Danny Boyle’s celebration of NHS nurses brought mixed feelings for some, who feel that the NHS should not be adored on purely nostalgic grounds, citing recent examples of theirs where NHS care has not been a positive experience. The fact that the UK is having a debate about its healthcare can only be taken as a sign that it is an aspect of UK life that most people care about. The reality is that the NHS Act has, for the time-being, come into law, and, with no certainty that it will be repealed, or that the current progress in implementing it will not be arrested, it is timely to consider news of Hinchingbrooke Hospital announced today.

In change management, change managers typically look for any positive ‘symbols’ that the change is having success. It is hoped that this will justify the change amongst participants, and may boost morale. Hinchingbrooke Hospital today reported  big improvements, reflected by high patient approval ratings, and its accident and emergency department becoming the “top performing full service trust among all hospitals in the Midlands and East of England region”. This is indeed very positive for a change in one failing NHS Trust, which had previously been underperforming. The problem in making this case nationally is that satisfaction ratings of the NHS had been at an all-time high, prior to the change which no party, as such, felt that they had directly voted for.

Any strategic change must be accompanied by stakeholder support, otherwise it will fail. The NHS change management is complicated as you are changing existing organisational structures, with many of the existing staff in place. The scope for resentment amongst the workforce amongst key stakeholders, for example UNISON, is enormous unless management seeks out the views of those stakeholders, and is seen to act on their recommendations. The culture in the NHS is well established, and therefore there could still be genuine resistance to change for the change nationally. There is not the sense of urgency nationally that there was with Hinchingbrooke.

Circle chief executive Ali Parsa said the company had saved £1.6m by ordering the hospital’s paper supplies differently, and they had introduced the same management style used at their private hospitals. The obvious issue here is that there does not need to be a volte face in the change of strategy of the NHS, as theoretically the operational efficiencies could and should be implemented in other NHS Trusts. The success of any NHS Trust legally will be the s.172 imperative of the Companies Act (2006) maximising shareholder dividend.

The public will not measure the profitability of a Trust as a yardstick of a NHS Trust, although they will judge a Trust nearing corporate insolvency as ‘failing’. Whilst it is easy for managers to measure waiting lists, or infection rates following surgery, the greater difficulty comes from measuring ‘health outcomes’. This is where the cardinal problem of running a health service in a piecemeal basis comes in – unless the service is national, you cannot have an overall view of the health service, because you are comparing like-with-like. The number of bed days following a hip operation is, not for example, a comparable measure to improvements in well-being of an individual with dementia. Clinicians often spend a lifetime developing their sense of what a good ‘clinical outcome’ is, and a private healthcare Trust management team can simply pick-and-choose whatever metrics it wishes to measure ‘success’ from a patient’s perspective. A scrupulous New Model Manager might argue that depression often is hidden, but it does not need to be measured, and it probably won’t be: not all managers are scrupulous though in a mercenary sense other than is required to secure a genuine competitive advantage.

There has been nothing in this debate to convince me there is a national regulatory body of quality in clinical outcome in the new NHS yet. Any improvement is to be welcomed, but whilst the purpose of the private limited company is to maximise shareholder dividend, it may be unnecessary to feel that the solution is fundamentally a need for more private hospitals, if the fundamental failing has been in operational inefficiencies of existing units. However, it does seem prima facie that the way in which Circle plc has been running is an useful model for others to emulate.