‘The thought that some A&E work could be done by a private company fills me with despair’ – York Hospital staff speak out
Doctors, nurses and other health staff have passionately attacked plans for a private company to undertake work in the York Hospital A&E department.
Staff have spoken of their anger and anguish at the proposal for Vocare Ltd to become integrated into the Accident & Emergency Department.
“The thought that some of the work currently done by my department could soon be done under the auspices of a private, for-profit organisation like Vocare actually makes me despair,” one A&E doctor told YorkMix.
A senior nurse from the unit told us that they “fundamentally oppose a private company getting involved” and it would lead to “a game of clinical tennis”.
York Teaching Hospital NHS Foundation Trust bosses say the move is just a further integration of work that Vocare has done at the hospital for several years – you can read their full statement below.
But it is clear that many A&E staff agree with York’s Labour MP Rachael Maskell, who called it “privatisation via the front door”.
A petition against the plan has now got more than 8,400 signatures.
‘Putting profit ahead of health’
Although they can’t come out into the open for fear of losing their jobs, two members of the A&E team asked YorkMix to publish their feelings about what is happening.
We have agreed to their request to remain anonymous so their important contributions to the debate can be heard.
The A&E doctor
“I’ve been working in accident and emergency medicine for many years and what I really love about A&E is the unswerving loyalty, humour and camaraderie of our staff and the amazing variety of patients and the illnesses and injuries they turn up with.
“For me, A&E is the epitome of what the NHS is all about.
“A department whose lights are always on where there will always be someone able to give care to people often in their darkest hour; where patients are treated based on their clinical need regardless of who they are.
“Many people like me went into A&E medicine precisely because there is no private work – we work for the NHS with great pride.
“The thought that some of the work currently done by my department could soon be done under the auspices of a private, for profit organisation like Vocare actually makes me despair.
“I want all NHS work to be publicly funded, publicly provided and publicly accountable. I am particularly concerned about staff employed by Vocare working to stream (direct) patients away from the A&E department.
“Access to the A&E department should never be controlled by another organisation.
“It is a fundamental tenet of the NHS that patients should be able to walk into their local A&E department.
“I’m also concerned about Vocare having control of our minor injury work.
“Patients who have suffered a so-called minor injury will know that the emergency nurse practitioners who work in the A&E department are experts in their field and treat these conditions very well already.
“Like me, these workers need to stay wholly employed by the NHS but I fear that in the future they, or those who come after them will end up on Vocare contracts instead.
“The pandemic has highlighted issues of putting profit ahead of health; from the shoddy contracts around the supply of PPE, to the test and trace system provided by the likes of Serco that has never been fit for purpose.
“That’s why it is important to act now to try to stop this further expansion of private for profit companies within your A&E department.”
‘Profits should not be anywhere near the NHS’
The A&E nurse
“I have worked at York A&E for a long time. I am an emergency nurse practitioner managing patients with minor injuries.
“My years of service have given me huge experience and knowledge, working alongside senior clinical colleagues, in the management of those patients.
“I believe this service will slowly be dissolved should a third party be involved.
“I appreciate the Government’s ongoing plan for urgent treatment centres to provide different streams of care to reduced workloads on emergency departments, but there should be no reason why this service cannot be solely managed by the trust.
“I fundamentally oppose a private company getting involved.
“Profits for shareholders should not be anywhere near NHS health provision, in my opinion.
“Some members of the public may feel a more efficient service will be provided. Efficiency comes with a cost.
“Reduced levels in training, reducing experienced workforce meaning difficult complex time consuming cases being handed back to A&E.
“A game of clinical tennis, if you like.
“This may not initially be the case, but over time as experienced staff leave, it will be.”
Another staff member said: “Treatment for minor injuries is already provided very well by the trust. Introducing Vocare and the Adastra computer system will actually cause more problem, delays and hamper working by the emergency nurse practitioners as they have to swap between two systems.
“Neither system is fit for purpose.
“For example Adastra (Vocare) is unable to request X-ray or bloods and doesn’t link in with the hospital fracture clinic.
“The hospital computer system does all of the above but cannot book appointments via 111.
“In turn this will mean practitioners and reception staff using two systems, increasing time spent on mundane tasks, ultimately increasing the length of time patients wait, increasing danger as notes will not be available for wards or clinics to see or to provide information for safeguarding of children and vulnerable adults.
“Therefore bringing in a private company is increasing workload and a dangerous practice which makes no sense. There is actually no benefit – apart from they can book an appointment!”
‘It’s about helping patients’
Dr James Taylor, medical director for York Teaching Hospital NHS Foundation Trust, says urgent treatment centres (UTCs) provide treatment for non-emergency patients, avoiding the need for them to wait in emergency departments when they don’t need to be there.
“This also helps emergency departments to focus on the patients that need more urgent help.
“Vocare is already commissioned by NHS Vale of York CCG to provide the current minor illness service and GP out of hours service, both of which are located in York Hospital alongside the emergency department, which has been the case for several years. The trust provides the minor injury element of the service.
“As NHS guidance on UTCs has evolved over time, there is now a requirement for a more integrated approach to minor illness and minor injury, and to support the ability for patients to be directly booked in to appointments via NHS 111.
“As the two current providers, the trust and Vocare, have agreed to continue to work together to ensure that York has a fully compliant UTC that best meets our patients’ needs.
“UTCs are seen as one of the ways of reducing overcrowding in emergency departments, ensuring that our emergency department staff are available to see the patients with the most urgent need, and that patients are seen in the right place by the right clinical staff.
“We know that staff have raised concerns that there may be plans for their employment to be transferred to Vocare.
“There are no plans to do this. As is the case now, staff employed by the trust will continue to work jointly with Vocare staff to deliver the service, and we are working with Vocare to establish joint governance arrangements.
“The streaming of patients on arrival into the emergency department will continue to be managed by the trust’s clinical staff.
“As well as the existing relationship with York Hospital’s emergency department, Vocare also runs the UTCs at Scarborough Hospital and Malton Hospital, as well as a number of other services on behalf of the NHS.”