Examination of Witnesses (Questions 280
THURSDAY 8 NOVEMBER 2001
280. How often does the sister sign it off?
(Mr Turner) The quality standards for each of our
wards are monitored on a monthly basis by the managers.
281. Can I ask you, who is on your user group,
(Mr Turner) We have got two, different level users
groups. We have got a strategic user group, which looks at the
strategy for the whole of the services, but we have got a working
user group, if you like, and it has got people like service nurse
managers on, those are senior nurses, ward sisters, departmental
managers, theatre sisters. And what I would like to do is to try
to get everybody who has a major input into the services onto
that user group.
282. I wondered if you had got patients on them?
(Mr Turner) We have not, at the moment, and one of
the things that we are looking at is how we do that, and I have
been having conversations with our (PALs?) officers. And, indeed,
on the train coming down today, the new cleaning standards are
out and I have been looking at those, and it is very clear in
those that you have to have patient involvement; so we need to
look at how we are going to do that.
283. The strongest critics are patients' relatives.
(Mr Turner) Absolutely.
284. And they need to be involved. How do you
share these measurements with the contractor, and are there financial
penalties for failing?
(Mr Turner) All our services are back in-house now,
and my experience has been that when our cleaning services were
out, and they were with Initial Services, the standard was very
good, and the cleaning services worked with the users and we worked
in a partnership. So, for cleaning services, we did not have a
problem in Bradford.
285. And the ultimate weapon is to withdraw
the contract and bring it back in-house?
(Mr Turner) We did not have any financial penalties
built into our contracts because our believe, naively or not,
was that it is a partnership and it is about working in partnership.
But, yes, the ultimate sanction is bringing the services back
(Mr Weeks) Can I just make a point on that though;
although that is the theory of how the penalty mechanism works,
there is a significant deterrent to Trusts going down that route,
particularly if they have been outsourced for some time, in that
they do not any longer have their own in-house management expertise
and other support that they would need to bring those services
back in-house. So the ultimate sanction is not used as much as
perhaps you might expect because of the fixed costs of bringing
the service back in-house, which the NHS centrally does not fund
in any way, an individual Trust would have to bear that. And on
some services there is an issue of capital investment, particularly
in catering, where the NHS is moving to chill provision; if the
decision has been taken not to allocate capital funds for NHS
facilities for catering, perhaps for different reasons, Trusts
may feel the only way they can move to the new technology they
want is in partnership with the private sector.
286. Mr Turner has just described how they actually
brought services back in, and yet you say there it is a deterrent;
perhaps you can tell us how much of a deterrent it actually was,
(Mr Turner) It was not used as a deterrent. For me,
bringing services back in-house was getting the best value for
the money that we had available, and delivering services in an
innovative way. There was no deterrent in it, for me.
287. Can I pick up on one or two of these things.
It is really a question to Mr McGuire, given that you are still
using a lot of contractors at the Trust at the moment.
(Mr McGuire) We are not.
288. I thought you were, I thought you were
still using some?
(Mr McGuire) We have six hospital sites, two major
hospital sites, St James's and the Leeds Infirmary, and four smaller
sites. On one of the smaller sites we use contractors, but in
a non-core function, (ie non ward based), so the FM contract as
a proportion of the workforce is probably less than 10 per cent.
289. But just in terms of your experience of
working with contractors, one of the things that emerged I think
surprised us a little bit when we visited Carlisle last week was
the extent to which staff were informed about the standards that
the private contractors were being asked to meet, the actual quality
standards, and the staff informed us that they did not know, they
were not aware, they had never had that information shared with
them. And it seems to me absolutely crucial that if you are going
to enforce these contracts properly the people who are going to,
on the ground, monitor the quality are the staff, and I just wonder
if you could comment on that really?
(Mr McGuire) Communication is critical. If anything,
in general, we monitor contract staff and private sector contractors
far more aggressively than we do our own people; and it is probably
the sensitivities that are around, using private sector in health
care, that force that, and, to a degree, that is almost unfair.
290. Why do you think a Trust would not tell
their staff what the . . .
(Mr McGuire) I do not know. I could not comment on
that. But I can comment on the placing of our contract with the
particular contractor. And I talked to you earlier about not awarding
the contract to the lowest bidder, and awarding the contract on
the basis of quality and partnership. One of the things that we
insisted on, in awarding the contract to that particular contractor,
was that the contract staff become an integral part of the Trust,
and that they attend Trust briefings, that the contract managers
become an integral part of the management team. So I would like
to think that the contract staff that we have, that relatively
small portion of the staff, are being briefed to the same degree
that our own staff are, and the same monitoring arrangements apply
to the contract cleaning that we have in the Trust, as does our
own in-house cleaning.
291. Just picking up on something Mr Turner
said a second ago, just following on from that, you were saying
that, in practice, you really would not want to levy financial
penalties, and it is a good working relationship with the contractor.
I understand that point, but does not that go against the principle
of whatone of the major benefits that the contracting process
can bring to you is this, you can wield athere has got
to be rigour in that relationship, otherwise perhaps somebody
could take liberties and not deliver the contract up to service,
if they feel the Trust is not going to be as hard with them as
really they should be?
(Mr Turner) I have to say, I have some difficulties
with this issue of financial penalties, because I firmly believe
that if you manage the services appropriately, whether it is contracted
in or contracted out, you should not get into a stage where you
are having to have financial penalties; it is about a partnership.
Now I have no experience of financial penalties, but talking to
private contractors that we have had in the Trust over time financial
penalties has never been an issue.
292. We have heard today, from UNISON particularly,
that there are a lot of occasions where the contract does not
meet the standard; how do you then, what mechanisms can you use
to bring the standard provided by a contractor up to the one you
want, if you are not prepared to go down to the ultimate penalties?
