Are Private Companies better at providing Healthwatch?

The answer is yes if you are in Lancashire, Greenwich, Lewisham, Harrow and Essex and Southend Councils. They all have contracts with Parkwood Healthcare to provide LINks or in the case of Lancashire County Council – Healthwatch.

In their blogs Paul Cotterill and David Floyd have already questioned whether letting Healthwatch contracts to the private sector is consistent with the requirements of the Health and Social Care Act.

I want to use the Parkwood experience to illustrate some of the issues arising from the increased marketisation of the public and voluntary sectors.

Parkwood Holdings

Parkwood Health Care is part of Parkwood Holdings PLC who are the second largest private sector operator providing management services for local authority sports, recreation, education and cultural services. According to their annual report for 2011 they employ over 5,000 staff (almost 3,000 FTE) and have an annual turnover of £114m.

Parkwood Holdings consists of 4 divisions – Parkwood Leisure (managing local authority leisure services), Glendale (horticulture and estate management), Parkwood Consultancy Services and Parkwood Health Care.

Parkwood Healthcare which had a turnover of £1.9 million in 2011 ‘is a medical services business based on a nursing agency but also includes facilitation work withiin the community based on the LINks programme’.

In 2009 they decided to “refocus on the ‘healthy living’ agenda adopted by the NHS.” (Annual Report 2009 page 14)

In addition to the LINk contracts it runs a nursing agency business – with branches in Central London, Manchester and Bishops Stortford this had a turnover of £1m. It also provided Health Trainer services in Buckinghamshire, Berkshire West and Leicester and South East Essex .

In their 2009 annual report (page 15) Parkwood say:

“Parkwood Healthcare’s role is to act as a host for voluntary organisations to meet and influence service provision. In this respect these contracts have a research and consultancy element. 

Parkwood Healthcare has also submitted bids for obesity management contracts, advocacy programmes and counselling services. Parkwood Healthcare would like to establish a full medical and clinical bias to this market, but must first gain sufficient credibility with a full range of simpler largely non-medical contracts, to penetrate this market.”

I interpret this to mean that initiatives like LINk/Healthwatch are helpful because they allow Parkwood to develop a greater understanding of the market.

Conflict of interest

The Care Quality Commission are not allowed to set up and run health services. However, at a local level it does seem that some commissioners consider it acceptable for the same organisation to run front line services and at the same time to be responsible for scrutinising all local health and care services.

For example Parkwood clearly have ambitions to expand into a range of front line health services and they are also in the business of running LINk/Healthwatch services that scrutinise locally commissioned health services – some of these may be their competitors and others might be provided by Parkwood – in Essex Parkwood already provide both the health trainer service and the LINk.

I am not suggesting that Parkwood have behaved unethically – but I do feel that potential conflicts of interest needs to be addressed in a clear and transparent way – this is primarily the responsibility of commissioners.

I think that there are a number of voluntary organisations that may also be in this position too – providing local services and delivering the LINk – however in most cases they will not have the ability to make such a strong impact across the market place as a large private sector company and they will therefore be less able to use the intelligence and profile they might gain through Healthwatch as a foundation to build other services from.

Holistic Approach

Interestingly the Parkwood model – with its strong leisure services and environment portfolio puts it in a very good place to compete as a public health provider. Parkwood in partnership with Bristol City Councily recently opened the PFI £27m Hengrove Park Leisure Centre which include a Health Living Zone where provides a range of services including screening, smoking cessation and nutrition.

As I noted at the beginning leisure service provision is one of Parkwoods main business areas – they are clearly seeking to build out from here to offer a more inclusive health and wellbeing offer.

Voluntary Sector

LINk services involve volunteers – until now the voluntary and community sector has considered it to be one of its unique selling points. I would like to understand what volunteers working for a LINk/Healthwatch which is run by a private sector company feel about how their contribution is being used to contribute to that companies market position and profits.

Conclusion

Parkwood are clearly a successful and innovative organisation with considerable credibility with a number of local authorities. In addition to this they seem to have a good understanding of the market opportunities that are available to them and a business model that is arguably more in tune with current policy and practice than some public health departments!

What I have tried to show is the implications that the current policy context and the approach of local authority commissioners has for the voluntary sector – particularly with regard to Healthwatch – in summary:

Citizens

• There are occasions when Healthwatch (as with LINks) will need to launch campaigns to challenge commissioners or providers. How can we ensure that such campaigns are not weakened because the organisation providing Healthwatch is also a potential provider in the market affected by the campaign?

Local Commissioners

• I am not convinced local commissioners are sufficiently clear about how to ensure that Healthwatch providers have no potential conflict of interest when it comes to bringing challenge and scrutiny to local health systems. Both with regard to whether a Healthwatch provider is already provider health services and where they may be scrutinising potential rival providers.

Voluntary Sector

• It cannot be assumed that local commissioners understand the added value that key specialist organisations like Councils of Voluntary Service or Citizens Advice Bx bring. They are generally not in the market for broader health and social care contracts but are instead focussed on their core offer around infrastructure support or welfare rights and advocacy.

• Volunteers – I think there are some broad issues for the voluntary sector to consider about the implications of volunteers working for private sector providers.

Scale

• While the quality of each of the LINk websites run by Parkwood and their outputs does vary a bit – it is also clear that they have benefited from some of the strategic and analytical expertise that Parkwood Healthcare can offer. The Voluntary and Community Sector need to learn from this and consider how – collectively and through collaborations – it can respond and compete.

Public Health

• There are clearly lessons to be learned from private sector providers who are seeking to develop a coherent approach to responding to the health and wellbeing challenge – and are also interested in partnerships from other sectors.