Case studies of successful private sector involvement in education, health, policing and prisons

It can be done

May 2011

It can be done

ContentsExecutive summary 2

1. For-profit universal healthcare in Valencia, Spain 4

2. For-profit universal healthcare in Germany 7

3. For-profit company leads the way on prisoner rehabilitation at HMP Doncaster 9

4. For-profit company provides effective police custody in South Wales 13

5. For-profit company helps to transform education in Islington 16

6. For-profit company helps to improve schools in Northhampton 18

Reform45 Great Peter StreetLondonSW1P 3LT

T 020 7799 6699info@reform.co.ukwww.reform.co.uk

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Reform comment

Andrew Haldenby, Director, Reform

The debate on public service reform in the UK has reached a pivotal moment. A new Government has made pledges to open up public services, including to for-profit providers. But the critics of change have put the Government on the defensive and, on the National Health Service, Ministers have become as critical of competition as their opponents.

Our job is to raise the level of debate above the politics and look at the evidence. Inevitably people will have different views about the future of public services but there are facts and experience on which all should agree, and which the examples in these pages bear out.

The first is that for-profit companies (and of course not-for-profit companies and charities) are delivering public services successfully in the core areas of health, education, prisons and policing, both in the UK and overseas. The second is that they are doing so at greater value and with equal, if not better, quality. The third is that the fears raised by the critics of competition have not materialised. The German healthcare system has not “fragmented” under competition, for example. In fact, the involvement of the private sector has added to the richness of German healthcare and provided new services from which every German citizen can benefit. Competition has strengthened the fabric of the UK prisons system in the same way.

This is not to say that private organisations will always be better than public providers or that public monopolies should be replaced by private ones (far from it). It is to say that Ministers are right to base their policies on the principle of competition. As Alan Milburn said recently, “Monopolies in any walk of life rarely deliver either operational efficiency or customer responsiveness.”

Ministers can actually go further. In practice there is isn’t much difference between a company running school improvement programmes at a profit (allowed by the Department for Education) and a company running schools at a profit (banned).

Last year, the reforming former Finance Minister of New Zealand, Sir Roger Douglas, wrote a pithy guide on public service reform for the incoming Government. His advice included the following maxim: “Consensus for quality decisions does not arise before they are made and implemented. It develops progressively after they are taken, as they deliver satisfactory outcomes to the public.” It will take real political leadership to implement open competition in UK public services and opposition is inevitable. But these case studies show that reform will indeed generate those “satisfactory outcomes” that go on to change the political weather. It can be done.

Andrew Haldenby,Director, Reform

Will Tanner, Researcher, Reform

Dale Bassett , Research Director, Reform

Nick Seddon, Deputy Director, Reform

Kimberley Trewhitt, Researcher, Reform

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Executive summary

For-profit universal healthcare in Valencia, SpainThe Spanish region of Valencia shows that for-profit private sector companies can run universal health services for large populations. A private consortium provides all healthcare services for over 20 per cent of the Valencia region, covering nearly one million people, under contract to the regional government of Valencia.

The first contract was granted in 1997 to UTE Ribera, a private consortium, for the Alzira Health District. All citizens have full access to health services.

The various private providers have improved services to their populations by:• Providing longer opening times. One provider provides outpatient

and elective surgery between 8am and 9pm on weekdays, and on weekends. The normal opening hours in Spain are 9am to 3pm on weekdays.

• Using information technology to connect patients and services. For example, patients can view up-to-the-minute waiting times for hospitals and GP surgeries at home over the internet.

• Delivering higher staff morale. Better IT has enabled managers to run a successful system of performance bonuses, contributing to higher staff morale.

The result has been not only better services but also better value:• Private providers in Valencia are required to provide services at a

25 per cent lower cost than the public sector (i.e. at least 675 euros rather than 900). Some provide at around 571 euros per year.

• Quality surveys indicate that there has been no fall in quality. User satisfaction surveys at one provider revealed a 91 per cent positive opinion towards services and a 95 per cent loyalty towards the hospital.

For-profit universal healthcare in GermanyGermany provides the same lesson as Valencia on an even larger scale.

In 2009, the proportion of hospitals run by for-profit companies (32 per cent) overtook the proportion run by public sector (31 per cent) for the first time. Since 2005, the share of for-profit hospitals has been rising while the share of government hospitals has been falling.

As in Spain, for-profit hospitals can be used by any German citizen as part of their universal system of health coverage.

Also as in Spain, private hospitals have offered much better value. Private hospitals operate with lower staff costs, mainly because they have their own collective labour agreements with lower wages. The much tougher finances of regional German governments, which provide some capital funds to hospitals, have been one key factor in the increase in private ownership.

Patient satisfaction is all but exactly the same in public and private hospitals.

Large shares of private and for-profit hospital ownership are common across the EU. The United Kingdom is unusual in having a near-100 per cent ownership by the public sector.

In the UK, the Coalition Government has pledged to create open competition within the NHS between public, not-for-profit and for-profit providers. In April and May 2011, however, Ministers have watered down their commitment to competition, for example by arguing that competition can undermine as well as improve services.

For-profit company leads the way on prisoner rehabilitation at HMP DoncasterHM Prison Doncaster is one of a number of prisons run by for-profit companies. It has been run by Serco Custodial Services since opening in 1994. In March 2011, Serco was awarded a further 15-year contract to operate the prison on a payment-by-results basis.

In 2010, an independent evaluation found that “the prison is considered to be leading the way in terms of the rehabilitation revolution”. It praised the prison for running “as many different activities to engage and challenge prisoners as possible”, including:• Better education, skills and work programmes. Prisoners on such

programmes are occupied from 9am to 5pm to simulate a working day.

• Stronger family relationships. The prison has lessened security for family visits and provided special facilities for new fathers to be with their partners and children.

• Courses and academies for prisoners. The Central School of Speech and Drama and professional sports clubs such as Doncaster Rovers FC, Featherstone Rovers RLFC and Yorkshire Cricket Club all run courses and academies within the jail.

• Drug treatment and rehabilitation for offenders. The prison records excellent performance on metrics that reduce reoffending, from delivering prisoners to suitable accommodation to education and training.

In 2010 John Biggin, Director at HMP Doncaster, was named “Public Servant of the Year” in The Guardian’s Public Service Awards, sponsored by the public sector union Unison.

Serco Custodial Services have been able to deliver greater value over the course of the contract. In the last two years, the overall expenditure per place has fallen from £46,400 (2007-08) to £43,900 (2009-10).

For-profit company provides effective police custody for South Wales PoliceSouth Wales Police is one of several police forces to outsource its custody suite provision to a for-profit company. The 60-cell custody suite at Cardiff Bay Police Station has been run by G4S since opening in 2003. In March 2009, G4S was awarded a further five year contract to manage the custody suite.

G4S operates the staffing and management of the civilian detention officers (CDOs) in the suite, who work in partnership with warranted police custody sergeants from the force.

In 2005, Her Majesty’s Inspectorate of Constabulary estimated

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that the use of G4S custody staff at Cardiff Bay released 53 warranted police officers back to frontline duty.

In 2008, evidence to the Home Affairs Select Committee estimated that the G4S contract saves South Wales Police £1.2 million a year.

Both police and visitor satisfaction with the survey is markedly improved. A 2007 survey of 120 South Wales Police officers recorded 98 per cent satisfaction that service levels were exceeded and 98 per cent agreement that detainee welfare was good. A 2010 report by the Independent Custody Visiting Scheme noted a marked improvement in the custody environment.

For-profit company helps to transform education in the London Borough of IslingtonDuring the first term of the 1997-2010 Labour Government, Ministers made it possible for for-profit companies and charities to take over the operations of local education authorities (LEAs). Nine LEAs were outsourced to new organisations.

