Just imagine an NHS hospital whose standards match those of a top-quality hotel, with a welcoming reception area, polished floors, tasteful artwork on the freshly-painted walls, and menus inspired by a Michelin-starred chef.
A public hospital where the doctors and nurses — and even porters and cleaners — are free to decide what’s best for the patients, and to put good ideas into practice without waiting for the orders of some remote, out-of-touch mandarin.
Where the innovative working practices owe more to successful modern companies such as Toyota and Argos than a welfare state system created more than 60 years ago to cater for the needs of a very different Britain.
Hinchingbrooke Hospital in Huntingdon is run at a profit by its staff, with from left, surgeon Andriy Solodkyy, Debbie Stewart, head of nursing, Dr Mirza and surgeon Ben Miller
In a week when the failings of the NHS have again been laid bare, with hospital trusts begging for bail-out loans to pay for vital equipment, and discharging thousands of elderly patients during the small hours to ease the pressure on wards, it sounds like a pipe-dream.
Unlikely as it might seem, however, last week I visited just such a hospital.
For someone like me, who grew up during the halcyon days of social healthcare in the Fifties and Sixties and has lived through its decline with mounting despair, my day at Hinchingbrooke Hospital, in Huntingdon, Cambridgeshire, was enormously uplifting.
And it was all the more remarkable because, barely three years ago, a health minister wrote off this same hospital as ‘a financial and clinical basket-case’, and placard-waving trade unionists were camped at the gates in protest against its seemingly certain closure.
Opened with great expectations in 1983 as one of the new wave of small, consultant-only hospitals, for a brief few years Hinchingbrooke had performed well enough.
But by the mid-90s, the quality of its service had faded along with its cheap, breezeblock façade.
John Major, the then-Prime Minister, was embarrassed by an acute bed shortage at the hospital just as he was proclaiming the NHS ‘safe in his hands’.
The hospital made headlines again soon after, when a supposedly dead woman came back to life in its mortuary; but as time marched on, and the Tories gave way to Labour, Hinchingbrooke itself seemed beyond miraculous revivals.
The Hinchingbrooke Hospital opened in 1983 as a small consultant only hospital, but by the mid 1990s it had started to fail
A few years ago, standards in some departments were among the worst in the country. In A&E, patients languished for ages in a dank, garishly-painted waiting room, and treatment, when it came, was so haphazard that one toddler was sent home with an undetected broken leg.
The colorectal unit was worse still. During one botched operation, a surgical instrument was stitched inside a woman patient.
Entering the unit now, it is hard to believe its grim recent history. The first thing that struck me was the cheerfulness of the nurses. Then, written on brightly-coloured stars pinned to the noticeboard, I read the patients’ own glowing tributes, copied from the feedback forms they must now receive before discharge.
‘So much care and attention . . . environment light, clean and airy . . . food is brilliant . . . fantastic! Everybody was great.’
The transformation was summed up by staff-nurse Leighann Shoebridge, who has worked at Hinchingbrooke for 14 years. ‘It wasn’t very nice coming to work, to be honest,’ she says, recalling the hospital’s darkest days. ‘We faced staff shortages every day, and there was no back-up if we needed help.
‘Patients’ bells weren’t answered; medication records were poor.
‘I feel so much happier now — this is a totally different place today.’
And while ward matron Joanne Dixon admits the unit’s problems ‘aren’t completely resolved’,
71-year-old Gillian Peacock, due to be discharged that day after recovering from an infection, told me she would gladly stay longer.
So how has this spectacular turnaround happened? How has one hospital managed to shake off its ‘basket-case’ tag and flourish, while dozens more are failing to cope?
What has happened at Hinchingbrooke only serves to confirm the inefficiency of the National Health Service’s hidebound bureaucrats, with their sclerotic systems and outdated ideology.
In truth, its fortunes have been reversed by the entrepreneurial vision and energy of Circle Partnership — the private equity health company handed a ten-year, £1 billion contract to run it as a franchise under the NHS ‘brand’.Mortality levels, waiting lists and treatment times are down; patient and staff satisfaction levels up.
Last week, the 235-bed hospital’s achievement was recognised when it was voted the best in the country for quality of care.
Phil Martin, 61, is one of the patients treated at Hinchingbrooke Hospital, Cambridgeshire which has a Michelin star trained chef on its books
Visitors are greeted by landscaped grounds, facades of terracotta and smoked glass, and Scandinavian-style pinewood. A new critical care unit is on the way.
That Circle has come this far in just 27 months makes it all the more commendable. And it has done so while reducing its capital debts, and turning a £10million-a-year deficit into a predicted £2million profit this year — a figure expected to soar to £60 million by the end of their tenure.
Given that the NHS is expected to face a £30 billion shortfall by 2020, we might even think it is little short of miraculous.
