Tuesday, 29 October 2013

Letter to Weston Mercury on Cabinet Members' interests in health industry

I have sent this letter to the Weston Mercury:

Dear Editor

Readers may remember that the Weston Patients Before Profits Campaign asked John Penrose MP to look into the number of Cabinet Ministers who have financial interests in private health corporations. Our MP took the view that this was not something he should be expected to do. The Weston Patients Before Profits campaign has therefore done the research, and we have found that five Cabinet Ministers, and also five senior MPs who have access to the Cabinet, have private financial interests in the health care industry. Some of these are directly involved in Circle and Care UK who are interested in taking on the franchise of our Weston hospital. In addition to this, the Conservative party was given in excess of £95,000 by health and pharmaceutical industries in 2011.

It would be naive to suppose that these financial interests do not influence the decisions of Government regarding whether Weston General Hospital should be taken over by an NHS group or by a private corporation. The only way that these vested interests can be overcome is by a significant community protest.


Dr Richard Lawson
Walnut House
BS25 5NT

Saturday, 26 October 2013

George Osborne's links with Health Companies

Part 2 of our series on cabinet members' financial links with the Health Care Industry: George Osborne the Chancellor.

Osborne invited Lord Nash, chairman of Care UK and founder of Sovereign Capital, which runs a string of private Health Care firms, to join his HM Treasury Independent Challenge Group, whose remit is to “question the unquestionable” in the Treasury's austerity drive.

Cabinet Ministers' connections with Private Healthcare (Part 4)

The saga continues, listing Cabinet Ministers' sticky pie-covered fingers.

Philip Hammond, Defence Secretary was chairman of Castlemead Ltd for 2 years in the 90s. Castlemead has interests in design and procurement in the NHS. He still has a financial interest in Castlemead's perormance.

Maria Miller (Secretary of State for Culture Media and Sport) is a former director of Grey's Advertising Ltd, who work extensively with clients in the healthcare sector.
Former director of the Rowland Group, which became Publicis Consultants, who are also a marketing company working extensively with private healthcare.

Andrew Lansley, the architect of the controversial Health and Social Care Bill that lies at the root of the current issue for WGH, was replaced as Secretary of State for Health by Jeremy Hunt after his bill was forced through Parliament.

Lansley received £21,000 for his personal office from John Nash, former chair of Care UK, one of the corporations who are interested in Weston Hospital.

One of his aides, Christina Lineen, went to work for Circle, again a corporation interested in Weston General.

Lansley was director of Profero, a marketing agency that acted for Diageo, an alcohol company that was accused in 2008 of flouting voluntary agreements, but whom Lansley nevertheless later allowed to "educate" midwives in alcohol advice.

Francis Maude has access to Cabinet. He was a director of Huntsworth until 2005, which has health and pharmaceutical interests. He is also non executive director of two other companies with interests in health care and software supplies to the NHS.

Oliver Letwin: has access to the Cabinet. He was a non-executive director of N.M. Rothschild Corporate Finance Ltd until 2009. Rothschild Group are one of the world's largest investment companies and invest heavily in healthcare.

David Willetts has access to the Cabinet. He had financial support paid to his research account by HgCapital private equity manager, Ian Armitage in 2008. HgCapital funds healthcare companies.

Dominic Grieve has access to the Cabinet. Has shares in Reckitt Benckiser, GlaxoSmithKline, Diageo , Astrazeneca, Standard Chartered (Health insurance).

Source for this data here.

Friday, 25 October 2013

William Hague's link with health companies

Part 3 of our series setting out the links of Cabinet Ministers with private health companies.

William Hague, Foreign Secretary, was in 2008 a director of AMT Sybex, a supplier of IT (computer technology) to the NHS.

George Osborne's links with Health Care companies

Part 2 of our series on cabinet members' financial links with the Health Care Industry:
George Osborne the Chancellor.

Osborne invited Lord Nash, chairman of Care UK (interested in WGH) and founder of Sovereign Capital, which runs a string of private Health Care firms, to join his HM Treasury Independent Challenge Group, whose remit is to “question the unquestionable” in the Treasury's austerity drive.

Osborne is a friend of Geoff Bridges, who lobbies for Quiller which lobbies for Capita (interested in  WGH). Quiller is owned by Huntsworth, a healthcare communications group.