Cambridge Education @ Islington became the education partner of the London Borough of Islington in 2000, taking on a contract to run a full range of support services to the Borough’s schools. That contract was renewed in 2005 and 2009.

In 1999, during the last days of Islington LEA’s direct control, Ofsted described the LEA as being “in disarray”. By 2001, Ofsted was able to say that the “tide had turned”. The letting of the contract had itself energised the elected members and clarified the respective roles of the members and the contractor.

In 2010, Islington’s GCSE results have nearly caught up with the national average, having once being among the worst. The proportion of 15-year-old children achieving five good GCSEs has increased by 46 per cent, against an average in England of 26 per cent.

Cambridge Education @ Islington has made particular progress by focusing on pupil performance in public examinations, on pupil attendance and on the differing needs of pupils from different ethnic minorities.

For-profit company helps to improve schools in NorthamptonOther LEAs have let contracts to for-profit companies to help them to improve schools rather than run all of the LEA operations.

In 2008, for example, Northamptonshire County Council agreed a three-year contract with the for-profit company EdisonLearning to improve seventeen primary schools and four secondary schools.

EdisonLearning has worked directly with the teaching staff of the schools to improve actual classroom teaching and learning. It observes teachers in the classroom and follows up with individual feedback and coaching. It also forms groups of teachers into “achievement teams” which use data on pupil performance to

change lesson plans, with a particular focus on vulnerable pupils and those making insufficient progress.

In the first two years of the contract, the proportion of 15-year-olds achieving five good GCSEs increased from 24.8 per cent to 33.3 per cent.

Other local authorities working with the private sector on school improvement, or seeking to do so, include Surrey, Waltham Forest, Halton and Warrington.

The Coalition Government has refused to allow for-profit companies to run state schools. This position is questionable given the success of for-profit companies in school improvement.

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For-profit universal healthcare Valencia, Spain

ChallengesThe Spanish health system offers almost universal coverage, a wide variety of services and a high quality network of hospitals and primary care centres.

In the south Valencia region of the Alicante province, challenges for public healthcare have escalated in the recent years. This is the fifth most populous region of Spain and more than 19 per cent of residents are foreign nationals, mostly north European retired citizens. The demand for top-class health services is high, due to population pressures, changing demography, raised expectations and escalating technology costs. In addition, supply has been restricted: many hospitals have struggled to survive due to a scarcity of trained doctors, as well as inefficient technology to support administration. As a result, most local authorities have struggled with budget deficits. The public-private partnership framework was envisaged as a way to break this cycle of overspending and to moderate costs.1

MethodLarge scale outsourcingIn 1997, the Regional Government of Valencia selected the Alzira Health District for the first public-private investment partnership in Spain. This is a pioneering approach to using private capital to finance hospital services, aiming to introduce competition and modern management tools. The PPIP arrangement, also called the “Alzira model,” is based on a strategic partnership between the Government of Valencia and the Union of Temporary Businesses (UTE) Ribera, a private consortium. UTE Ribera is contracted to:• Design and build a technologically advanced 300- bed University Hospital - Hospital de La Ribera -

and operate the district health network consisting of Hospital de la Ribera, 4 integrated health centres and 46 primary health centres.

• Deliver clinical and non-clinical services for the 250,000 residents of Alzira district and for any out-of-district patients.2

At present the Government of Valencia lets four different contracts: Alzira district, Denia district, la Manises and Torrevieja, with more planned in the future.3

By giving responsibility for a population’s full-service hospital provision, this approach enabled the autonomous government of Valencia to provide free and universal integrated healthcare to a designated region and within budget. Over 20 per cent of the Valencia region (around 850,000 people) is now covered by similar contracts which explicitly set out the costs the government will pay for the hospital’s services for the area it covers.4

1 Pardo, J.L. (2008), Spanish Alzira Model: NHS contracting out a geographical area, 4th International Health Summit, Prague, 7 April.

2 The Global Health Group (2009), Public-Private Investment Partnerships: http://globalhealthsciences.ucsf.edu/GHG/docs/PPIP_Overview.pdf

3 Healthcare Europa (2010), Spain: How the Alzira model works, Laing & Buisson, April.4 http://www.nhsconfed.org/NATIONALANDINTERNATIONAL/NHSEUROPEANOFFICE/GET-INVOLVED/Pages/

Valenciastudytour.aspx

Nick Seddon, Deputy Director, Reform

The Spanish region of Valencia shows that for-profit private sector companies can run universal health services for large populations. A private consortium provides all healthcare services for over 20 per cent of the Valencia region, covering nearly one million people, under contract to the regional government of Valencia.

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Figure 1: Alzira Model: NHS contracting out in a geographical area Source: Pardo, J.L. (2008), Spanish Alzira Model: NHS contracting out a geographical area, 4th International Health Summit, Prague, 7 April

Public funding Private investment and management

Payment per capita: fixed budget (risk transfer) Investment in infrastructure

Freedom of choice: money follows patients Management Innovation

Client orientated healthcare

Integrated healthcare

Public property Public guarantee

Reversion to the Government at the end of the contract Equal access and services for everybody

Integrated in the NHSGovernment: Inspection and control, through the commissioner working in the hospital

Length of contractA private company is awarded a contract to build and run an integrated health system, including hospital and primary care. The contract for the “concession” term is 15 years (extendable to 20 years),6 contrasting sharply with Britain’s short-term contracts (ISTCs were five years), so real changes can be tested and established. In return, the company runs the entire health department and must offer universal access to its wide range of services. The private contractor assumes the risk, employs its own medical staff and management and builds new healthcare facilities. In essence, it is a privately managed public hospital.

An added dimension of this arrangement is that the “concession” arrangement requires healthcare providers to deliver care for the patient right through from primary care. This means that operators have an incentive to treat people in the most appropriate and cost-effective setting, which means limiting the demand on hospital services through preventative and community care.

Use of technologyFrom the very start, these hospitals set out a clear goal of creating a “paperless hospital”. They planned an infrastructure that could integrate systems used in all departments; from digital X-rays to electronic medical records, from business management to the supply chain.

Microsoft has created a system for Torrevieja hospital which has the ability to “understand” other clinical databases running outside of the department. Specialists, GPs, and administrative staff can all access comprehensive and up-to-date information drawn from a shared database. At Torrevieja, staff can monitor a patient’s health around the clock and casualty department staff can work on patients’ medical records using a Tablet PC mobile computer.7

Hospital de Manises displays the benefits of this service oriented architecture. Another manifestation is that digital screens present all departmental waiting times, and these are accessible from peoples’ homes over the internet, along with waiting times at primary care physicians’ surgeries, enabling patients to choose where to go with full information.8

OutcomesHigher productivityThe easy and quick access to patient information afforded by the new technology has led to high employee productivity at Torrevieja Hospital, resulting in an average time of 4.3 days for a patient’s stay at the hospital compared to 6 days in most other hospitals in Spain. Likewise, in the first year, between October 2006 and the end of 2007, it had carried out 15,000 operations – up to four times more output than other Spanish health centres.9

The Alzira PPIP has substantially increased surgical theatre output to 6.7 surgeries per theatre per day, compared to 3.8 in a comparable local public hospital, and reduced the average length of stay to 4.76 days, against 7.68 in the public hospital.10 The Alzira hospital, de la Ribera, has been rated as one of the top 20 hospitals in Spain for 7 out of the last 10 years.11 In user satisfaction surveys for Hospital de la

5 IMF (2010), Macro-Fiscal Implications of Health Care Reform in Advanced and Emerging Economies.6 The Global Health Group (2009), Public-Private Investment Partnerships: http://globalhealthsciences.ucsf.edu/GHG/docs/

PPIP_Overview.pdf7 Microsoft (2008) “Healthcare Provider Increases Productivity”, Hospital de Torrevieja, 2008. 8 Reform/McKinsey study visit 15/11/10. 9 Microsoft (2008) “Healthcare Provider Increases Productivity”, Hospital de Torrevieja, 2008.10 Pardo, J.L. (2008), Spanish Alzira Model: NHS contracting out a geographical area, 4th International Health Summit,

Prague, 7 April.11 Healthcare Europa (April 2010), Spain: How the Alzira model works, Laing & Buisson.

