This month saw an interesting test of the world of Public Service Mutuals, as Circle Health announced its withdrawal from the contract to manage mid-sized hospital Hinchingbrooke.
I must confess, I was quite disappointed, especially as the experiment had reported rather impressive results not that long ago, and some of my friends who work at Hinchingbrooke had been quite positive. But the world of health is complex, and before you know it the tables have turned and the thing goes pear-shaped.
So, what can we learn from this case?
Firstly, we should try to be protective of brand Mutual. I wondered whether commentators would be able to review the - by definition complex - case in a balanced manner. And I now know the answer, thanks to Lord Owen’s article in the Guardian ‘Lesson one from the Hinchingbrooke hospital scandal: beware the ‘mutual’, in which he tarred the whole Mutual sector with the Circle brush.
So, when organisations conveniently call themselves a Mutual or even Social Enterprise when this requires a bit of a stretch of the imagination (or definition) perhaps we - as a sector - should become a bit more vocal early on. Perhaps we were secretly quite curious to see whether Circle’s combination of employee ownership (just over 49%) and high finance (the rest) would work and allow them to prove a big point to the rest of the NHS. But now we’re finding ourselves having to defend our choices and our beliefs.
We can’t expect commentators - let alone the general public - to see all the nuances in cases like this. So we’ve got to make sure we’re not exposed in a similar way in the future.
Secondly, even if Circle/Hinchingbrooke had been a 100% pure bred Mutual, one should be careful to infer general lessons from a single case. Just as it isn’t right to generalise about the NHS - good and bad examples abound, as the Mid Staffordshire scandal showed; and various other trusts in Special Measures - nor is it right to conclude that because of the failure of one partly-mutualised organisation the mutual model has no role in the NHS.
After all, we know better than that. Between 2009 and 2014, 42 new mutuals were formed from parts of the NHS. Most have now been in business for over three years and their results are impressive. Patient feedback is consistently positive and well above the NHS average. CQC ratings are generally good to outstanding, and the Friends and Family Tests have been passed with flying colours. And Mutuals achieve this whilst generating efficiencies and consistently innovating the services they provide.
Finally, although the message might just have become a little bit harder to get across, this is not the time to fly the white flag. The DH and Cabinet Office have just invested £1m into its ‘Mutuals in Health Pathfinders’ programme, in which under the guidance of Kings Fund nine NHS trusts are exploring how they can apply the positive lessons from Mutuals to their situation.
We have an important role to play in demonstrating what makes Mutuals generally so successful. For the rest all we can do is to continue the hard work and let outstanding patient outcomes do the talking. That single clear message will ultimately come through.Back to stepping out now