I am sitting in my front garden at 5am feeling slightly shell-shocked, wondering what has just happened - and wondering if I am still a doctor.
What a strange opening to a blog. To put my dawn chorus into context, I thought it would be useful to share with you the effects which the Health and Social Care Act are having on our NHS, and how privatisation is taking doctors and nurses away from frontline care, turning valued colleagues into the competition, and potentially jeopardising the fantastic services that we have spent years trying to build.
I've not seen a patient in three months! I normally do five clinics a week, and I think I do a pretty good job. In fact, I'm told my patients are missing me. That is comforting. But the reason that I have been away from my post for a quarter of the year is that I have been part of a tender team which is desperately trying to keep our sexual health and HIV service from being sold off and pulled apart.
We are one nurse consultant and two consultants, plus a dedicated NHS manager and a commercial contractor. These five people are the core of our Trust's bid team. In addition, countless others have given valuable time to try and support our tender. Those of my colleagues who are covering my clinics are also suffering, doubling up without complaint because they know that what we are trying to do aims ultimately to protect our entire service.
It all started in April 2013, when the NHS reorganisation, and the Health and Social Care Act, really put a knife in the back of our specialty. I'm a sexual health doctor and an HIV specialist. And what has happened to my clinical specialism? HIV care is now commissioned by NHS England. Unfortunately the money for sexual health and contraception has meanwhile been given to the city council. Half my team is now paid by one arm of the NHS, and the other half is paid by the local authority (which has financial difficulties of its own).
This means that an integrated, collaborative system that has developed over many years has seen physicians skilled in both sexual health and HIV suddenly finding themselves pushed into a new, possibly private, organisation because they spend more than fifty per cent of their time in sexual health. What is left behind for the HIV service itself? Possibly very little: the private companies don't want to be concerned with the HIV service ... and yet will happily take the lion's share of its staff once it wins a sexual health contract.
So what happens to the one HIV consultant and one nurse left behind, deemed necessary to look after the patients who have previously enjoyed a much fuller service? Funnily enough, they soon find the new system is not viable. It's not long, either, before the Trust realises it has lost 80% of the workforce that once looked after its HIV patients to an external contractor uninterested in HIV; and that unless it supports the remaining staff to deliver a service that was delivered seamlessly before, they will have to put the HIV out to tender, too. It is madness.
So let me take you back to 11.54pm one month ago. The five people described above are staring at a computer screen, looking grey, tired and washed-out; drained, exhausted, and waiting to press a button to send a document the size of my PhD thesis to the city council. They are waiting for the council's consideration, to see whether they might be good enough to deliver a service they have trained all their lives to provide. The reason that they are doing it at all, of course, is that they truly and deeply care about a service they have spent years putting everything into: they care about patients, they care about the NHS, and they don't want to see their service asset-stripped and cherry-picked, colleagues made redundant and patient care suffering.
The spectre of the fact that our clinical service was going to be tendered out has been around our neck for the last eighteen months. I have lost count of the number of meetings I have had to go to, sitting in a room with countless other people that really should be at work seeing patients, having to act like businesspeople considering the margins on a particular project, and making decisions: to bid or not to bid, and how much money could we loose? It beggars belief.
I'm sure - in fact I know - that in other hospitals in our region there will be a team of equally dedicated people not wanting to lose their jobs or see the services that are just as good as ours dismantled. Whoever wins or loses, the next nine months are going to be just as bad. Staff are going to lose their jobs because the bids that we have had to put in to make ourselves financially competitive means that we will have to lose nurses, outreach workers, and doctors. For the last nine months, we haven't been replacing staff because of "The Tender". We don't know where we're going to be, we don't want to invest in staff at such an uncertain time and especially when we have to keep our costs 'competitive'. The impact is the knock-on effect on staff morale, and an increase in sickness because we are all over-worked.
The public need to know that our NHS is being privatised, not through the back door, but very blatantly through the front. There may as well be very large advertising placards directed at potential providers, promising in twelve-foot type: "If you can do it cheaper - it's yours." What about quality? Quality, I'm afraid, is worth only 40% of the total value of the bid. There is something very wrong when the specification for a clinical service is skewed in this direction. It's not why I became a doctor, and it's not why my nursing colleagues became nurses.
Why are we having to compete against an army of experienced bid-writers who work on the assumption that maybe one in five of their tenders are successful, and for a company which can invest up to two million pounds into any given 'tender' to secure a win? Of course, in truth they are not just working on another 'tender': they are playing with crucially important NHS services that deal with some of the most stigmatised, marginalised people in our country. But this is the situation in which we all now find ourselves.
Who will protest, and how? How many people are going to stand up and say, "Yes: I've had a sexual health problem, and I was treated with courtesy, respect and compassion in an NHS service which I do not wish to see destroyed"? I suppose not many. A certain circumspection comes with the territory of the speciality we're in. But I know that our patients truly appreciate the dedication and care that we give them, and I want very much to be able to continue to provide it. The fact that I may not be able to is saddening.
I've seen the effects that privatisation can have in other areas of the country - in Milton Keynes, Trafford, Teeside and Leicester. I also know that other colleagues all over the country are currently going through the same nightmare. In fact, it is likely that all of our NHS sexual health services will be put out to tender in the next few years. It is really rather desperate.
After we submitted that bid just before midnight one month ago, we spent four more weeks in what can only be described as purgatory: locked in a room, staring at spreadsheets and wondering whether the hospital could afford to keep us and make the second, 'best and final' bid low enough to give us a chance of winning. That process, too, is now finally over. In two months we will learn who our new employers will be.
I'll let you know how it goes. In the meantime, I am looking forward to being a doctor again.