“Among micro-level reforms, strengthening market mechanisms—increasing patient choice of insurers, allowing greater competition between insurers, relying on a greater degree of private provision, and allowing more competition between providers—is particularly important to contain costs.”1

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Ribera, users recorded a 91 per cent positive opinion towards services and a 95 per cent loyalty towards the hospital.12 Absenteeism among staff at la Ribera is also just 2.5 per cent, far lower than equivalent public hospitals and other enterprises of similar dimensions.13

Hospital de Manises demonstrates better control of clinical records and makes the process of going to hospital easier and quicker for the patient.

Better performance managementUp-to-the-minute business intelligence reports can be accessed at all times on staff laptops. Performance of staff can be easily monitored and they receive bonuses depending on their monthly performance. As a result of high performance, they can earn up to 40 per cent more at Torrevieja Hospital than other hospitals in Valencia; a key reason they retain world-class doctors for a longer time.14 This system of accurate, target-related bonuses also assists Hospital de Manises in reaching high levels of staff satisfaction.

Improved waiting timesThe system also alerts patients of upcoming appointments and waiting times by text message. At the hospital entrance, appointment statuses are displayed on automatic appointment machines. This appointment scheduling system helps patients contribute to the management of supply and demand for healthcare services. The average waiting time in Torrevieja Hospital is 60 minutes-compared to 120 minutes in most other Spanish hospitals.15 At Hospital de la Ribera, lower waiting times are complimented by longer opening times, as outpatient and elective surgery hours run from 8am - 9pm, as well as on weekends, compared to normal opening times of 9am -3pm in public hospitals in Spain.16

Touch screens in accident and emergency departments keep patients’ relatives informed of their health status. The time saved by not personally communicating this information can then be devoted to other patients.17

Demand managementNumerous hospitals have taken steps to reduce referrals to hospital following primary care consultations. Hospital de la Ribera recently attached a consultant physician to each health centre, working with the same patients as the GP. This is designed to implement clinical guidelines with the local GPs, resolve medical problems in the health centre, and reduce the number of inappropriate hospital referrals. Further innovations include enlarging health centres with on-site X-ray services, accident and emergency departments, and medical specialist outpatient clinics. Hospital de Manises is integrating medical care pathways with the aim of streamlining the management of health problems, from primary prevention through to palliative care and including acute care, rehabilitation, secondary prevention and chronic care.18

Reduced costOne of the key benefits of the Alzira model is the reduced cost for all those involved. Hospital de la Ribera has now been in operation for over a decade and has improved accessibility and quality of care, while remaining cost neutral for patients and the Government. For patients, health services are free as they previously were, and for the Government, healthcare costs per capita are at least 25 per cent lower than in other areas.19 In addition, the contractor assumes the financial risk of operating the hospital.20

These hospitals are financed by the Valencian government which makes capitation payments to the private company for the duration of the contract (an annual sum, based on the Consumer Price Index and the Valencia Health Ministry’s budget, paid per head of population). Currently, the public average cost is around 900 euros.21 Private providers are required to deliver healthcare at a lower cost – at least 25 per cent lower than in other areas.22At Torrevieja Hospital, for instance, just 571 euros is spent per patient per year, yet all the evidence from quality metrics indicates that there has been no diminution of quality.23

12 Pardo, J.L. (2008), Spanish Alzira Model: NHS contracting out a geographical area, 4th International Health Summit, Prague, 7 April.

13 Bulletin of the World Health Organization, Vol. 87, No. 12 (December 2009), Spanish health district tests a new public-private mix.

14 Microsoft (2008) “Healthcare Provider Increases Productivity”, Hospital de Torrevieja, 2008.15 Microsoft (2008) “Healthcare Provider Increases Productivity”, Hospital de Torrevieja, 2008.16 Rechel, B. et al (2009), Capital Investment for Health: Case Studies for Europe, European Observatory on Health Systems

and Policies, WHO.17 Reform/McKinsey study visit 15/11/10.18 Administrative concessions: the vision, Hospital de Manises, 15/11/2010 ; Reform/McKinsey study visit 15/11/10 ;

University of Barcelona (2009): http://hpm.org/en/Surveys/University_of_Barcelona_-_Spain/14/Hospital_at_Home_in_Valencia.html;jsessionid=C483116864A5339B8359ABBE073098E5?p_c:255=255&content_id=251&a=sc&language=en

19 The Global Health Group (2009), Public-Private Investment Partnerships: http://globalhealthsciences.ucsf.edu/GHG/docs/PPIP_Overview.pdf

20 Pardo, J.L. (2008), Spanish Alzira Model: NHS contracting out a geographical area, 4th International Health Summit, Prague, 7 April.

21 Microsoft (2008) “Healthcare Provider Increases Productivity”, Hospital de Torrevieja, 2008.22 The Global Health Group (2009), Public-Private Investment Partnerships: http://globalhealthsciences.ucsf.edu/GHG/docs/

PPIP_Overview.pdf23 Microsoft (2008) “Healthcare Provider Increases Productivity”, Hospital de Torrevieja, 2008.

For-profit universal healthcare Germany

Andrew Haldenby, Director, Reform

Germany provides the same lesson as Valencia on an even larger scale.

In 2009, the proportion of hospitals run by for-profit companies (32 per cent) overtook the proportion run by public sector (31 per cent) for the first time.

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Challenges During the last two decades, German hospitals have come under great pressure to become more efficient. In particular, the regional governments of Germany, which historically have funded the capital investments of hospitals, have suffered rising deficits and debts. In practice hospitals now finance approximately half of their capital investments themselves, driving them to demand greater efficiency. The result has been a steady move towards private ownership.24

German healthcare has been seen as amongst the most market-oriented in the OECD, along with the Netherlands, Switzerland and Slovakia. German citizens choose their health insurer and have a wide choice of provider. As seen above, the majority of hospitals are run in the for-profit and not-for-profit sectors. Nearly all citizens make a statutory contribution to health insurance based on a percentage of income, divided between employee and employer, which guarantees access for all citizens.25

MethodThe shift to private hospitalsBy 2009 there were more private than public hospitals in Germany for the first time. From 2005 to 2009, the share of public hospitals as a proportion of the number of all hospitals decreased from 36 per cent to 31 per cent, whereas the proportion of private hospitals increased from 26 per cent to 32 per cent. The proportion of non-profit hospitals has remained relatively constant at around 37 per cent.26

Other European countriesLarge shares of private and not-for-profit ownership are common across Europe. The United Kingdom is unusual in having a near-100 per cent ownership by the public sector. Where the private sector has been introduced in recent years, patient satisfaction rates are reportedly very high.

Figure 2: Public / private mix in the provision of hospital acute care bedsSource: OECD survey on health system characteristics, 2008-09

Public Not-for-profit For-profit

Belgium 34 66 0

France 66 9 25

Germany 49 36 15

Italy 82 17 1

Spain 74 17 9

United Kingdom 96 4 0

24 Wootton, I. (2009), Privatisation in the Healthcare Industry, AEMH Conference, 7 May, p. 11. 25 Journard, I. et al, (2010), Health Care Systems - Efficiency and Institutions. OECD Economics Department. Working

Papers No. 769.26 KPMG Public Governance Institute (2010), Public Governance magazine, Autumn, p.14.