Osborne received help in develping policy from Boston Consulting Group who work extensively in healthcare. Three other firms with healthcare connections have advised Osborne with policy development.

Sources and links for this information can be found on the excellent Social Investigatons blog.

Thursday, 24 October 2013

David Cameron's financial engagements with health companies

We asked John Penrose MP to find out how many Cabinet members had financial interests with companies who stood to benefit from the increasing privatisation and franchising of NHS services.
He declined, and tossed the question back to us.

Although we feel that it is properly the job of an MP to investigate potential conflicts of interests in the Government which could distort decisions that bear on his constituents' interests, we have started the process here, not least because a Conservative researcher might be inclined to find out the whole truth.

We will post on the ministers one at a time. There is a lot to get through. "Over 200 parliamentarians have recent past or present financial links to companies involved in healthcare and all were allowed to vote on the Health and Social Care bill, turning it into an Act."

Our source is the excellent Social Investigations blog. though the Search the Money website is useful also.

We start at the top, with David Cameron.

Cameron (DC) has received £22,000 from Huntsworth, which has health interests. £10,000 went to his leadership campaign.

DC received £25,000 shortly after the health reforms were started from Lord Popat's TLC Group, which funds private nursing homes. Popat was made a Lord shortly after Cameron got into No 10.

DC has an adviser called Mark Britnell. He is/was head of KPMGs Global Health group. KPMG is heavily involved with the NHS dismantling reforms and CCGs. Britnell said the NHS should be shown no mercy.

In 2005 Cameron received £1,500 from care home property company Chiltern Care Holdings according to the electoral commission

Thursday, 17 October 2013

Question : how can private corporations be more efficient? Is there any evidence?

At the CCG meeting last Tuesday we were asked to submit a question in writing regarding the financial consequences of private corporations running NHS services, so that the CCG could forward it to the Trust Development Authority.

The question is – how can it be more efficient in cash terms for a private contractor to provide a product for the NHS, given the following circumstances:
·      The administrative work associated with granting the franchise?
·      The fact that a private corporation’s primary responsibility is to make sure that their shareholders get a bigger dividend each year?
·      The fact that generous salaries and bonuses must be paid to the directors of the private company?
·      The fact that the company is very likely to pay large fees to tax accountants in order to minimize the amount of tax that they will pay in the UK?

The flow of money in the classical NHS model is simple. Money goes from taxpayer to the Treasury to NHS patient services.

The flow of money in the case of a franchise to a private health corporation is from Taxpayer to Treasury to CCG to private corporation, some of which goes to patient services, and some to the corporation's shareholders as dividends and to bonuses, some of which will flow onwards to tax accountants and tax havens.

There is therefore a net outflow of money in the case of private corporations which does not exist in the NHS model.

As a supplementary question, is there any objective evidence that franchising is more efficient than the public service model. For instance in rail services franchising is there any evidence of increased efficiency?

The question has been put. We await a response.

Tuesday, 15 October 2013

North Somerset CCG meeting 15 October

Spending a sunny afternoon in the North Somerset Clinical Commissioning Group (CCG) with another campaigner. We put the question about the Kathy Headdon, the Chair, and her conflict of interest. The CCG will come back with a formal written response.

I asked how it could possibly be that a private company, with shareholders and overpaid bosses to feed, can be more efficient than the NHS model. They have asked me to submit the question in writing and they will get an answer from the  Trust Development Authority

Apart from that the meeting was a long exchange of information, mostly delivered in an inaudible monotone.

The one item of interest was when a GP, Dr Stephen Pill, raised the matter of rising demand by patients. He was told that not only demand, but demand for a more speedy response, is rising, and a paper measuring the demand will come to a later meeting. 

Demand management is vital to the survival of the NHS. Richard Lawson's book Bills of Health  showed that unemployment, poverty, bad housing and pollution absorbs up to 20% of GHE NHS clinical budget.

In terms of demand, we ain't seen nothin yet. North Somerset Council is about to put large numbers of people in poverty, in fear of losing their council houses and even make them homeless outright. This is through cuts in Council Housing Benefit relief. That is going to send people to their GPs in droves with anxiety, depression and exacerbation of physical illness.

