NHS for Sale: Myths, Lies & Deception (27 page)

The process of privatisation has also been helped along by the outsourcing of NHS policy decisions to private companies – the so-called privatisation of policy – and by the infiltration of the NHS by private sector cheerleaders. These are typically people who come from a private sector background to work in or advise the NHS and/or those with financial interests in the private sector who are appointed to positions of influence in the NHS.

Typical of the latter is Lord Carter of Coles, the Labour peer who founded Westminster Health Care and built it into a major healthcare provider, which he sold in 1999. His own biography says ‘He is a private investor and director of public and private companies in the fields of insurance, healthcare and information technology’.
⁷⁸

In 2008 Lord Carter, (who also conducted the pathology
reviews mentioned above), was appointed as chair of the Competition and Co-operation Panel (CCP), in which position he was meant to ‘ensure fairness when private-sector firms bid for public contracts’. In March 2012
The Daily Mail
revealed that he had a number of well-paid positions with the same private firms which were bidding for NHS contracts, including chairman of the UK branch of the American healthcare firm McKesson (for which he had received £799,000 in the previous year). There were immediate calls for him to step down, including from Professor Clare Gerada,
*
who said, ‘he cannot have any credibility when he is also heading a company with such huge interests in the very contracts his organisation is meant to police’.
⁷⁹

Another classic example is that of Sir Stuart Rose, former head of Marks and Spencer, who in February 2014 was appointed ‘to lead a review into how to improve management in the NHS in England’. The BBC headline: ‘Ex M&S Boss to Advise NHS Managers’,
⁸⁰
typically enquired no further but others were more curious and 4bitnews was soon reporting that Sir Stuart had some worrying conflicts of interest
⁸¹
in his new role. He was,
The Independent
reported: ‘paid to sit on the advisory board of Bridgepoint, an international private equity group, which is the major shareholder of private healthcare firm Care UK. Care UK is in the running to take over the George Eliot NHS Hospital Trust – one of 14 hospital trusts in Sir Stuart’s review.’

A DoH spokesperson hastened to reassure everyone that Sir Stuart ‘committed to recuse himself from any relevant
health discussions at Bridgepoint European Advisory Board meetings’ but it didn’t look good for transparency in the NHS.

There are many egregious examples of such conflicts of interest and the curious reader is referred to the NHS Support Federation website ‘NHS for Sale’,
⁸²
which includes details of the revolving door between the public and the private sector as well as the financial interests of peers and MPs who voted on the HSC Act. The latest politician to pass through the revolving door between government and the private sector is Stephen Dorrell MP, until recently Chair of the House of Commons Health Select Committee. He took a job as a ‘health policy consultant’ with KPMG, and announced that he would be standing down at the general election as his new position would be ‘incompatible’ with his role as MP. He did not apparently see any problem with staying on as an MP until then, and there were immediate calls for him to step down, not least because KPMG was looking to bid for a £1bn NHS contract. Labour MP Grahame Morris referred him to the Commissioner for Standards for a possible breach of the Commons Code of Conduct and Dr Clive Peedell said: ‘This case demonstrates everything that is rotten about our political system.’ KPMG declined to reveal his salary but noted that ‘his knowledge and expertise will be a huge help’.
⁸³

Another appointment that raised eyebrows was that of Lynton Crosby, hired as an advisor to David Cameron in 2012. His PR firm had previously advised businesses looking for NHS contracts, and Andy Burnham thought it was no coincidence that after his appointment the government announced new rules on tendering out all NHS contracts.
The Mirror
quoted Burnham:

Shortly after Lynton Crosby started work for the Conservatives, the Government shifted its position in favour of private health companies by trying to sneak NHS regulations through the House, forcing services out to the market. At the time, experts expressed surprise at the sudden shift. Now we can guess why. Once again, it is more proof that you can’t trust David Cameron with the NHS.
⁸⁴

One the most alarming and insidious encroachments of the private sector into the NHS has been via the ‘privatisation of policy making’, much of which has involved the big management consultant firms. McKinsey (the Jesuits of capitalism) have for example been called the ‘firm that hijacked the NHS’ and they have been credited with undue influence at every level from coming up with the £20bn ‘efficiency’ savings to drafting the HSC Bill. A 2012 article in the
BMJ
– ‘Behind closed doors: how much power does McKinsey yield?’ – revealed the full extent of their penetration.
⁸⁵
Former and current senior staff could be found in many influential positions including ‘think tanks’ like the King’s Fund and the Nuffield Trust, as well as NHS bodies such as Monitor, and there is a revolving door between McKinsey and government departments
⁸⁶
with consultancy staff on government secondment while ‘civil servants leave to join consultancies they may previously have hired’.
⁸⁷

(More details of the web of connections between government, management consultants and the lobbying industry can be found in the appendix on the health lobbying industry).

The term ‘creeping privatisation’ is now appearing in the media, but as ever they are behind with the NHS news. Under the coalition the process has accelerated from creeping to galloping and is now, to mix metaphors, advancing across the front lawn and kicking down the door. Despite the evidence all around us the media are still often surprisingly shy about using the word – even
The Guardian
still sometimes puts it in inverted commas as though there remained some doubt about it.
⁸⁸

In their excellent book
The Plot against the NHS,
Colin Leys and Stewart Player write: ‘For 20 years successive governments have pursued a policy [for the NHS] that the public hasn’t voted for and doesn’t want.’ The public has never voted for privatisation of the NHS and certainly doesn’t want it. Poll after poll shows that the public does not want further involvement of the private sector and would be prepared to pay more for the NHS. According to a 2013 YouGov poll, 84 per cent of the public would prefer to see the NHS run as a not-for-profit public service, whilst just 7 per cent favour privatisation.
⁸⁹
The latest poll shows 80 per cent of the public are ready to pay higher taxes to protect the NHS from privatisation.
⁹⁰
And yet by all accepted criteria the coalition is proceeding with the privatisation of the NHS while denying what it is doing. Hundreds of GP surgeries are now owned by private companies and billions of pounds worth of contracts have been awarded to the likes of Serco and Virgin.