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What is happening in the UK? 2728

Patients have had the right to choose their provider of acute elective care since 2008.29 As of June 2010, there were more than 250 NHS and independent sector providers of acute elective care to NHS patients worth approximately £400 million per annum and treating over 220,000 NHS patients a year. This represents only a small fraction of the total healthcare budget, around 3.6 per cent. Political support for the private sector has been uncertain:• The previous Government reversed its support for private sector involvement in September 2009,

instituting a policy by which NHS providers became the “preferred provider”.30 • The Coalition Government moved back to a policy of free competition between NHS and private

providers. Since April 2011, however, leading Ministers have become critical of private sector involvement. Announcing a review of Government health policy, the Secretary of State for Health, Andrew Lansley, said that the Government would not allow private sector hospitals to operate where they would “undermine” NHS providers. In practice, that would prevent the operation of any meaningful competition at all. The Prime Minister and Deputy Prime Minister have also spoken against the “privatisation” of health, and while their specific target may have been the private health insurance system of the USA, in practice their words are a criticism of private sector involvement per se.

OutcomesBetter efficiency for equivalent qualityThe shift to private hospitals is one of the key ways in which German healthcare has controlled its costs over recent years. Private hospitals operate with lower staff costs, mainly because private hospitals have their own collective labour agreements with lower wages.31 Patient satisfaction has been measured to be all but exactly the same in public and private hospitals.32

As a result, in spite of technological progress and demographic change, the health care expenditure in Germany as a percentage of GDP has only increased moderately, from 10.3 per cent in 1999 to 10.5 per cent in 2008. In comparison, in the UK, starting from a lower level, health care expenditures have risen significantly from 6.9 per cent of GDP in 1999 to 8.7 per cent in 2008.33

27 Journard, I. et al (2010), Health Care Systems - Efficiency and Institutions, OECD Economics Department. Working Papers No. 769.

28 Journard, I. et al. (2010), Health Care Systems - Efficiency and Institutions, OECD Economics Department. Working Papers No. 769.

29 Co-operation and Competition Panel for NHS-funded services. http://www.ccpanel.org.uk/cases/Operation_of_any_willing_provider_for_the_provision_of_routine_elective_care_under_free_choice.html

30 Burnham, A. (2009), speech to the Kings Fund, 17 September: “With quality at its core, I think the NHS can finally move beyond the polarising debates of the last decade over private or public sector provision. Let me begin with where I stand in this debate, and that is that the NHS is our preferred provider.”

31 Herr, A. et al. (2010), “Profit efficiency and ownership of German hospitals”, Health Economics.32 Braun, B.; Müller, R (2006), Versorgungsqualität im Krankenhaus aus der Perspektive der Patienten.33 KPMG Public Governance Institute (2010), Public Governance magazine, Autumn 2010, p.11.

“By increasing rivalry among suppliers, the degree of private provision in both the inpatient and outpatient care sectors strengthens competitive pressures, potentially reducing costs of provision, improving quality and fostering innovation.”27

“Inequalities in health status tend to be lower in three of the four countries with a private insurance-based system – Germany, Netherlands and Switzerland –, indicating that regulation and equalisation schemes can help mitigating cream-skimming and the effects of other market mechanisms which can raise equity concerns.”28

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Company and length of contractSerco Custodial Services has operated HM Prison and Young Offenders Institution Doncaster since opening in June 1994 as a Core Local Prison (Category A). It was downgraded to a local Category B establishment in March 2003 following changes within the Prison Service’s High Security Estate. In August 2000, Serco Custodial Services was awarded the contract to continue operating the prison for a further ten years.

On 31 March 2011, Serco was awarded a further 15-year contract, worth £250 million, to operate the prison on a “payments by results” basis until 2026.

Serco Custodial Services is part of Serco, the international services company. Serco is a leading provider of custodial services to governments around the world. In the UK, Serco operates four adult prisons, a Young Offenders Institution and a Secure Training Centre for juveniles under contract to the Ministry of Justice’s National Offender Management Service, the Scottish Prison Service and the Youth Justice Board of England and Wales. In addition, Serco operates two prisons in Western Australia (Acacia and Borallon Correctional Centre) and provides non-custodial services to Hunfeld Prison in Germany.

ChallengesHigh prisoner turnoverAs a Category B local prison and young offenders institution, HMP Doncaster holds prisoners who have recently been convicted or sentenced, as well as those on remand and awaiting trial.34 Local prisons have extremely high population turnover, containing prisoners on short sentences who serve the entirety of their sentence there, and while those on longer sentences who are transferred to another establishment at some point during their custodial sentence.35

At HMP Doncaster, the challenge of a transient prison population is acute. The prison population is turned over more than three times a year.36 As a result, initiatives to address the causes of offending behaviour, improve health or educational outcomes and implement interventions to reduce post-release reoffending are restrained by the limited time available.37

OvercrowdingThe prison estate has been overcrowded since 1994.38 In March 2011, the National Offender Management Service estimated the ratio of overcrowding, measured as prisoners to In-Use Certified National Accommodation (CNA) places, at 111 per cent.39

HMP Doncaster was initially built to contain 771 male prisoners in June 1994. However, due to pressure on custodial places across the prison estate as a whole, the prison is severely overcrowded, housing a population of 1102 prisoners in March 2011, from an operational capacity of 1145.40 The ratio of prison population to In-Use CNA places in HMP Doncaster was recorded as 155 per cent in March 2011, significantly higher than the systemic average.41

34 HM Prison Service (2008), Prisoners’ Information Book (Male/YO), Ministry of Justice and Prison Reform Trust, p. 52. 35 Ibid, p.54. 36 The Custodial Review, ‘Interview with John Biggin, Director, HMP Doncaster’, 5 May.37 The difficulties local prisons face in terms of high prisoner turnover were well documented by Dame Anne Owers during her

time as HM Chief Inspector of Prisons. See for example: HM Inspectorate of Prisons (2010), HM Chief Inspector of Prisons for England and Wales: Annual Report 2008-09, 23 February, p. 45: “Local prisons face particularly challenging circumstances, always overcrowded and holding a transient population.”

38 House of Commons Library (2010), Key issues for the new Parliament: Should we build more prisons?, p. 97.39 National Offender Management Service, (2011) Monthly bulletin – March 2011, 23 March.40 National Offender Management Service, (2011) Monthly bulletin – March 2011, 23 March.41 National Offender Management Service, (2011) Monthly bulletin – March 2011, 23 March.

For-profit company leads the way on prisoner rehabilitation HMP Doncaster

Will Tanner, Researcher, Reform

HM Prison Doncaster is one of a number of prisons in the UK run by for-profit companies. It has been run by Serco Custodial Services since opening in 1994. In March 2011, Serco was awarded a further 15-year contract to operate the prison on a payment-by-results basis.

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As has been documented by successive academic reports and independent inspectorate reports, 42 prison overcrowding severely inhibits efforts to improve behaviour and substance abuse, and to reduce reoffending behaviour.43

MethodAt HMP Doncaster, Serco has adopted an innovative operational strategy that places reducing the rate of reoffending at the heart of its work with prisoners, both within the prison itself and after release. John Biggin, Director at HMP Doncaster has stated that reducing the rate of recidivism is “the central reason and theme around which the prison is run and organised”.44 This focus is manifested in number of areas, including innovative partnership working and the creation of a positive prison environment complete with comprehensive education, skills and resettlement services.