Monday, 14 October 2013

Nine Myths about NHS privatisation

Reblogged from the excellent Red Pepper magazine:

Myth: We can't afford the NHS

International studies have consistently shown the NHS to be one of the most cost-effective health services in the world. A recent Commonwealth Fund study showed that the UK saves more lives for each pound spent, as a proportion of national wealth, than any other country looked at apart from Ireland. Among the 17 countries considered, the US healthcare system was among the least efficient and effective.

If we are agreed – and most people are – that the state has a role in providing health care, then the NHS is doing a good job with our money.  

Myth: ‘Health tourism’ is bankrupting the system

The most reliable figures suggest that unrecovered costs from treating foreign nationals account for less than 0.2 per cent of the NHS budget. The government has encouraged scaremongering as a useful distraction from the real problem of £20 billion in cuts to the service.

Myth: The government has no intention of privatising the NHS

Politicians assure us that the NHS will remain ‘free at the point of delivery’, but one tenth of surgeries are now privately owned, and contracts worth millions of pounds have been given to the likes of Virgin and Serco. Because contractors may go on using the trusted and familiar NHS logo, patients may not even know they’re receiving treatment from a private company.

These claims also assume that how we pay for our health care is the only thing that matters. The population values the public service ethos that has traditionally underpinned the NHS. Polls show that the majority of people want local and national government to run public services, and only consider contracting out if this fails. People also want accountable health care, while private contracts hide behind ‘commercial confidentiality’. The chair of the House of Commons public accounts committee, Margaret Hodge, says that even she can’t break through their wall of secrecy.

Myth: Private companies will deliver a cheaper and more efficient NHS

There is not a scrap of evidence that the price goes down and efficiency increases when private companies deliver NHS care. In fact, the evidence points the other way. Costs increase and services may well get worse. The fiasco of hospital cleaning has shown the reality of privatisation: apparent short-term savings, but at the expense of lower hygiene standards, higher rates of hospital-acquired infection, the break-up of established ward teams and casualisation of the workforce.

Already we have seen major companies such as Serco criticised for failing to report accurately on their performance. Recently an NHS contract for elective services with the private company Clinicenta was terminated due to poor quality care. It has been bought out at great expense to the taxpayer and taken back in‑house by the NHS.

Myth: The government’s reforms are aimed at cutting bureaucracy

The Health and Social Care Act was never about cutting bureaucracy, though that argument helped to get Lib Dems on board and push the massive bill through parliament. Today we have a bigger bureaucracy that consumes more time and resources. The 150 primary care trusts have morphed into 211 ‘clinical commissioning groups’ (CCGs). Most of the CCGs’ work is outsourced to ‘commissioning support services’ (CCSs), to be performed by people the NHS does not call employees, and who are not subject to the Freedom of Information Act. By 2016 these services will have been put out to competitive tender.

CCGs and CSSs are monitored by a new national bureaucracy, NHS England, which has 27 local area teams that don’t meet publicly or publish papers. Among the other tiers of bureaucracy are the health and wellbeing boards, Healthwatch England, toothless local Healthwatch patient groups (which are forbidden to conduct any ‘political’ campaigning), citizens’ panels, clinical senates and dozens more. The difference is that the new bureaucracy is less accountable.

Myth: The reforms will save money

The NHS is now less cost effective. Money is being wasted on turning hospitals into a market, in which they have to compete rather than cooperate and GPs are legally required to spend money on expensive and lengthy tendering processes. The proportion of the NHS’s budget spent on administration has increased dramatically, rising from around 6 per cent to around 15 per cent (the government won’t tell us exactly how much). An increase of this size represents about £10 billion. Another £54 billion has been spent on PFI projects that will eventually cost taxpayers an estimated £300 billion. Meanwhile, the NHS has suffered rationing, bed closures and staff cuts over the past two years. If we abandoned costly and unnecessary privatisation schemes, we would save billions for frontline care. 

Myth: The reforms will give patients more choice

Patients have less choice now than they did 20 years ago, when a GP could send a patient to see any provider. Many GPs are now given targets to lower their referrals to hospital. Referrals may pass through a management centre where they are checked and may be redirected by people with little or no clinical training and no knowledge of the patient. One in eight referrals is rejected altogether. Operations once available from the NHS, such as joint replacements and hernia repairs, are increasingly being rationed or withdrawn.

