A summary of our history

Taken from

A Passion for Care The first 50 years of Nuffield Hospitals The origins of Nuffield Health can be traced back to the fundamental changes that occurred in the healthcare sector in the aftermath of World War Two. Before the war, there were broadly three classes of care available: the wealthy retained the services of the best physicians and surgeons in private practice; increasingly professional services were being provided through patrician employers such as Rowntree in York, while the middle classes were beginning to have access to similar levels of treatment via contributory insurance schemes provided by provident associations and 'friendly societies'; and the poor relied largely on charity and some council-run facilities.

The National Health Service Act of 1948 promised free medical and hospital treatment to all. In this context the ongoing role for contributory insurance schemes seemed very much in doubt—why would anyone pay over and above tax for a service they could get for free?

When the British United Provident Association (BUPA) was formed in 1947, incorporating several smaller organisations, many suspected that its primary function would be to wind-up the existing services, and indeed subscriptions fell for the first three years. However, the demand for an independent alternative to the NHS was much stronger than had been expected. One factor that appeared to have been underestimated was the belief among the middle classes that those who could afford to pay for themselves should do so—the NHS was seen as a form of charity, to which only the truly needy were entitled. Clearly, others wanted a higher standard of care for their families than the young NHS could provide, and were prepared to pay for that. A third factor was undoubtedly the desire of many surgeons to retain their private practice.

By the end of the 1950s, BUPA's subscribers numbered nearly a million and the demand for care was outgrowing the limited number of pay-beds available in public hospitals and the capabilities of the older charitable nursing homes. The key issue now was finding facilities suitable to provide the level of care required.

It was on the 14th January 1957 that BUPA's Governors established the Nursing Homes Charitable Trust (which would some years later become Nuffield Hospitals and then Nuffield Health), with the intention of acquiring or building community hospital facilities properly equipped for the demands of modern medicine. In 1959, Lord Nuffield—the ennobled motor tycoon William Morris, then President of BUPA—suggested that the new charity might benefit from incorporating his name in its title and so it was re-registered as the Nuffield Nursing Homes Trust (NNHT). Although he gave permission for his name to be used—an early example of astute branding—Lord Nuffield never provided any capital funding.

In the early years, the Trust grew up side by side with BUPA, sharing many of the same Governors and managers including Sir Andrew Rowell, who was president of both BUPA and NNHT, and Teddy Webb, who was also instrumental in the founding of both organisations and served as life president of Nuffield Hospitals until passing away in 2005. Teddy's outstanding contribution to independent healthcare was recognised by a Laing & Buisson award in 2006.

In January 1958, the Trust purchased the Strathallan nursing home in Bournemouth for £23,150. It was closed for ten months to be totally refurbished, and reopened in November as the very first Nuffield Hospital.

In its first ten years, the Trust acquired and modernised a total of six dilapidated nursing homes and built seven new ones, together providing more than 400 beds. (By contrast, only one new hospital was built by the NHS in the first 13 years of its existence). Among the institutions saved by the Trust were some of the oldest and most famous in the country, such as the Royal Scottish Nursing Home, Edinburgh, and the Acland Hospital in Oxford. Another was Fitzroy House in London, which, under the patronage of Queen Victoria, had been the original prototype not only for the private nursing home, but also for the pay-bed wards of the teaching hospitals. The earliest purpose-built hospital opened at Woking in 1962; others followed at Exeter, Shrewsbury, Hull, Birmingham and Slough. In 1966, the NNHT opened a new flagship hospital in London’s Bryanston Square, built at a cost of over half a million pounds.

The funding from this growth came from a variety of sources. Enormous support was received from the larger provident associations including PPP (Private Patients Plan—now part of AXA), BCWA (Bristol Contributory Welfare Association, now part of SimplyHealth), WPA (Western Provident Association) and, of course, BUPA, who all made loans on favourable terms as they were keen to nurture the development of a credible care provider. Also keen to nurture improved local care were philanthropic members of the community, often including doctors, who generously gave many millions of pounds in the form of legacies and covenants. Indeed at one point the Trust employed a Director of Fundraising with a professional staff whose job it was to maximise this source of income. Throughout its history, Nuffield Hospitals has enjoyed excellent relationships with the banks, notably Barclays, who have been the company's bankers since 1957 and have supported all of the capital expansion projects.

However, according to Sir Arthur Bryant , “Once a home had been established, the Trust’s policy was to run it on strictly self-supporting, though non-profit-making, lines, charges from patients being expected to cover not only operating costs but repairs and depreciation.”

During the 1970s, the work of the Trust continued to expand impressively, with another 15 hospitals opening. Patient income increased from £1.7 million to £14.5 million by the decade’s end. At the start of the 1980s, two new hospitals were opened in Stockton-on-Tess and Derby. A new concept was incorporated into these sites—they were designed with a 'core' of operating theatres, kitchens and other facilities capable of supporting a larger hospital, allowing them to be expanded at a later date at only marginal cost.

Growth was further boosted by changes to health policy in the 1970s, championed by Barbara Castle, that pay beds should be removed from all NHS hospitals (in practice only a third were removed and the policy was later reversed—the NHS is currently the third largest provider of private care), and by new demand for private health insurance during the 1980s.

