By Irwin Nash and John Lister
Hundreds of non-clinical support staff are being forced out of NHS employment by East Suffolk and North Essex NHS Foundation Trust (ESNEFT) by a process that appeared all along to be secretive and dishonest.
Back at the beginning of April last year the main union, UNISON, reacted strongly to a management letter to staff saying that housekeeping, security and other services related to the running of Colchester Hospital were to be privatised: this was following a decision of a private board meeting.
UNISON’s requests to see the business case setting out the argument for privatisation (which other trusts making similar proposals would normally provide) were refused, which appeared from the outset to be a cover for the lack of any coherent or credible case.
Ever since then ESNEFT has refused to provide full information, while still indignantly defending what they have done.
Local campaigners Suffolk Keep Our NHS Public, who sought to challenge the Trust, were advised there was an arguable legal case that ESNEFT’s behaviour – and secrecy – led to a failure in its duties around engagement and consultation. However, the group was unable to raise the high costs of taking ESNEFT to a full Judicial Review.
What is certain is that ESNEFT could have been open, and could have engaged: but it chose not to. But more important, it turns out nobody could make them do it. Despite vigorous challenge, the Integrated Care Board refused point blank to become involved – or, astonishingly, even to read the Trust’s proposals.
What allowed both the Trust and the ICB to get away with this outrageous behaviour was a ludicrous assumption that ‘non-clinical services’ like cleaning and portering were not part of the NHS’s Standard Contract with the Trust, which dealt only with ‘clinical’ services. However it is quite obvious that clinical sercvices can only be delivered if adequate non-clinical support services are in place.
Back in 2011, the then Colchester Trust explicitly recognised this essential link when it decided – running against the tide at that point – to bring these very services back in-house,arguing it was the best way to “gain greater direct control over … estates and facilities services.”
Colchester trust chiefs boasted to other health bosses and the wider public about the many advantages of delivering services in house and briefed local councillors on what a good decision this had turned out to be. In 2012 the Trust’s special projects director and associate director of estates wrote an extensive article for the Health Service Journal, explaining why they jhad ended the outsourced contract, arguing that it:
“gave the trust little control over how services were delivered and how they were aligned to support clinical care. This made it difficult for the trust to achieve added value and efficiency from the contract.”
But in 2024 the merged Trust was unable to offer any coherent rationale for their recent, abrupt change of policy, or why they could nto share the basis for that decision with staff or with the local public.
Denied any answers or any opportunity to challenge the ESNEFT Board, UNISON won strong support for repeated rounds of strike action, warning that outsourcing would threaten jobs as well as the quality of care .
The strikes did not halt the Trust’s drive to outsourcing but they were not in vain: they forced out at least some information, and resulted in a better deal for the staff involved.
There is a hope that now the spotlight has been turned on this case, government promises about ending outsourcing are more likely to be honoured in the future and other jobs can be protected from privatisation.
However the dispute has also exposed so much that is wrong with the NHS.
Claims that the NHS is open and transparent NHS have been exposed as false; transparency only applies when convenient. When a Trust decides to proceed in secrecy nobody enforces any duty upon them. Sky high costs mean using legal action is virtually impossible for activists.
If the local NHS can be this secretive with its staff, it will be just the same with patients, carers and the public. Beware of pointless “consultations”.
Trusts like ESNEFT view “partnership working” as a completely one-sided partnership, in which they call all the shots and staff representatives can be ignored when convenient.
The grand idea of an NHS as one big team, ‘One ESNEFT’, all working together for the best interests of patients is an aspiration for the unions. But right now it’s an empty phrase, especially when non-clinical staff such as cleaners, porters and catering staff are involved.
They are seen as “other” by trusts like ESNEFT, and are treated differently: the NHS already has a two-tier workforce.
ESNEFT also claims that it has a “commercial” role, and so can refuse to release information; and when they refuse nobody in the NHS hierarchy challenges them. Nor indeed will Labour’s health secretary Wes Streeting, despite Labour’s manifesto promises to bring a wave of insourcing, and a direct appeal from UNISON.