Market ‘competition’ is unlikely to result in diversity. Large companies have the resources to enter expensive tendering processes for NHS contracts, crowding out NHS workers and small social enterprises. Between April and August 2013, 16 major NHS contracts went to the private sector and two to NHS providers. If this continues we face the possibility of quasi-monopoly private providers, which may have more talent for winning contracts than for running clinical services. The private sector also has no obligation to provide a full range of services, so it tends to pick the ones it sees as profitable. Any replacement of local NHS providers by private companies can result in reduced services and gaps in care for vulnerable patients.

Myth: The reforms put GPs in charge

Polls show 73 per cent of GPs now believe they have been set up to take the blame for rationing health care. Far from being in charge, GPs will effectively be rubber stamping decisions imposed by NHS England and commissioning support services. Only a third of GPs are actively involved with the work of CCGs, and of those who are involved, more than a third have links with or shares in private medical companies and insurers.

Myth: The reforms give power to local people

Local consultations have been consultations in name only. Petitions with thousands of signatures have been ignored. After Lewisham’s local hospital was sacrificed – to bail out a nearby trust crippled by a massive PFI debt – community members had to take Jeremy Hunt to court to overturn the decision. Ministers have said they’ll appeal, or change the law if necessary to give themselves new powers, making their willingness to go against local people entirely transparent.

The English NHS is under attack as never before, with the government briefing against it at every opportunity and aggressively pushing a privatisation agenda. But the NHS wasn’t broken and didn’t need fixing. When the Labour government left office, the NHS had its highest ever popularity ratings. After investment in the service, waiting lists had come down and outcomes were improving rapidly. There was every reason to believe that a public, accountable NHS could continue to evolve, improve and meet the challenges of the future, including care for an ageing population.

Jacky Davis is a consultant radiologist, co-founder of Keep our NHS Public and co-chair of the NHS Consultants Association. She is also co-editor of NHS SOS: how the NHS was betrayed – and how we can save it (Oneworld Publications, July 2013)

Who is getting the NHS contracts? Private or NHS contractors?

Saturday, 12 October 2013

What is the evidence that Cabinet Ministers have interests in health corporations?

We asked John Penrose MP for a list of cabinet ministers who have a financial interest in health corporations. He answered that we should look for them ourselves, which is a bit disappointing. 
Normally John is very helpful. 
Maybe there is something to hide. 

We searched the Register of Member's Interests and they all came up clean as a whistle. The only interests recorded are a list of charities of which the Ministers are patrons. It reads like the records of daily activities in a monastery. 

The nearest to a hit on the Register was Mark Simmonds,  Parliamentary Under-Secretary of State in the Foreign and Commonwealth Office who had been a strategic adviser to Circle Healthcare. 

Then we hit paydirt on the excellent Social Investigations blog, which has:
 Compilation of vested interests
Over 70 MPs connected to private healthcare companies
Member of NHS Future Forum colluded with lobby group over competition

We have lifted the records of MPs who are either in the Cabinet, or who have access to the Cabinet.
We found 10 people who have financial interests in health companies, including David Cameron and George Osborne, William Hague and seven others.

We will put relevant parts of this information before our MP.  Our guess is that he will say that there is no evidence of wrongdoing here, and that all the connections are in the past. This is not good enough.

Reading the list, and realising that 200 Parliamentarians have financial interests in health corporations gives the ugly impression that a large number of MPs and Lords, mainly but not exclusively Conservatives, divide their time between their Parliamentary duties and various profitable directorships, while their financial investments, and those of their family, must powerfully influence their political decisions.

This is not good for democracy. MPs and members of the House of Lords should be working solely for the good of the nation and people of the United Kingdom. The vast number of directorships and financial interests they hold in profit making corporations is totally wrong.

In particular, the involvement of Cabinet members in Circle and Care UK, who are interested in the Weston franchise, casts doubt on the objectivity of the choice that will be made between private and NHS bidders.

The NHS - the Wolves are Circling

Thanks to the excellent Martin Shovel for permission to use this cartoon

Saturday, 5 October 2013

Good news on Wyre Forest

We can win

Oct 3rd

At a recent meeting held in public, the board of the Wyre Forest Clinical Commissioning Group (CCG), agreed NOT to tender out services to the private sector.