When I asked Steve Melton, the company’s CEO, how it was done, the word most frequently on this 52-year-old former Argos, Faberge and Unilever executive’s lips was ‘empowerment’.
It was, he said, all about stripping away layer upon layer of management and red-tape that strangulates other NHS hospitals, and handing power back to the people who really understand the needs of the infirm: the frontline staff.
The average hospital trust is governed by a board of ten to 15 members, perhaps two of whom will be doctors or nurses — and often not practising. Between them and the clinical director are multiple tiers of middle-management through which front-line concerns and ideas permeate painfully slowly, if at all.
By contrast, 11 of the 15-strong board at Hinchingbrooke Hospital are practising clinicians, and there are no clipboard-wielding bureaucrats.
In early 2012, when Circle — a John Lewis-style partnership of stakeholder workers and private investors — took the reins, it invited the 1,700 workforce to a half-day meeting and asked them to map out the hospital’s future.
Some 500 were too apathetic or sceptical about the company’s motives to attend. The majority showed up, however, and their goals, set out in a booklet handed to each staff member (or ‘partner’ as Circle prefers to describe them) now underpin the hospital’s ethos.
The hospital was taken over in 2012 by Circle – a John Lewis style partnership – has improved patient satisfaction ratings as well as medical outcomes
They include taking a pride in their work, striving to be the best, making the hospital safer and healthier, forging closer ties with the community they serve, and the ‘six Cs’: care, compassion, competence, communication, courage and commitment.
The manifesto also makes it the duty of every employee to call a halt to any procedure immediately and raise the alarm if he notices something awry.
Devised by Toyota workers to prevent faulty cars from leaving the production line, this measure, known as ‘stop the line’, has already prevented a repeat of the surgical instrument fiasco.
As a patient was about to be stitched, a theatre nurse spotted that a swab was missing and stopped the operation — an act that would have incurred the consultant’s wrath under the old regime. It was duly found inside the open wound.
Other buzz-phrases have become the norm among Hinchingbrooke’s evangelical staff. When someone wants to rectify some problem, or improve efficiency, they might ‘swarm’ it by brainstorming with colleagues, or call an impromptu group ‘huddle’.
If all this creates a rather cultish ambience, it is plainly working. In the well-equipped maternity unit, the standard induction drug, prostaglandin, costing £27.95 per dose, is seldom used these days.
Instead, women are offered reflexology, aromatherapy and acupressure to speed up difficult labours — a gentler New Age method devised by one of the midwives.
In orthopaedics, I met Mr Arpit Patel, who came to Hinchingbrooke as a junior doctor in 1997, and now doubles as a consultant surgeon and hospital board member.
Before Circle, he said, the hospital was riven with divisions: ‘We thought the managers were all useless, and they thought we doctors weren’t working hard enough.’
At first, he was among the sceptics where Circle was concerned. But he decided to try the business-style methods the company was proposing.
By listening to his own staff and adopting their simple suggestions to get patients on and off the operating table quicker, he can now perform four operations a day, not three, and sometimes hits six.
‘What people don’t realise is that if I do three knees, the hospital makes about £800; but if I do just one more, that increases to £3,000, and if I do five we make £6,000 or £7,000. That is because staff costs stay the same and my operating time doesn’t change.
‘The whole staff feel they can really do things now. The NHS could learn tremendously from Circle’s approach to management.’
The mood was similarly buoyant in A&E, where staff have opted to wear theatre ‘scrubs’ rather than nursing uniforms, and name-tags so patients can identify them.
The hospital has undergone a dramatic refurbishment with landscaped grounds and a bright Scandinavian pine interior
They also use a colour-coded computer system (similar to that used to keep the tills working at Argos) to flag up outpatients who are waiting too long.
In the kitchen, head-chef Lisa Normanton, 46, cooks fresh, locally-sourced food instead of standard-issue frozen supplies, and takes inspiration from the company’s Michelin-starred head chef Andreas Wingert.
The restaurant-standard meals not only make patients happier. As ever with Circle, there is a financial benefit, too. Though they are more expensive — £10 a day as opposed to £7 — well-nourished patients tend to recover quicker and go home sooner.
Politicians on all sides are surprisingly reluctant to claim credit for Hitchingbrooke’s success. In a risible volte-face, Shadow Health Secretary Andy Burnham, who sanctioned the franchise during the last Labour government, now criticises it.
Why? Because the very idea that public services might operate more efficiently under private stewardship is anathema to Ed Miliband.
As for the Tories, who rubber-stamped the deal, they are under orders from their Australian election strategist, Lynton Crosby, to avoid at all costs the sensitive NHS debate and concentrate on the economy.
Were David Cameron to take a bold step and champion the wide-scale franchising of our failing hospitals, however, it could be a gamble worth taking — revitalising, and perhaps even saving, the National Health Service.