Select Committee on Health Minutes of Evidence

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.


Rated 2 stars overall Cleaning contract
Barts and The LondonRoyal 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 HospitalsPFI—Interserve
  (Was also under-achieving when in-house but shows privatisation doesn't equal improvements)
Essex Rivers Health CareCARILLION
Forest Health Care (Whips Cross)ISS
Heatherwood and Wexham ParkMEDICLEAN
  (Contract just renewed)
Royal Liverpool and Broadgreen Hospitals SODEXHO
  (Broadgreen not generally regarded as a dirty hospital but both are Sodexho)
Salford Royal HospitalsRCO
  (RCO may have been taken over by another company, RO doesn't know)
South Manchester University HospitalsSODEXHO
University College London HospitalsINTERSERVE FM (PFI)
University Hospital LeicesterSERCO
West Middlesex University HospitalSODEXHO
  (Will transfer to ECOVERT next year as part of PFI)
West HertfordshireMEDIREST
  (This is part of a consortium of hospitals covering West Hertfordshire's Acute Hospitals)
Worthing and SouthlandsIn-house
  Branch Secretary Nigel Westlake 01903 205111 bleep 015
Rated 1 star overall  
Hillingdon HospitalMEDIREST
Maidstone and Tunbridge WellsNow 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 HospitalISS MEDICLEAN
St Georges Health CareINITIAL
St Marys Health CareWas 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 HospitalMEDIREST
E & N HertfordshireMEDICLEAN
Oxford Radcliffe HospitalJohn Radcliffe = ISS
  Churchill/Horton/Radcliffe Infirmary = In-house
United Bristol Health CareINITIAL

  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.

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