Chapter 8
has already examined why the private sector should not be delivering NHS care, and
Chapter 11
will expose some of the reasons why privatisation is nevertheless still on the political agenda. In the meantime we must continue to explain to the public and the media that we are not, as
ministers suggest, indulging in ‘ludicrous scaremongering’ but responsible truth mongering. We must use the ‘P’ word on every possible occasion. Privatisation is proceeding apace and will do irreparable damage to the NHS and our patients.

Will Hutton recently wrote an article in
The Guardian,
contrasting the public and the private sector. He accused the latter, exemplified by G4S and Serco, of having ‘built a culture in which exploiting, rather than serving, the customer comes first’. The NHS on the other hand: ‘still manages to combine humanity and efficiency. Its systems are not extravagant, but there is a sense, as I recently discovered with a close family member in a long spell in hospital, that the patient remains at the centre of everyone’s preoccupations.’
⁹¹

This is the precious quality we stand to lose when we privatise public services, in particular a service as person-centred as the NHS. The final warning comes from Professor Arnold Relman, the former editor of the
New England Journal of Medicine:

The continued privatization of health care and the continued prevalence and intrusion of market forces in the practice of medicine will not only bankrupt the health care system, but also will inevitably undermine the ethical foundations of medical practice and dissolve the moral precepts that have historically defined the medical profession.
⁹²

_____________

*
Tory MP, previously head of the Privatisation Unit at Rothschild’s in the 1980s, then in Margaret Thatcher’s policy unit, currently Chairman of the Conservative Research Department and of the Conservative Party’s Policy Review.

*
Unite has published an informative pamphlet on the privatisation of the NHS in England
http://www.unitetheunion.org/uploaded/documents/GuideToNHSPrivatisation11-10734.pdf
.

*
Despite the fact that the government had promised there would be no competition on price.

*
It has proved impossible to establish a figure. There is little or no government transparency about the rate of privatisation of NHS services.

*
This chapter was written before the events of January 2015 mentioned in Chapter 12.

*
Although rumour has it that the tendering process itself had cost up to £10m.

**
Donors were not slow to express their dismay that a rumoured £800,000 of their donations to Macmillan were being spent on helping private companies bid for NHS cancer services.

*
The local hospital has already written to local GPS expressing serious concerns about the viability of local A&E departments if orthopaedic services are outsourced.

*
The article is worth reading in full because of the covert connections it reveals between some NHS officials and the private sector, and some interesting facts about McKesson’s criminal record in the US, where its chief executive was jailed for one of the biggest corporate frauds in American history.

We’ll cut the deficit, not the NHS.
¹

David Cameron, election poster 2010

We were told that whilst we would lose our A&E, we would also gain all these excellent community services. Now they’re planning to cut millions from their budget that would have been spent on community services. It’s unfair on residents.
²

Sharon Massey, Bexley council’s cabinet member for health, February 2009

Despite David Cameron’s pre-election promise to ‘cut the deficit, not the NHS’, cuts in health services resumed within weeks of the 2010 election, driven by the freeze on NHS budgets. By October 2014, 66 A&E and maternity units had been closed or downgraded along with the loss of 8,649 beds. One fifth of these were mental health beds, but most were ‘general and acute’ beds dealing with emergencies and waiting list patients, many of them older people for whom there is only restricted provision of social care after 27 per cent cuts in local government spending.

Cost-saving schemes in various hospital reconfiguration plans include reducing ‘non-elective’ admissions (i.e.
emergencies and urgent referrals), as well as cutting numbers of A&E attendances, outpatient appointments, and even elective (waiting list) operations. So each of these ‘efficiency savings’ is in fact a planned
reduction
in the availability of services.

Many reconfigurations revolve around closure or downgrading of an A&E, even though A&E services represent only a very small share of NHS spending. However, closing A&E is often a first step to downgrading and closing hospitals.

No closure plans are ever honestly presented as cuts: they are painted up as ‘reconfigurations’ to centralise services in other hospitals, and treat patients ‘closer to home’. But hardly any of the promised community-based or primary care ‘alternative settings’ for care actually exist, even on paper. There are no staff, no premises, no plans, no money and no political will to establish these services – which may well prove more expensive and less efficient than the hospitals they are supposed to replace.

The evidence for cost savings from developing GP and community out of hospital initiatives is very limited. In 2012 authoritative research challenged the received wisdom that hospital admissions could be reduced by improving primary care interventions, especially those aimed at ‘high risk’ patients.

Promising to locate more and more services in smaller community settings ‘closer to home’ makes good soundbites, but hard questions need to be asked about the costs and efficiencies involved, and availability of essential but sometimes scarce professional staff. It’s clear that most local communities have not been persuaded: campaigns continue against almost every cutback and closure.

* * *

Cuts, closures and plans for reconfiguration did not begin in 2010 with the Tory-led coalition government, but they have proliferated in the last few years and will continue to pose a threat to services until such times as the spending freeze is broken and serious fresh investment can match resources to local needs.

Already the impact has been considerable. In October 2014 the staunchly Tory
Daily Telegraph
published an updated list of the 66 A&E and maternity units that had been closed or downgraded since 2010,
³
or were still under threat, four years after David Cameron and then shadow health minister Andrew Lansley had toured the country promising to halt such closures and ‘cut the deficit not the NHS’.