Partnership and innovationHMP Doncaster is operated around an integrated management framework that promotes collaborative working and innovation. A Partnerships and Innovation Directorate has been established to coordinate activity thematically, rather than in vertical silos symptomatic of similar prisons, and identify external partner organisations in the Doncaster area.45

The Partnerships programme has successfully reached out to a wide variety of external organisations, many of which now provide courses and academies within the prison itself. The prison has a partnership with the Central School of Speech and Drama, which provides an applied theatre programme designed around offenders confronting their offending behaviour.46 Similarly, professional sports clubs, such as Doncaster Rovers FC, Featherstone Rovers RLFC and Yorkshire Cricket Club all run academies inside the jail.47 The emphasis on short courses and the strong involvement of the local community is designed specifically to target reoffending rates among prisoners.48 For prisoners being released back into the community, Doncaster operates a “Through the Gate” scheme, in partnership with the charity Catch 22, that matches prisoners being released to a volunteer mentor to help the transition back into the community over the following three to six months.49

Positive prison environmentHMP Doncaster has made the creation of a positive prison environment a key feature of its efforts to reduce reoffending and improve outcomes. In the last twelve months, a concerted effort has been made by prison management to reduce unnecessary security infrastructure and ensure staff show a high standard of duty of care towards prisoners.50 This includes the removal of virtually all electronic security, painting of walls and open consultation with staff about changes to the operational strategy.51 Prisoners on education, skills, and work programmes are occupied from 9 am to 5 pm to simulate a working day.52

A Family First initiative has also been developed, removing security from family visiting to create a family friendly environment. This includes a room specifically for fathers to be with their partners and baby in order to reinforce family relationships during custody.53An estimated 45 per cent of prisoners lose contact with their families during custody.54

Effective substance abuse interventionHMP Doncaster operates a zero tolerance approach to drug and alcohol abuse and violence.55 All prisoners are subject to mandatory drug testing, in addition to health screens upon arrival at the prison, and the prison has a comprehensive and responsive substance abuse intervention process to effectively treat prisoners and reduce drug or alcohol dependency.56 In 2010, the National Audit Office commended HMP Doncaster for its partnership working with local authorities around drug treatment of offenders on short custodial sentences.57

42 Independent Monitoring Board, HMP/YOI Doncaster (2010), The Independent Monitoring Board’s Annual Report to the Home Secretary: October 2009 to September 2010, p. 6.

43 See for example: Allen, R. (2010), Current situation of Prison Overcrowding, International Centre for Prison Studies, King’s College London.

44 The Custodial Review, Interview with John Biggin, Director, HMP Doncaster, 5 May.45 The Custodial Review, Interview with John Biggin, Director, HMP Doncaster, 5 May.46 The Custodial Review, Interview with John Biggin, Director, HMP Doncaster, 5 May.47 Mark Easton, BBC Online (2011), “Colleges of crime”, 31 March: http://www.bbc.co.uk/blogs/thereporters/

markeaston/2011/03/colleges_of_crime.html48 The Custodial Review, Interview with Debbie Hall, Director, Partnerships and Innovation, HMP Doncaster, 6 May.49 The Custodial Review, Interview with John Biggin, Director, HMP Doncaster, 5 May.50 The Custodial Review, Interview with John Biggin, Director, HMP Doncaster, 5 May.51 The Custodial Review, Interview with John Biggin, Director, HMP Doncaster, 5 May.52 The Custodial Review, Interview with John Biggin, Director, HMP Doncaster, 5 May.53 The Custodial Review, Interview with Debbie Hall, Director, Partnerships and Innovation, HMP Doncaster, 6 May.54 Nacro (2000) The forgotten majority, London: Nacro.55 The Custodial Review, Interview with John Biggin, Director, HMP Doncaster, 5 May: “This is a zero tolerance policy for

drugs and violence. It’s the carrot and stick approach. They clearly know what will not be tolerated and what will be available if they adhere to the rules, they want what is on offer so they obey the rules and also buy into the ethos.”

56 HM Chief Inspector of Prisons (2010), Report on an unannounced inspection of HMP Doncaster, 2-12 November 2010, p. 34: “Drug- or alcohol-dependent prisoners received treatment immediately and were located on a designated stabilisation unit, which offered a safe environment”.

57 National Audit Office (2010), Managing offenders on short custodial sentences, 10 March, p. 33.

“The whole ethos of the prison is centred around the expectation that prisoners and staff behave responsibly and that the key to successfully reducing re-offending is to have as many different activities to engage and challenge prisoners as possible.”42

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Outcomes 58

Effective rehabilitationThe initiatives that Serco has established at HMP Doncaster have recorded substantial success in a number of areas crucial to breaking the cycle of reoffending.

In 2010, HM Inspectorate of Prisons (HMIP) found that 92 per cent of prisoners were released to suitable accommodation in 2009-10, against a Ministry of Justice target of 85 per cent.59 In addition, 23 per cent of prisoners were released into education or training upon release in 2009-10, more than double the official 11 per cent target.60 The prisoner survey conducted by HMIP in 2010 also found marked improvement (five or more per cent) in the number of prisoners confident of gaining employment, finding accommodation, continuing education and managing finances upon release, measured against both the previous 2008 inspection and the local prison comparator.61

The commitment of prison staff to reducing the rate of reoffending was recognised by the Independent Monitoring Board as “enormous” in its 2010 statement to the Home Secretary62 and HM Chief Inspector of Prisons has written that “the work with families was among the best that I have seen”63.

Reduced drug and alcohol abuseIt was estimated in 2007 that 80 per cent of incoming prisoners to HMP Doncaster have committed crimes related either directly or indirectly to drugs due to a prevalent drug culture within the local area.64 However, the zero tolerance approach and an effective Integrated Drug Treatment System (IDTS) have significantly reduced substance abuse within the prison.

According to the 2010 HMIP survey, 85 per cent of prisoners knew who to contact as a result of a drug or alcohol issue, against an 80 per cent comparator rate, and 82 per cent, against a 76 per cent comparator, found the help they received useful.65

Moreover, drug levels are at an historic low within HMP Doncaster, with just 6 per cent of prisoners recording positive on mandatory tests against a government target of 9 per cent.66 The success of the Zero Tolerance campaign was recorded by the Independent Monitoring Board of the prison, which noted: “with the success of the Zero Tolerance campaign prisoners are now reaping the benefits of remaining drug and violence free”.67

Safer custodyHMP Doncaster’s strict approach to violent behaviour has also led to substantial success in ensuring the establishment is a safe environment for prisoners and staff alike. 61 per cent of inmates reported never feeling unsafe within the prison and the prison has achieved reductions in the victimisation and intimidation of prisoners against both local prison comparators and previous surveys.68

Improvements to the safety of the prison, especially in regard to the low level of violent incidents, led the Independent Monitoring Board to commend HMP Doncaster and its staff in 2010.69

Improved staff-prisoner relationshipsA key feature of HMP Doncaster, at variance with many private sector establishments, is the good relationships between staff and prisoners. In 2010, HM Inspector of Prisons Nick Hardwick wrote that “prisoners themselves reported positively on the way staff treated them; we saw good staff-prisoner relationships and first names were commonly used. We saw excellent staff-prisoner relationships in the segregation unit where some of the most challenging and troubled prisoners were held”.70 The Independent Monitoring Board has argued that the work of segregation staff “should be recommended for best practice”.71

58 Ibid, p. 6. 59 HM Chief Inspector of Prisons (2010), Report on an unannounced inspection of HMP Doncaster, 2-12 November 201060 Ibid. 61 Ibid, Prisoner survey responses HMP Doncaster 2010.62 Independent Monitoring Board, HMP/YOI Doncaster (2010), The Independent Monitoring Board’s Annual Report to the

Home Secretary: October 2009 to September 2010, p. 15.63 Nick Hardwick, HM Chief Inspector of Prisons (2010), “Introduction”, Report on an unannounced inspection of HMP

Doncaster, 2-12 November 2010, p. 5.64 Ethos Magazine (2007), Interview with Brian Anderson, Former Director, HMP Doncaster (2007), Summer.65 HM Chief Inspector of Prisons (2010), Report on an unannounced inspection of HMP Doncaster, 2-12 November 2010,

p. 111. 66 The Custodial Review, Interview with John Biggin, Director, HMP Doncaster, 5 May.67 Independent Monitoring Board, HMP/YOI Doncaster (2010), The Independent Monitoring Board’s Annual Report to the

Home Secretary: October 2009 to September 2010, p. 6. Ibid. p. 6.68 HM Chief Inspector of Prisons (2010), Report on an unannounced inspection of HMP Doncaster, 2-12 November 2010,

p. 111.69 Independent Monitoring Board, HMP/YOI Doncaster (2010), The Independent Monitoring Board’s Annual Report to the

Home Secretary: October 2009 to September 2010, p. 20.70 Nick Hardwick, HM Chief Inspector of Prisons (2010), “Introduction”, Report on an unannounced inspection of HMP

Doncaster, 2-12 November 2010, p. 5. 71 Independent Monitoring Board, HMP/YOI Doncaster (2010), The Independent Monitoring Board’s Annual Report to the

Home Secretary: October 2009 to September 2010, p. 12.