(Mr Turner) With respect, I have to say, I think that
is about the way you manage and monitor the contract and the way
that you work with the contractor. And our experience, in Bradford,
other than catering, I have to keep saying that, is that we worked
with the contractors well, and when they were below standard,
because we met with them regularly, we had regular monitoring
sessions, it was a partnership, because sometimes it was the Trust
that was causing them not to be able to provide the services.
So I firmly believe it is about partnership and working together
and not about financial penalties.
293. A final question, just to UNISON really.
Based on what we have heard from a Trust there, you were talking
about cleaning services falling, it was 20 out of the 23, I can
understand why that might be proving your argument, and the argument
(may not ?) stack up, but do you accept that there are occasions
when quality has improved by bringing in contractors?
(Mr Weeks) I am sure there are individual examples.
We have to make an overall assessment, and we have documented
evidence of failures in various places, but clearly that is anecdotal,
and equally examples, so what we have decided to do is take the
only nationally agreed survey that has been carried out on one
service, which is cleaning, and that is the evidence that we based
our argument on. We would like a similar approach to be adopted
for catering, portering, security, so then everybody could be
working from the same evidence base. Obviously, we are not going
to say that there are not any places where there is a good service
provided by the private contractors; despite what I said earlier,
we have a good working relationship with a number of private contractors,
up to and including having partnership arrangements with them,
and if they are in place we work to provide a good service, it
is not in anybody's interest to provide a bad service. But we
look at the overall record, and the overall record, in our view,
does not show that the involvement of private sector in delivering
the services has improved them.
294. I would just like Mr Rose to comment on
that, the fact that the private sector, in that survey, in April
2001, did have 20 out of the 23 worst hospitals, and what you
are doing, as an Association, to try to improve that record, because
obviously it is not going to do the private sector any good at
(Mr Rose) That is true. One has to accept that the
survey was a snapshot survey, and there are circumstances beyond
everyone's control, at the time that anything is done like that.
There are hospitals which are going out to PFI, which are on that
list, where clearly there is a massive contract to build a new
hospital alongside an
295. That might be a justification if it was
just a small change, a small difference between the public and
the private, but 20 out of 23 of the worst hospitals being private
sector contractors I do not think can be justified, when, in fact,
they only produce 50 per cent of the contracts, cannot be justified
by being a snapshot on a particular day?
(Mr Rose) No-one is happy with that; we would dispute
some of the findings of the survey, certainly. But it is not in
our interest ever to be there, and it is not in the patient's
interest to be there, but there are circumstances, in many of
these instances, which I do not have to hand, which militate against
doing the job well, and sometimes it is to do with the contract
we are given. If we do not have the correct contract in place
you cannot do the job you want to do.
296. So what are you doing, as an Association,
to try to improve this?
(Mr Rose) It is not my job, as BSA, to tell my members
what to do.
297. It is in your interests to do it though,
is it not?
(Mr Rose) It is in their interest to do it, and it
is up to them to do it. My interest is making sure the policies
work. We are not a trade association, so we do not have that involvement
with member companies. My members do not want to be ever branded
as giving bad services. There is nothing that I need to do to
force them to do it, even to ask them to do it, because that is
not their standard, and, therefore, it is something that they
themselves take on board. Because if they have a dissatisfied
client then they have a bad reputation in an area, if they have
a dissatisfied client they lose the contract, and that is something
they do not wish to do. They have already taken it in hand to
make sure that will not happen.
298. But is the problem that there is no corporate
responsibility for the private sector, and as far as patients
are concerned it takes one press story to see a bad private sector
contractor, there that 20 out of 23 performing badly, and then
any patient who is in an area that is having their cleaning services
provided by a private sector contractor will naturally raise worries
and think what is being done to try to sort that out?
(Mr Rose) I think that is not a real premise. Why
are we asked to come in, by Trusts, to perform services, because
they believe, and they have experience, that we do it better.
We would not be in the market at all if we were providing bad,
second-rate, shoddy services; we are involved because the Trusts
ask us to come in. We do not go knocking on the door saying, "You
must use us and give us a contract," we are approached by
the Trusts as a client to bid for the provision of services; and
if, in the case of Bradford, as a result of that, the service
is taken back in-house, or kept in-house, that is fine, it is
a result of a fair competition. We are dealing here with things
going wrong in individual cases; and the snapshot does not give
a picture of what has led up to that failure in service and what
has been done since to remedy that and bring it up to standard.
299. So there is a real difference then in regulation
there, is there not, because in the NHS there are systems for
trying to make sure you get services consistent across the country
and you raise the services of the lowest standard up to the best,
but you are saying, in the private sector, there is not any equivalent
thing, so that you will have the odd cowboy and there is nobody
outside putting pressure on the cowboy, those patients in that
particular area have to suffer until the next contract gets set
(Mr Rose) You are confusing two issues, with respect.
The private sector, to no greater extent than the NHS, can control
individual sets of work or staff; Trusts do not. You do not have
within the NHS a standard of staff across every Trust, any more
than we have standards of staff across companies, companies take
on board staff, and indeed the staff we are using are, in general,
the majority of them, staff who have transferred from the NHS
into the private sector. We, in working in the NHS, are subject
to exactly the same quality control standards as any other NHS
employee and any other NHS manager; so all 18 of them which are
existing now we have to comply with in the relevant areas. That
is part of the contract, we work with the Trust management, abide
by those standards, and it is the excellent, high level of those
standards which we applaud and have welcomed; that has shown that,
in some cases, at that snapshot period, the services were not
attaining a high standard. So there is no difference between the
way that we do the cleaning or the catering job than were it provided
directly; exactly the same standard applies, and we welcome it
and we work with the Trusts on it.