In 1982, the Nuffield Nursing Homes Trust celebrated its 25th anniversary, by which milestone it had grown to 31 hospitals and 1,076 beds. Turnover was in excess of £33 million. Looking back on the first 25 years, the then Chairman Harry Axton commented: “It is no exaggeration to say that during the majority of those years it was BUPA’s encouragement and financial support that enabled the Trust to develop so rapidly.” Ironically, BUPA’s own hospitals, along with British and American commercial operators, were now providing increasing competition in the field of private acute medicine. The Trust by now had its own governance arrangements and no longer depended upon BUPA.

In 1983, the trading name of the company was changed to Nuffield Hospitals, the 'nursing homes' element of the old name being dropped because it failed to convey that the group now operated well-equipped modern hospitals offering a wide range of major surgical and medical treatments.

Well-equipped was the key word. Advances in technology were having a major impact on patient care. Equipment which did not exist ten years previously was now commonplace in hospitals, examples being sterile enclosures and gas scavenging systems for operating theatres, image intensifiers and ultrasound equipment in X-ray departments, and flexible endoscopy instruments. A major development was the establishment of fixed cost surgery, meaning that patients had certainty as to how much treatment would cost.

Insured and paying patients remained the core business of Nuffield Hospitals throughout the 1990s and remain so today. The new millennium heralded some liberalisation of the public health market as the Government turned to the private sector to reduce waiting lists, presenting the group for the first time with the opportunity to work more closely with the NHS. Nuffield Hospitals has been vocal in its support of NHS reform and has embraced the opportunity to provide care free at the point of need. By 2005, Nuffield Hospitals had established itself as the largest independent provider of surgery to NHS patients. Although a degree of tension remains in the relationship between the NHS and independent providers, in general there is cautious optimism about the potential for a successful working relationship going forward.

However, in spite of rapid growth and the appearance of steady success, the organisation's journey has not always been straightforward. By the late 1980s it was clear that the rising costs of modern medicine, coupled with changes in the perceived role of private healthcare, meant that donations could no longer play a significant role in the growth of Nuffield Hospitals. Oliver Rowell, son of Sir Andrew, realised during his time as Chief Executive that the company had to become more commercial in order to remain sustainable. The fundraising operation was wound up, and the Trust became almost wholly dependent on being able to cover its costs from the charges made for treatment.

There were also entries into various markets that were not sustainable, including a single foray into the provision of care for the elderly at Redhill in Surrey. Somewhat ahead of its time, Redhill was what would now be recognised as a close care community. Among the Trust's earlier acquisitions were the Lansdown Nursing Home in Bath, which was sold in 1983, and the Royal Scottish Nursing Home in Edinburgh which was rescued from closure in 1961 and sold in 1979. The Trust has twice had an operational presence in central London, through the flagship Fitzroy Hospital on Bryanston Square which was part of the group for thirty years from 1966, and later the Nightingale Hospital, sold in 1986. The Princess Christian Hospital in Windsor, was also part of the group from 1996 to 2004. Various other facilities, starting with the Strathallan Nursing home in Bournemouth, have been sold or closed as they have been replaced with newer, more modern facilities.

It is interesting to note that this year BUPA has decided to sell the group of hospitals that it began building in the late 1970s during the period of rapid growth. With those hospitals going into private equity ownership, Nuffield Hospitals is once again the only not-for-profit independent provider in the market, other than the various smaller organisations that manage one or two facilities.

In recent years, the Trust has opened purpose-built modern hospitals to replace older facilities in Cheltenham, Hull, Leeds, Oxford (The Manor) and York. Among these, Leeds and the Manor in particular represent the evolution of independent healthcare, incorporating advanced facilities such as intensive care units and enabling the provision of an enhanced range of services. New techniques allow improved recovery and reduce the time that a patient needs to stay in hospital.

The group has also begun to diversify, acquiring Vanguard Healthcare, which operates the world's most advanced mobile hospital solutions, and launching Nuffield Proactive Health, the UK's leading provider of workplace health and fitness services, which has also brought new dynamism to health screening and physiotherapy.

At the age of 50, Nuffield Hospitals is an organisation employing several thousand people with a turnover approaching £500m per annum (it actually passed this mark in 2005). It is the UK's largest trading charity, one of the largest not-for-profit organisations, and the second largest independent provider of hospitals and health services. Most importantly, the group's forty hospitals saw more than one million patient visits in 2006, while well over 100,000 people benefited from the services offered by Vanguard Healthcare and Nuffield Proactive Health.

Some information here is taken from the publication A History of the British United Provident Association 1947-1968, Sir Arthur Bryant, published by BUPA.

Postscript  Since A Passion for Care was written, Nuffield Health has acquired (in November 2007) Cannons Health & Fitness.  On 1 February 2008 Nuffield Hospitals sold 9 hospitals to the General Healthcare Group.  The nine hospitals were in: Birmingham, Bury St Edmunds, Gerrards Cross, Harrogate, Huddersfield, Lancaster, Lincoln, North London and Nottingham.