Care UK chief urges swift ISTC take-up

Care UK chief executive Mike Parish is definitely feeling optimistic about the future growth of his company and its plans to work with the NHS, and he has good reason to be.

Fresh from signing off the market-boosting buy-out of rival private sector provider Mercury Health, he has secured a deal which means his company has acquired five independent sector treatment centres across the South of England, a GP practice for City and Hackney primary care trust, and a contract with the Department of Health to provide diagnostics across the West Midlands.

Care UK is growing rapidly and now has a significant share of the independent sector market providing services to NHS patients. Alongside its latest, the company has four existing ISTCs, walk-in centres in Victoria station and Newcastle, and a GP practice in Barking and Dagenham, Essex. And if Mr Parish has his way the expansion is set to continue.

'When developing Care UK's strategy we are always looking at the five, 10 and 20-year time horizon. In some ways we are privileged to be able to do that because we are a plc, but it is important to take a long view' and this is where Care UK's strategy is paying dividends.

Rather than trying to expand by providing commissioning and provider services to the NHS - the model being adopted by some of the company's private sector rivals - Care UK is clear that it only wants to provide health services. The company's historical and profitable base in social care allows them to concentrate on building up their NHS and healthcare model. 'We understand the NHS and the government's strategy to introduce a mix and plurality of services and transfer care out of hospital and we want to create services that respond to that,' says Mr Parish.

He feels the NHS can learn a lot from the Care UK approach. 'We know how to work in a public and private market. This experience is something we have always had from a social care background; we have the right mindset to approach this for the NHS and we can help'.

Direct approach

One thing Mr Parish is keen to do is speak directly with patients. 'There are strict rules around marketing to the public in terms of the rules of engagement and there should be, but we have found that patient information packs - which go to patients who come to our ISTCs - are working really well.'

Mr Parish says that 'effective marketing to patients' is only just starting. And with the ISTCs that are up and running, this is increasingly through word of mouth about positive experiences. But he is keen to see GPs engaged with more often, and hopes private providers will be allowed to work with them directly to improve awareness of the services on offer.

One thing Mr Parish is clear about is the need for the NHS and private sector to be allowed to publish outcomes. 'It's one of these cases where we must not let perfection get in the way of progress; we have got to drive the publication of outcomes.'

He says one way the private sector could capitalise on publishing outcome data would be to publish their MRSA and other healthcare-acquired infection rates - which are historically low because ISTCs routinely screened patients before they are operated on.

However, he is aware that politically this might not be very expedient and does not want to go against the government's stated approach. 'There is a huge precautionary mindset that unless the data is perfect we are not going to publish, 'he says. 'I think this needs to change so that we do as much as we can and then publish - the public can receive imperfect data and make use of it.'

So is he confident that Care UK's plans to work with the NHS will continue when the centrally procured ISTC contracts end over the next four years?

'I have a high level of confidence and there is no question that demand will not continue to be very strong because of both the patient feedback we are getting and the way the reputation of ISTCs is spreading.'

Mr Parish highlights the work of two of the company's ISTCs, Balborough in Lincolnshire and Plymouth, as its spearhead centres.

'They are the longest running and we have a fully employed workforce there, they are our show centres,' he says.

He admits that in some of the other ISTC areas, relationships with PCTs is 'variable', but he is confident there are 'opportunities' across the patches to become 'entrenched' in the local health economies.

Another area of expansion for Care UK is in walk-in health centres, where they have bases at stations in London and Newcastle, and in running GP surgeries, where Care UK are managing practices on behalf of City and Hackney and Barking and Dagenham PCTs.

Against the tide

He also points to Portsmouth ISTC as a model for one type of future provider model. 'Portsmouth is a walk-in diagnostic and day centre; it is a blueprint for what primary care should look like.'

He says that what Care UK is keen to create are 'entry points' in the market to help provide services for NHS patients. 'There should be no monopoly on creativity, the more of us there are the better solutions there will be, on top of what the market currently provides.'

Mr Parish adds that Care UK also want to diversify to set up and run day clinics for minor operations as well as move into sexual and mental health service provision.

However, he is critical of the current primary care models of provision. 'There are some solutions that are first-class but generally the current solutions serve the public very poorly. The more the public is demanding convenience and is time driven, the more restricted primary care becomes. It seems to be going against the tide.'

And he warns that the number of hospital referrals for minor procedures is far too high and that the 'general hospital is an overused solution'.

Mr Parish is not afraid to speak his mind, and has a few words of friendly advice for the government. 'A cautionary note to government and the NHS is that if they miss the boat for too long the transition from a central to local system won't take route.'

He refers to the current lack of take-up of the government's wave-two ISTC programme, which many in the private sector now believe will not reach the DoH's£550m target yearly spend.

'I am not too worried if the target£550m only comes to£350m [a year] because it shows that central procurement is no longer fitting the devolved NHS which needs local solutions. We are now seeing difficulties in connecting central procurement to local demands'.

What Mr Parish is worried about, however, is the speed at which that local ownership is taking route and he sees it as a risk for the continued plurality of providers in the market. 'The NHS is used to working in a public sector environment with public sector providers and it will naturally revert back to that approach if the momentum does not continue. To ensure a mixed economy a fundamental change needs to happen.'

Negative lessons

He is also keen that the NHS learns from the mistakes of the social care market in creating a plurality of provision. 'Social care has done well at using a mixed economic market but there is not a lot of innovation in the services. The relation between commissioners and providers has been transactional and controlling. The NHS needs to learn that negative lesson from social services.'

He says that the NHS also needs to be careful about the controls and expectations they place on a mixed-provider economy. 'Whether they are necessary or not, they stifle creativity and imagination; the NHS needs to avoid replicating the same bureaucracy as social care.'

And innovation is certainly something Care UK is eager to get its teeth into. Asked whether the company would be interested in forming partnerships with foundation trusts, Mr Parish says he is open to any new type of partnership.

'It is a complex market and we already work in different partnerships and alliances, but we are keen to build more and there is no reason why we can't do that with foundation trusts as well.'

Ultimately he wants the healthcare market to open up enough to see new solutions to the provision of services, and he regards any attempt to stifle such innovation as 'Luddite'.