Comment by Irwin Nash
The Health Service Journal has reported that
“A hospital chief executive (of East Suffolk and North Essex NHS Foundation Trust (ESNEFT)) has apologised after being filmed telling staff his trust had already decided to outsource its facilities management services”.
It is unclear how this apology went down with hundreds of striking NHS staff who want to remain employed by the NHS.
The HSJ could have added that the chief and senior managers had repeated the same assertion many more times. And that the BBC reported on 5 April that:
“ESNEFT chief Nick Hulme said privatisation of the services was the ‘best’ option”.
The BBC report (still available on BBC website) also stated that:
“Mr Hulme wrote to staff to say the trust would move to privatise housekeeping, security and other services related to the hospitals and community services.”
This was not denied at the time; indeed, it was repeated to staff, who understood that the decision had been made and just the details needed sorting. ESNEFT continued to refuse to even consider alternatives.
So, was this all a misunderstanding? If this dispute was due to a misunderstanding, then those who caused it should be held accountable—a half-hearted non-apology is hardly enough.
ESNEFT’s hostile attitude towards these staff, who are vital to the effective performance of our NHS, was shown in a document leaked to the HSJ and reported in August. In it, ESNEFT stated that the in-house staff are too compassionate!
There is no misunderstanding. The Trust – in secret – changed its policy on outsourcing more than 18 months ago and has tried to keep it under wraps.
ESNEFT has not been transparent or open in its decision-making. It did not offer any kind of partnership working—it refused to engage with staff and with UNISON at any stage.
ESNEFT has not collaborated with the local ICB, which gives it no role at all in scrutinising changes that will impact the patient care that it commissions. It is hard to see how The public, staff, and patients’ views and opinions have been sought or heeded.
ESNEFT now claims any decision will be based on a ‘Full Business Case’. However, after receiving a leaked version of the Outline Business Case, UNISON has submitted a response demonstrating that it was biased, marred by ‘optimism bias’ inflating the claimed level of savings, and more widely based on incorrect and incomplete information. It fails to meet the most basic tests for compliance with Treasury guidance. The OBC also confirms suspicions that ESNEFT has made no attempt to find plausible alternatives to outsourcing the services, nor has it obtained any proper independent assurance or brought in any expertise – other than experts in outsourcing.
The Full Business Case has to be based on the Outline, so many of these basic failures can’t be corrected. Perhaps this is why ESNEFT is still refusing to follow the usual procedure and publish their Business Cases, not even to the union reps.
Sources close to the dispute have also told The Lowdown that the Trust will not allow any representations on behalf of the staff involved and will make the final decision in a closed session, as it has done all along.
A search back through Trust Board papers has confirmed that neither tendering nor outsourcing has been discussed in the public sessions. Sources have confirmed to UNISON that ESNEFT made the policy decision in a closed board meeting long ago.
As the Lowdown has pointed out, outsourcing of these services is now against government policy. It would reverse the decision of the Colchester Trust, prior to the merger into ESNEFT, to bring the services back in-house after years of unsatisfactory relations with private contractors. And it makes a nonsense of the merged Trust’s early commitment to “One ESNEFT- One Team Culture” and the current Trust’s promise that
“we will remove or improve the things we do that cause unnecessary stress or frustration for our patients, their families and carers and our staff.”
ESNEFT’s drive to privatise also goes against the very clear trend across the NHS to bring such services back in-house. Indeed, it puts ESNEFT in a small minority of Trusts that are still choosing to rely on outsourced services: according to NHS England guidance, in 2022, just 27% of Estates and Facilities Management staff were outsourced to the private sector.
The consensus, built on many years of proper peer-reviewed research, is that outsourcing these services does not improve patient care and brings risks.
Unions and campaigners are now saying it is time for those who are supposed to be accountable to stop rubber-stamping lame apologies and take steps to halt deeply flawed decision-making.
The Trust should not contemplate outsourcing but should make plans to integrate the remaining outsourced support services into a unified in-house service when the OCS contract expires next spring.
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