And we know that whilst Trusts like ESNEFT are supposedly bound by a “contract” with the local Integrated Care Board, that contract is not enforced: it’s a pointless stack of paper.
Now persistent demands by Suffolk Keep Our NHS Public have secured belated publication of a redacted Full Business Case under the Freedom of Information Act, so we can also now piece together a lot of what ESNEFT wanted to hide away.
It turns out ESNEFT started considering how to approach its ‘soft facilities management’ staff in the summer of 2022, and from the outset did so in secret. In December 2022 the Board in private agreed that bringing all work in house was the best approach. From the very outset they failed to work with the staff, their representatives or other stakeholders
This was not a popular decision in some quarters, and a team of executives had by March 2023 made a new case that was different, although surprisingly they used the same data!
A high-level Strategic Outline Case was approved by the executives, but that case failed to do a proper evaluation of Options. Better possible alternatives to outsourcing – such as for example insourcing – were not evaluated as they should have been.
All the plans were iased from the start.The choice was always portrayed as being between in house and ‘bad’ (as at Colchester) and outsourcing and ‘good’ (as at Ipswich).
Another team were brought in to write an Outline Business Case, which went to a private Board in April 2024. That case was so poor that a leaked copy was actually ridiculed by the Health Service Journal.
Analysis undertaken for UNISON showed numerous basic flaws. The OBC evaluation was laughably weak; making absurd unsubstantiated claims, not least that the ‘Fully Outsourced’ option was the strongest economic option, with a total cost £5m lower than the ‘Do Nothing’ option, and £12m lower than the ‘Fully In-Source’ option.
It also claimed there had been some consultation with staff representatives, but that was a mystery to those representatives.
Nevertheless, that OBC was rubber stamped by the Board, again in secret session. The Chief Executive had already told the staff they were to be outsourced. He also announced to staff that the decision had been made – but in public denied this until the video of him doing so was produced.
ESNEFT still had to complete a Full Business Case. It did so whilst already running the procurement for a new provider.
That FBC turned out to be the best of the documents. It set out honestly that there was no evidence one way or the other to choose between an outsourced and an insourced solution – although it insisted a single model was essential.
It refuted the OBC’s claims, and on several measures the FBC showed the inhouse option to be cheaper. It also showed that any potential savings from outsourcing would be down to creating a new 2-tier workforce, through “the departure of staff currently being paid at NHS employment terms and conditions, replaced by new recruits on commercial employment terms and conditions.” (FBC p41)
The FBC goes on to conclude “There is no expected difference in the outcomes from each of the options in this business case: they are all expected to deliver the same scope of service and achieve the same level of performance. On this basis, there are no discernible differences in the benefits offered by them, certainly not in terms of monetisable benefits.” (FBC p42)
At last, some sensible analysis was produced: but it was far too late to examine what might have been achieved by a collaborative and open process. That would have involved genuine discussions between management and staff delivering the services. ESNEFT had rejected that approach from the outset.
The FBC confirmed UNISON’s view that analysis and objectivity were never the basis for the executive team’s decision to outsource. The decision made in December 2024 to award a contract to Sodexo had nothing to do with better services or lower costs, it came down to management failure.
The executive was apparently collectively convinced that they could not manage an in-house service – they were not up to the job. The only option was to give some other body the job, who would be blamed if anything went wrong.
The root cause all along was poor management – or rather a senior executive team who did not accept these staff were really an integral part of the proper NHS, and so found it hard to manage them. Worse still, because these were marginal staff there was to be no investment in what they did.
Management failures led to the outsourcing. All the rest was garnish and there to fool the foolish. No wonder it was all so secret.
A spokesperson for Suffolk Keep Our NHS Public asked:
“What has been going on inside this Trust that justifies all these secret meetings and that requests for information are repeatedly blocked on grounds of “commercial confidentiality”?
“No doubt there were frank exchanges at the 5th December Board Meeting which may throw light on this damaging and inexplicable decision. Given the Trust’s record, the meeting minutes remain, of course, secret. We challenge the Trust to stand up and be counted – release the minutes so we all know the truth!”
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