“All in all, the prison is considered to be leading the way in terms of the rehabilitation revolution.”59

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Reduced cost 72

In addition to delivering improvements in service quality and innovations to reduce the risk of reoffending, HMP Doncaster has realised substantial savings for the taxpayer. Although direct comparability between prisons is difficult between prisons due to variations in profiles, HMP Doncaster consistently ranks among the lowest costs for male local prisons in terms of cost per place and cost per prisoner.73

In addition, figures recently released by the Minister for Prisons and Probation reveal that Serco Custodial Services has successfully reduced the operational cost of HMP Doncaster year-on-year since 2007 (See below table).

Figure 3: Annual overall expenditure at HMP Doncaster, 2007-10Source: Crispin Blunt MP (2011), House of Commons, Written answers and statements, 3 May

YearOverall expenditure (£): Cost per place

Overall expenditure (£): Cost per prisoner

2009-10 43,937 30,302

2008-09 44,026 30,504

2007-08 46,437 31,572

In March 2011, it was announced that Serco has been awarded a £250 million contract to continue operating HMP Doncaster until 2026. Under the terms of the payments by results contract, 10 per cent of the contract price is conditional on the operator reducing the reconviction rates of offenders within a year of release by 5 per cent, thus tying a significant proportion of public funding to successful rehabilitation outcomes. A saving of at least £1 million is guaranteed regardless of any success in reducing reoffending rates, further reinforcing the cost saving Serco represents.74

72 The Guardian (2010), “Raising standards behind bars”, Guardian Public Services Awards, 24 November.73 CBI (2003), Competition: a catalyst for change in the prison service: A decade of improvement, p. 15.74 Rt Hon Kenneth Clarke MP (2011), “Announcement to the House of Commons on ‘Prisons competition’”, House of

Commons, 31 March.

“John Biggin has made significant changes to improve the lives of staff and prisoners at Doncaster prison and the young offender institution.”72

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Company and length of contract G4S (formally Group 4 Securicor) the world’s leading international security solutions group. G4S works in partnership with governments, businesses and other organisations to provide integrated solutions to security challenges.

G4S has managed police custody suites since 2003 and currently provides services to police authorities in Lancashire and Staffordshire in addition to the contract in South Wales.

The South Wales contract was for a five year period. On 1 March 2009, South Wales Police Authority renewed the contract for a further 5 years. Financial risk for custody staff and custody management are also transferred to G4S within the terms of the contract.

ChallengesThere are 43 police forces in England and Wales, operating an estimated 350 custody suites combined. Data collected from forces by the Department of Health and the Home Office suggests that an estimated 2 million people are detained by police forces every year. 75 After arrest, or when answering bail, detainees are held in police custody suites. It is estimated that the total annual cost to the police service of detaining suspects is £1.1 billion.76

Of the 43 forces, 36 provide custody services in-house, using warranted police officers and police staff in custody management roles. This model of custody suite management requires the resource of 5,000 police officers and support staff across the 43 forces. It has been estimated that the total cost of staff for running custody suites is greater than £208 million per annum, as well as the additional expenses incurred by detainee welfare such as catering and medical care costs.77

South Wales Police detains an estimated 50,000 people in custody every year.78 Prior to 2004 custody suite facilities in South Wales Police Authority were located at several sites of varying sizes, and managed by warranted police officers. However, existing premises were in poor condition and had limited cell capacity, and the dispersed location of sites led to significant operational inefficiencies.79

In 2002, South Wales Police Authority rationalised its custody suites into a single Basic Command Unit with a 60-cell capacity custody suite at Cardiff Bay, completed in 2004. The contract to provide the staffing of this new facility was awarded to G4S.

MethodCivilianisation of custody staffIn the new facility, G4S civilian detention officers assumed the duties previously carried out by warranted officers. These staff are able to complete all the functions required within the custody suite, including booking in, searching, identity checking, shoe impressions and fingerprinting, with the sole exception of breath-testing.80 The civilianisation of staff roles in police custody suites has been recommended by a number of police reviews and organisational reports for more than fifteen years as a means of improving value for money and releasing warranted officers for frontline duties.81

75 Department of Health and Home Office (2010), Police Healthcare Baseline Survey. Unpublished data. Cited in Independent Police Complaints Commission, Deaths in or following police custody, 3 December 2010.

76 Financial Times (2010), “Police to rent custody cells from G4S”, 15 October 2010.77 G4S, Police custody outsourcing briefing note.78 South Wales Police Authority website: http://www.southwalespoliceauthority.org.uk/en/content/cms/getting_involved/

independent_custody/independent_custody.aspx79 Mark Phillips, Estates Manager, South Wales Police, in The Custodial Review, “Cardiff’s new custody suite”, 3 May 2004.80 Paul Chapple, Head of Custody, South Wales Police, in The Custodial Review, “Cardiff’s new custody suite”, 3 May 2004.81 The Masefield Scrutiny Report (1995), Reducing Administrative Burdens on the Police in the Context of the Criminal

Justice System, recommended the extension of civilianisation in the custody suite. In March 1997, HMIC reiterated this recommendation in its Thematic Inspection Report, How heavy is the administrative burden on the Police now?, arguing that: “Introducing or expanding civilianisation in the custody suite provided forces with an opportunity to make the best use of police personnel and reduce administrative burdens on the custody officer.”

For-profit company provides effective police custody South Wales Police

Will Tanner, Researcher, Reform

South Wales Police is one of several police forces to outsource its custody suite provision to a for-profit company. The 60-cell custody suite at Cardiff Bay Police Station has been run by G4S since opening in 2003. In March 2009, G4S was awarded a further five year contract to manage the custody suite.

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Workforce specialisation 82

The 97 civilian detention officers employed through the G4S contract in South Wales undergo eight weeks of specialised custody training, including two weeks of “on-the-job” monitoring training.83 The specialisation of this training and the constancy of duties enable CDOs to achieve substantially better results than delivered by police officers previously or in comparable forces.

Outcomes Increased frontline police presenceBy enabling civilian staff to take on functions previously reserved for warranted police officers, the civilianisation of custody staff roles immediately released warranted officers back to front line duties. Her Majesty’s Inspectorate of Constabulary estimates that in South Wales 53 warranted officers have been released to front line or other roles as a direct result of the Cardiff Bay contract.84 This represents an estimated saving of 57,855 police officer hours per annum.

Improved efficiency and productivity Since G4S took over duties there has been a 25 per cent increase in efficiency in the day-to-day running of South Wales Police’s Custody Suite function. In the first full year of the contract to March 2005, G4S were able to increase the number of detainees by 20 per cent on the previous year.85 There has also been a reported increase in the accuracy of fingerprint collection and DNA samples.

