The whistleblowers who have revealed serious deficiencies in an out-of-hours GP service run by a large private health company which is believed to be putting patient care at risk have performed an important public service. This concerns the contract in Cornwall run by Serco, a private operator which provides services for government in defence, prisons, and education, but is now trying to break into health as well, with its prospects of lucrative future contracts.
Whilst this initial evidence is confined to Cornwall and only covers a small part of the health service, it is likely that the failures and weaknesses exposed here will be replicated elsewhere in the country under Lansley’s Act and will apply across the wder ambit of the health service too. The complaints based on unannounced inspections by the Care Quality Commission reveal deeply worrying flaws.
- One of the most serious charges being investigated by the CQC is that Serco altered log tracking response times and targets. Computer logs which have been examined show that some of the ‘red’ failed targets have been removed and replaced by ‘green’ achieved targets.
- Shortage of medical manpower has raised disturbing questions about patient safety because the number of unfilled shifts is unacceptably high. Senior clinicians in Cornwall have written to Serco saying “we are surprised and relieved there has not been a critical event or patient death resulting from the extremely low levels of cover” and chronic under-staffing.
- The assessment of the urgency of patient need, which was previously made by expert clinicians, has been replaced by call handlers using a series of computer-generated questions and checks.
- The regional RCN officer has stated that nurses have reported that “waiting hours have been extended by several hours and the current reporting system manipulated so that it does not reflect accurate activity or the time of visits or call-back times”.
- Staff shortages have led to up to 90 patients queueing at a time on the telephone helpline as well as visiting doctors being taken off roving duties in order to operate clinics and hotlines because there were too few staff to cover the county.
These first revelations of how a Lansley privatised health service actually works are not only worrying in themselves, but more importantly raise wider questions too. Such issues include:
- How far can complex medical priorities be reduced to legal clauses in a contract (since Serco claims it is sticking to the strict letter of legal contracts as opposed to meeting medical need as and when it arises)?
- Do public sector bodies have the negotiating and auditing expertise to supervise manipulative companies like Serco?
- How can private companies run health services more cheaply than a public NHS without cutting staff wages and/or terms and conditions or slimming down cover to the point where patient safety is at risk?
- What accountability is there of a privately run service when the CQC range of responsibilities is so enormous and their staffing has been drastically cut back?