Thanks to observant local readers of Lowdown in Protect Our NHS Bath and North East Somerset for drawing our attention to plans by the Bath, Swindon and Wiltshire Hospitals Group to outsource management of its bank staff to a private company, Pulse.
Pulse, as is so often the case with outsourcing contractors, is owned by Acacium, which in turn is owned by (in this case, Canadian) private equity interests seeking profit, whatever the consequences.
The decision to outsource has been taken behind closed doors (Board level) and against the written objections of UNISON and all the hospital Staff Side unions.
The issue has been raised with Bath council’s Health Scrutiny Panel by the UNISON Bath Health Branch secretary Baz Harding-Clark, and by a former RUH Bath Hospital governor Nicola James.
They not only alerted the Scrutiny Panel to the plan, but also presented evidence-based concerns about the way that the procurement process has been managed by the Hospitals Group.
Nicola James quoted from RUH Bath Hospitals trust board papers to show that the policy in September 2023 had been to grow the NHS staff bank as a way to reduce dependence on “high cost agency workers,” and where possible move them into the staff bank.
But this policy has now been abandoned. In fact:
“By March 2026 the Trust had completely reversed that strategy, abolishing the staff bank entirely and handing it to a private equity company. No public explanation. No long term cost modelling. No transparency about what changed.”
Worse still, the case for this U-turn on policy hangs on the hopes of saving millions each year – through reduced spending … on staff pensions. Ms James explained:
“The projected saving of £3.3 to £5.4 million comes entirely from cutting employer pension contributions from 23.7% to 6%. That’s not an efficiency saving. It’s a cost deliberately shifted onto workers to plug a deficit.”
UNISON’s response followed this up by pointing out that staff would be worse off in other ways too, as a result of the privatisation:
“Bank workers are not being transferred. Their NHS bank employment will cease on 1 August without choice. If they want to continue working bank shifts at the same hospitals, the only option will be to register with a private company — Pulse, part of the Acacium Group.
“There is no continuity of service. No NHS terms and conditions. And from that point forward, no ability to continue accruing their NHS pension. For a healthcare assistant working bank shifts for another ten years, the difference between a 23.7% NHS employer pension contribution and around 6% in the private sector represents tens of thousands of pounds in lost retirement income.”
It is likely that at least some of these staff will leave the bank/flexible work option if the outsourcing takes place, which will significantly impact patient care in an already understaffed NHS.
Ms James also emphasised the brutal way the hospital group had ignored the views of UNISON and all of the unions involved:
“The new model goes live 1 August 2026. Once implemented it cannot easily be reversed. Both UNISON and all of Staff Side formally opposed this decision in writing. Their opposition was noted and overridden. A formal letter has been sent to Secretary of State Wes Streeting by UNISON Bath Health Branch describing this as privatisation by stealth. No response has been received.”
The Scrutiny Panel, too, which under the Local Government and Public Involvement in Health Act 2007 has a statutory right to be consulted over substantial variations in local NHS health services before decisions are made, has been blatantly ignored: Ms James stressed the obvious point:
“Removing hundreds of NHS workers from NHS employment across three trusts and outsourcing core workforce provision to a private equity company is exactly such a variation.”
The UNISON statement also pointed out that a majority of the staff affected by this change are from groups who should be protected under the 2010 Equality Act:
“56% of RUH bank workers are from ethnic minority backgrounds, compared to 27% of substantive staff [and] between 64% and 87% of bank workers are female. This indicates a disproportionate impact on protected groups.”
UNISON also shared the Bath, Swindon and Wiltshire Hospitals Group board paper from December, which astonishingly given the actual proposal, claims that it helps: “Developing an engaged workforce; Making our teams diverse and inclusive; Making our services safer; Improving timely access to our services; Improving the experience of those who use our services” … and “Improving health equity.”
Despite the fact that the new provider would slash pension payments and not offer staff NHS terms or conditions, trust chiefs apparently believe both that the change would somehow bring “Significant cost savings: Realisation of substantial financial benefits, including pension and National Insurance savings …” and also increase staff satisfaction, claiming the new system would offer:
“Enhanced engagement: A dynamic and inclusive approach to bank worker engagement, offering flexible opportunities and recognition, to strengthen retention and satisfaction.”
The Board paper also made clear that the procurement process had already begun, and a preferred provider had been selected even before any consultation with the unions. And it explicitly states that the change was to be pushed through without any consultation with the Bank staff themselves:
“The temporary staffing workforce (workers) are not covered by the Organisational Change Policy. While Trade Union representatives will be consulted on the option appraisal for temporary staffing, the workers themselves will not be consulted, and TUPE provisions will not apply.”
Staff who are treated in this shameful way while still NHS employees can expect to be treated with even less consideration by a profit-driven subsidiary of a private equity-owned corporation. As if working for Pulse was not bad enough, the Acacium group’s credit-worthiness has just been downgraded from B- to CCC, and its status from ‘weak’ to ‘vulnerable’ by an S&P report published on May 6.
The S&P report notes that Acacium’s shareholder base includes “financial sponsors Onex Partners (about 79%) and TowerBrook (an investor since 2014 with an approximately 20% stake). Management owns the remainder of the group”:
“The business originated in the U.K. and now delivers health care staffing across the UK, the US, Australia, and Ireland; health care services across the UK and the US; and life sciences staffing and consulting globally.”
However, more than two-thirds of its income (68%) is from the UK, and in 2025 the group generated Global Ratings-adjusted Earnings Before Interest, Taxes, Depreciation, and Amortisation of just £22.6m out of £712m revenue.
S&P warn that the future is far from stable:
“we now assess Acacium’s capital structure as unsustainable due to its very weak credit metrics and limited prospects for meaningful deleveraging.”
The NHS has already been struck a succession of heavy blows by the collapse of Carillion and other private contractors that ministers had mistakenly assumed could prove useful “partners” for trusts or alternative, lower-cost providers.
Labour was elected almost two years ago, promising to “learn the lessons from the collapse of Carillion and bring about the biggest wave of insourcing of public services in a generation.” So far, the drift has been in the opposite direction, with a resurgence in the North West of plans to form “wholly owned subsidiaries” – ignoring NHS England guidance to the contrary.
Now the plans in Bath, Swindon and Wiltshire Hospitals threaten to strip bank staff of their NHS status, terms, conditions and pension rights – and to hand over the job of securing a reliable supply of staff to a private provider whose future seems seriously in doubt.
UNISON’s submission urges the Scrutiny Committee to “Write to the Secretary of State for Health and Social Care [Wes Streeting] to raise these concerns formally, and to “Formally note concerns regarding the adequacy of consultation, particularly in relation to bank workers.”
The clock is ticking towards the August 1 deadline. Mr Streeting needs to take prompt and decisive action to force the BSW trusts in to line, and prevent Labour’s manifesto promises becoming a laughing stock.
Lowdown readers: Have you seen other examples of privatisation that fly in the face of Labour’s declared policy? Let us have any details you can find, and we will help spread the word.
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