The specialist expertise of CDOs has also resulted in substantial improvements in the processing times for detainees. The booking time for detainees has been reduced to an average of 24 minutes, compared with the average for non-outsourced custody suites of almost double.86 These improvements thus reduce the time that the arresting officer spends processing detainees and maximises officer time spent performing front line duties. Evidence shows that booking-in detainees causes the longest delays in custody, and a 30 minute reduction in custody waiting times would deliver £1.39 million of efficiency savings a year.87

Closer management and supervision of detaineesThe G4S contract at the Cardiff Bay custody suite provides ten G4S custody staff, two per bank of 13 cells, within each shift session, who work in partnership with five police custody sergeants and a police custody inspector. This represents an increased level of staff per custody cell in a more specialised environment, allowing for closer supervision of detainees.88 G4S also provides a dedicated management team for the Cardiff Bay contract in order to provide immediate response to issues.

High levels of satisfactionThe annual survey of 120 South Wales Police officers in 200789 reported the following results:• 98 per cent of service levels were exceeded. • 96 per cent of officers rated G4S helpfulness as excellent. • 98 per cent of officers rated detainee welfare as good.• 96 per cent of officers rated G4S co-operation as good.

In addition to improved police satisfaction levels, the Independent Custody Visiting Scheme for South Wales Police Authority, whose volunteers visited 93 per cent of detainees in 2009-10, noted a marked improvement in the custody environment.90

In its 2005 Baseline Assessment of South Wales Police, HMIC also noted that: “The relationship between South Wales Police and Securicor, the contract provider for civilian detention officers, is good at both senior and operational level, which ensures good team work within custody suites”91. This good working relationship is demonstrated by the fact that on 1 March 2009, G4S retained the contract to provide civilian detention officers in Cardiff Bay BCU.92

82 The Custodial Review, “Cardiff’s new custody suite”, 3 May 2004.83 Home Affairs Select Committee (2008), Policing in the 21st Century, Oral and written evidence, Appendix 31.84 HMIC (2005), Baseline Assessment: South Wales Police, October 2005.85 Home Affairs Select Committee (2008), Policing in the 21st Century, Oral and written evidence, Appendix 31.86 G4S, Police custody outsourcing briefing note.87 ‘Police Custody Process Research’, published as part of the Reducing Bureaucracy in Policing report (2 December 2009),

p100; NPIA (2010), High level working group report on police value for money, 2010.88 Paul Chapple, Head of Custody, South Wales Police, in The Custodial Review, “Cardiff’s new custody suite”, 3 May 200489 G4S, Police custody management case studies, G4S website: http://www.g4s.uk.com/en-gb/Media%20Centre/Case%20

Studies/Government/Police%20-%20Custody%20Suite%20Management/ 90 Shirley Hodges, Co-ordinator of the South Panel of Independent Custody Visitors (2010), South Wales Police Authority,

Volunteers Annual Report 2009-10.91 HMIC (2005), Baseline Assessment: South Wales Police, October 2005.92 South Wales Police Authority (2009), Agenda and Papers, Meeting of South Wales Police Authority, 16 February.

“This has released a lot of time to the police officers and they can return to frontline duties far more quickly. And because the custody staff are doing these functions constantly, a higher quality of result is achieved in less time.”82

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Reduced cost 93 94

The civilianisation of custody staff roles also significantly reduces the cost of custody suite management, due to lower staff costs compared to warranted police officers. Using warranted police officers to staff its custody suite would cost South Wales Police more than £3.2 million per year, or £33,000 per officer.95 However, the cost of the G4S CDOs is below £2 million, amounting to savings for South Wales Police of £1.2 million per year on staffing costs alone.

It has been estimated by G4S that at least £65 million per annum could be saved in England and Wales if police constable posts in custody suites were replaced with civilians in all 43 forces. The potential of significant savings through custody management outsourcing has also been noted by the former Chief Executive of the NPIA, Peter Neyroud.96

93 HMIC (2005), Baseline Assessment: South Wales Police, October 2005.94 Shirley Hodges, Co-ordinator of the South Panel of Independent Custody Visitors, South Wales Police Authority, Volunteers

Annual Report 2009-10. 95 G4S, Police custody outsourcing briefing note.96 Peter Neyroud (2009), Oral evidence taken before the Home Affairs Select Committee, 15 December. Quoted in Home

Affairs Select Committee (2009), Police Service Strength, Fifth Report of Session , 2009-10.

The introduction of civilian staff has been instrumental in “freeing up to 54 police officers for front-line duties and speeding up the custody process for arresting officers.”93

“We have all been very pleased to see improvements in the facilities for detainees in the new suite in Cardiff Bay. The custody suite is a much more pleasant environment for those who work there as well as those who visit.”94

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Company and length of contract Cambridge Education @ Islington became the education partner of the London Borough of Islington in 2000, taking on a contract to provide a full range of support services to the borough’s schools in April 2000. That contract has since been reviewed, and Cambridge Education @ Islington will continue to work in partnership with the council until at least 2013.

Cambridge Education @ Islington is a division of Cambridge Education Ltd., a member of the Mott MacDonald Group - a global independent education, health, management and construction consultancy with more than 40 offices world-wide. Employing just under 400 staff and based at four different locations within the borough, the company aims to improve the academic aspirations and achievement of all pupils and students in Islington through the provision of a range of high-quality advice and support services to schools, teachers, pupils, governors and the wider school community.

ChallengesIn 1999, during the last days of Islington Local Education Authority’s direct control, Ofsted described the LEA as being “in disarray”. Ofsted summarised its 1999 inspection report as follows: “The report identified failures of vision, strategy, planning and management in many areas. Overall, the LEA had lost the confidence of the schools and the parents. The Secretary of State issued a direction contracting out most of the LEA’s statutory functions.”

MethodThe contract with Islington sets out a range of Key Performance Indicators (KPIs) which are monitored on a termly and annual basis. These KPIs include pupil performance results, both at the end of Key Stage 2 and at GCSE, plus targets related to school exclusions, school attendance, statutory duties, strategic plans and policies, and surveys and customer feedback.

Cambridge Education @ Islington has innovated by delivering new, individual strategies to improve attainment for pupils from minority groups, in particular the African Caribbean, Bangladeshi, Somali, Turkish and Kurdish, boys; the white working class; and refugees and asylum seekers. In 2009, Cambridge Education @ Islington’s Ethnic Minority Achievement Service was asked by the government to coordinate and provide substantial elements of the delivery of the Pan London English as an Additional Language (PLEAL) Strategy.

Ofsted has praised the close working relationship between the council and Cambridge Education.97

97 Ofsted (2008), Annual performance assessment of services for children and young people in Islington Council 2008, December. “The partnership between the council and Cambridge Education, who provide most education services, is highly developed and effective.

Andrew Haldenby, Director, Reform

Cambridge Education @ Islington became the education partner of the London Borough of Islington in 2000, taking on a contract to run a full range of support services to the Borough’s schools. That contract was renewed in 2005 and 2009.

For-profit company helps to transform education London Borough of Islington

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OutcomesEducational outcomes in Islington have been transformed during the period of Cambridge Education @ Islington’s management.

Transformed education leadershipThe Cambridge Education contract began in April 2000 and by March 2001, Ofsted was able to say: “The tide has turned in Islington.” Its evaluation made clear that the letting of the contract itself was a turning point for education in the borough. The definition of roles provided by the contract had energised the elected members of the council to take strategic decisions, from surplus places to the budget. The new arrangements were already delivering better value for money despite the extra costs of strategic management involved in the contract. Ofsted concluded: “There is a forward momentum which is engendering the confidence needed to raise expectations on all fronts.”

Exceptional school improvement Taking the whole period from 2000 to 2010, Islington’s GCSE results have nearly caught up with the national average, having once being amongst the worst. The percentage of 15 year-old pupils achieving Level 2 (i.e. the equivalent of five GCSEs at grades A* to C) increased by 45.5 percentage points between 2000 and 2010. The average improvement for all English schools was 26.2 percentage points.

