressure on support services meant many
contract's have insufficient income to achieve their targets.
In other cases output specifications are inadequate and there
has been insufficient focus on cleaning services. UNISON welcomes
the remedial action taken since April 2001.
There is also a general problem of staff shortages
in ancillary services, which is common to both in-house and contracted
out contracts. No staffing or turnover figures are compiled for
private contractors but UNISON believes their turnover is higher
especially amongst newly recruited staff who often have inferior
terms and conditions such as inadequate pension. The lack of continuity
created by high rates of turnover is a problem in maintaining
quality in cleaning services.
There has not been a national audit of catering
provision although the audit commission recently produced a study
on the issue.
This did not specifically look at whether contracting
out had an effect on quality though it did find that it did not
have a clear cost benefit. Most of the examples of best practice
recommended by the Commission, were in-house.
UNISON has identified a range of problems with
privatised catering services including inflexibility in contract
arrangements; moves to cook chill delivery without sufficient
provision for halal or vegetarian options and in a few cases quality
issues and concerns over snack box provision. UNISON believes
that where there are redevelopments lack of access to public capital
is the main driver to privatise catering services.
In portering and security services UNISON concerns
relate to the staffing levels specified in contracted out contracts
and in some PFI hospitals. Concerns over these levels are difficult
to resolve when they became tangled up between the parties. The
definition of services can also become a matter for contractual
dispute.
Private sector involvement in other ancillary
services such as sterile supplies is much more limited. UNISON
believes that the NHS has not been given sufficient public capital
to develop its own services in this area but is driven to choose
private providers who can provide substantial investment.
UNISON welcomes recent government investment
and initiatives designed to improve cleaning standards and catering
services. UNISON believes that the long promised market testing
review ought to be brought forward in line with PFI pilot developments,
to have an approach based on in-house provision for high quality
service. At present individual trusts are left to make their own
choices. In many areas services are being brought back in-house
following quality problems but some contracting out is continuing
largely for financial reasons. A new national framework is needed
based on achieving high quality in-house provision.
UNISON supports the greater role of "modern
matrons" in ward based cleaning but would point out that
this new relationship is obstructed where services are contracted
out. Similarly the ward housekeeper role can only be fully developed
where catering services are retained in-house.
UNISON believes the evidence demonstrates that
privatisation of ancillary services has been a failure and has
had a serious adverse effect on quality as well as dividing the
NHS team and contributing to the creation of a two-tier workforce.
UNISON supports well resourced in-house service provided by directly
employed staff.
NHS TRUSTS UNDER-ACHIEVING ON CLEANLINESS
(OCTOBER 2001)
| Rated 2 stars overall
| Cleaning contract |
| Barts and The London | Royal London = ISS
|
| | Barts = in-house; Chest = in-house
|
| Bury Health Care (Greater Manchester) | Bury General = ISS
|
| | (Hospital being run down with only two departments left, more to do with fabric)
|
| Dudley Group of Hospitals | PFI—Interserve
|
| | (Was also under-achieving when in-house but shows privatisation doesn't equal improvements)
|
| Essex Rivers Health Care | CARILLION
|
| Forest Health Care (Whips Cross) | ISS
|
| Heatherwood and Wexham Park | MEDICLEAN
|
| | (Contract just renewed)
|
| Royal Liverpool and Broadgreen Hospitals |
SODEXHO |
| | (Broadgreen not generally regarded as a dirty hospital but both are Sodexho)
|
| Salford Royal Hospitals | RCO
|
| | (RCO may have been taken over by another company, RO doesn't know)
|
| South Manchester University Hospitals | SODEXHO
|
| University College London Hospitals | INTERSERVE FM (PFI)
|
| University Hospital Leicester | SERCO
|
| West Middlesex University Hospital | SODEXHO
|
| | (Will transfer to ECOVERT next year as part of PFI)
|
| West Hertfordshire | MEDIREST
|
| | (This is part of a consortium of hospitals covering West Hertfordshire's Acute Hospitals)
|
| Worthing and Southlands | In-house
|
| | Branch Secretary Nigel Westlake 01903 205111 bleep 015
|
| Rated 1 star overall |
|
| Hillingdon Hospital | MEDIREST
|
| Maidstone and Tunbridge Wells | Now in-house but it was GRANADA pre-August 2001
|
| | (Was Granda then came back in-house following criticism of cleaning standards. Problems relate to fabric of building and refurbishment. Branch think Granada provided better equipment and management.)
|
| North Middlesex Hospital | ISS MEDICLEAN
|
| St Georges Health Care | INITIAL
|
| St Marys Health Care | Was SODEXHO when it failed last time. Has been ISS since April 2001—it failed again but nothing changed much until recently. Were still using SODEXHO practices and procedures until recently.
|
| Rated no star overall |
|
| Ashford and St Peters Hospital | MEDIREST
|
| E & N Hertfordshire | MEDICLEAN
|
| Oxford Radcliffe Hospital | John Radcliffe = ISS
|
| | Churchill/Horton/Radcliffe Infirmary = In-house
|
| United Bristol Health Care | INITIAL
|
Footnote: Our list only refers to the acute Trusts that failed
the April 2001 cleaning audit. We were not able to check the small
number of community Trusts but there is no reason to believe that
the trends are affected. All Trusts have now been passed as meeting
the audit in a September inspection the results of which were
released yesterday.
| 