Cambridge Education @ Islington’s contract was renewed in 2005 and 2009.

The national experienceIn 2005, the CBI reviewed the performance of the nine LEAs that had outsourced some or all services to the private sector.99 It found:• The nine private sector-outsourced LEAs improved more than the average performance of all the LEAs

in England.• The performance of the nine private sector-outsourced LEAs improved more than LEAs that had

similarly low levels of educational attainment in 2000.

The CBI identified the following causes of the improved performance:• National leadership on the part of Ministers.• A renewed relationship between councillors and officials, based on the process of contracting with the

private sector.• Effective contracting based on performance management.• A fresh management approach.

The CBI noted, however, that the Government did not build on this success by opening education services in other areas to competition from the private sector. It put this down to “an underestimation of the cultural and political resistance from local authorities to a change in their role from direct providers to commissioners of services”.

98 Ofsted (2010), Annual children’s services assessment - London Borough of Islington.99 Confederation of British Industry (2005), The business of education improvement.

“School provision is strong in the borough with a higher proportion of primary and secondary schools that are good or better than found elsewhere. Most primary and secondary schools are good or outstanding.”98

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Company and length of contractEdisonLearning (formerly Edison Schools UK) was founded in 2002 to provide a range of frontline

school improvement and educational services in the UK.EdisonLearning is staffed by experienced UK educators and specialists in school improvement, and

headed by Director Tim Nash. The company is based in Coggeshall, Essex, and is a subsidiary of EdisonLearning Inc., based in New York, USA.

Founded as Edison Inc. in 1992, EdisonLearning is a leading provider of educational services in the US. EdisonLearning UK works with its educational partners and clients in a variety of areas, including school improvement, project management and curriculum development.100

EdisonLearning was awarded the three year Northamptonshire contract in 2008.

ChallengesAt the start of 2008, sixteen primary schools and three secondary schools in Northamptonshire were deemed to be at risk of underperforming. Six of the primary schools were in need of urgent intervention, three of which were given a notice to improve at their last Ofsted inspection. Seven of the sixteen primaries were in the bottom quartile of “value added” scores for assessment at Key Stage 2 (11 years old). All three secondary schools were part of the National Challenge programme for seriously underperforming secondaries.

These schools, together with Northamptonshire County Council, engaged EdisonLearning in 2008 to improve outcomes and help build sustainable capacity for on-going improvement. (They were joined by a fourth National Challenge secondary and another primary in 2009.)

MethodEdisonLearning adopted a dual approach of engagement with each individual school and with the network as a whole. Creating a robust network and shared leadership practices in the local system was

viewed as central to the success of the work.The company focused on collaborative change management, refining and reaffirming the schools’ ethos

and strengthening systems and processes. The goal was to transform those things that would have the greatest impact on standards: leadership and management, the curriculum and schools’ engagement with pupils and their families. The overall aims of the intervention were to improve the quality of teaching and

learning in the schools, and to strengthen the schools’ own capacity to improve and develop leadership.One of the key methods of engagement EdisonLearning uses is school-based development days

focused on classroom practice and leadership. These involve three key activities:• Classroom observation followed by individual feedback and coaching to improve the quality of

teaching and learning.• Training sessions with the whole staff to develop and share best practice.• Working with the head teacher and leadership team to support implementation and follow through of

the key actions.

Another principal activity was the formation of “achievement teams” – groups of teachers that use pupil assessment data as a basis for discussion about improving classroom practices, with a focus on

vulnerable pupils and those making insufficient progress.Through this direct, deep engagement with the schools’ staff, EdisonLearning aimed to drive

improvements in the schools’ performance in a way that would be sustainable and self-perpetuating. The company describes their aim as “building capacity in the school rather than making a ‘quick fix’”.101

100 http://www.edisonlearning.net/who-we-are.html101 EdisonLearning (2010), Northampton Town Partner Schools – Impact: One Year On.

For-profit company helps to improve schools Northampton

Dale Bassett, Research Director, Reform

In 2008, Northamptonshire County Council agreed a three-year contract with the for-profit company EdisonLearning to improve sixteen primary schools and three secondary schools across the locality.

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OutcomesThe immediate impact of the new school improvement programme was demonstrated by exam results, Ofsted inspections and feedback from the schools involved.

Exam resultsThe schools working with EdisonLearning achieved an average improvement of 33 per cent on the key 5 A* to C grade GCSEs including English and Maths measure in the first nine months of the work. There was a significant narrowing of the results gap between these schools and national measures, of 6 percentage points at Key Stage 4 and 22 percentage points across the aggregated level 4 in English,

Mathematics and Science at Key Stage 2, by the end of the first year of the partnership.102

All four secondaries improved their Contextual Value Added scores. The average gap in attainment between the primary schools and the national average halved, by the end of the first year of the partnership.103

Figure 4: Attainment of EdisonLearning partner secondary schools, average percentage of GCSE pupils achievingSource: EdisonLearning (2011)

2007 2008 2009 2010

English (Level 4 or higher) 69.5 72.3 72.7 73.9

English (Level 5) 20.8 17.3 18.6 22.1

Maths (Level 4 or higher) 64.9 67.8 70.8 74.6

Maths (Level 5) 19.4 18.8 23.9 23.8

Figure 5: Attainment of EdisonLearning partner secondary schools, average percentage of GCSE pupils achievingSource: EdisonLearning (2011)

2007 2008 2009 2010

5 A*-C incl. English and Maths 24.8 24.5 33.3 36.7

5 A*-C 34.5 38.3 49.5 55.7

Improved Ofsted results Ofsted has inspected several of the schools since the partnership with EdisonLearning commenced. Two of the schools were graded “good with outstanding features”, while another was removed from special measures.104 Three of the primaries were removed from “notice to improve”.105 Of the thirteen schools inspected, all but one were at least satisfactory; of the seven for which comparison to last inspection can be made, four improved their grades for overall effectiveness, achievement and value for money.106 One school, Duston Eldean Primary School, has been inspected twice during the period: the first inspection, at the very beginning of the partnership, in June 2008, judged the school to be satisfactory; in March 2011 it was been judged to be good with outstanding features.107

An Autumn 2009 assessment of the teaching quality across the schools found that 90 per cent of the teaching was satisfactory or better, with 62 per cent designated good or better.108

102 Ibid.103 Ibid.104 CBI (2010), Fulfilling potential: The business role in education.105 EdisonLearning (2010), Northampton Town Partner Schools – Impact: One Year On.106 EdisonLearning (2010), Case study: Northampton Town Area Improvement Partnership.107 Ofsted report.108 CBI (2010), Fulfilling potential: The business role in education.

“EdisonLearning describes their aim as building capacity in the school rather than making a ‘quick fix’.”

“84 per cent of the schools strongly agreed that ‘The school has made progress as a result of the partnership with EdisonLearning.’ All the schools considered the partnership value for money with three quarters strongly agreeing that this was the case”.

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It can be done

Positive school feedbackThe schools involved have expressed considerable satisfaction with the partnership. A 2010 survey of all the schools involved found: 109

• 99 per cent of all ratings were positive.• 84 per cent of schools strongly agreed that “The school has made progress as a result of the partnership

with EdisonLearning.”• All schools considered the partnership value for money with three quarters strongly agreeing that this

was the case.• All strands were regarded as having impact in the school.

Ongoing workFollowing their work in Northamptonshire and Essex, EdisonLearning launched their “Quality Framework for Teaching for Learning” in March 2011. Built on their experience working with these schools and developed in conjunction with the excellent school leaders and teachers, this programme takes these lessons to create a “complete set of tools and resources” to deliver school improvement.110

109 http://www.edisonlearning.net/evidence-and-impact/2010-customer-survey.html110 http://www.edisonlearning.net/news/edisonlearning-launch-the-quality-framework-for-learning-and-teaching.html

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