To the great satisfaction of members of the public present, board members approved the purchase of services from the current providers.

The controversial Health & Social Care Act is now forcing CCGs to go for competitive tendering, but the Wyre Forest board was persuaded that the existing providers were the most appropriate for the best integrated services and thus could avoid tendering.

If other CCGs could be persuaded to take the same approach to commissioning services, the coalition government’s hated potential privatisation of the NHS, pushed so forcefully by the Health and Social Care Act, could be halted in its tracks.

The first action point listed under the heading of practical steps you can take to save the NHS in “NHS SOS”, the splendid book by Jacky Davis and Raymond Tallis, is exactly relevant to this: “Attend CCG board meetings. Ask your CCG to adopt a pro-NHS code and to publish all their board papers, or explain where proposals are being withheld from public view.”

Tuesday, 1 October 2013

About the Private Health Corporations Who are Interested

Five private health corporations have expressed an interest:

  • Circle
  • Serco
  • Interserve Developments
  • Capita
  • Care UK

Circle claim to have a co-operative type of structure like John Lewis. However, it is not quite as straightforward as that. Their corporate history is convoluted. Their financial record at Hinchinbrooke Hospital is not good.

Hinchingbrooke Hospital in Cambridgeshire was franchised to private company Circle in November 2011 for a period of 10 years. Circle promised unprecedented savings. Government ministers were clearly in a hurry to give privatisation of the NHS a kick-start. Yet a year on, MPs on the House of Commons Public Accounts Committee who investigated the deal described the savings plan as ‘over ambitious’ and ‘unachievable’. Despite promises to pay off Hinchingbrooke Hospital’s debts this is unlikely to happen. Indeed it emerged that the deal was structured to allow Circle to take a profit of £2m each year and not pay down the debt. Despite plans to break even in the first year, the Trust is currently forecasting a deficit of £3.7m. Circle also parted ways with its Chief Executive only 6 months into the project. From NS Unison website

The MPs commented that ‘franchising’ in the NHS is untested and were considered that others were considering going down the same road before the full outcomes of Hinchingbrooke can be tested.

The MPs on the PAC made a series of recommendations aimed at preventing a repeat of the clear mistakes made at Hinchingbrooke.

Circle are UK tax avoiders. "Circle Health, the self-styled “social enterprise” that became the first private company to take over the management of an NHS hospital, is owned by companies and investment funds registered in the British Virgin Islands, Jersey and the Cayman Islands. " Corporate Watch 

Serco is another private corporation that is interested in Weston. However, they are controversial, with problems with inhumanity abuse in one of their operations and failure in its pathology services. Highly relevant is the fact that the Irish Government has cancelled Serco's bid to take over one of its services because it is under investigation  for overcharging the tax payers by £50 Million. Which taxpayer? Us - the UK taxpayer.

So the Irish block Serco, but the British do not. It is up to us to press the Government not to deal with this company until the investigations are complete.

Interserve is interested.

Care UK is reducing its tax liability by routing £8m a year in interest payments on loan notes issued in the Channel Islands.

Capita is compromised because it has a consultant who is Chair of the Clinical Commissioning Group and the Stakeholder and Quality Assurance Group.
Here is some background on Capita Group:

Capita is a major company which does an extensive range of work in most areas of the public sector, and for many private companies. Its income from the public and private sectors is roughly equal.  Its half-year results for the six months to 30 June 2013 show a half-year revenue of £1.8 billion and half-year profits before tax of £205 million. In the same six-month period, it secured new contracts worth £2.0 billion.

Capita Symonds is the property and construction management subsidiary of Capita.

There is a health division, Capita Health and Wellbeing, which has clinics which provide occupational health services to employers.

At present Capita does not appear to run clinical treatment or care centres, but in early August 2013 Capita and Circle announced that they are forming a partnership to bid for a range of NHS contracts including those for hospitals, adult and social care and administrative systems. (Financial Times, 1 August 2013)

The company is one of the hundred largest listed on the London Stock Exchange. By far the biggest shareholder, with 22.4% of the shares, is Invesco Asset Management Limited, a fund and asset management company.

Local contracts
Capita Symonds worked for North Bristol Trust on the accommodation for its children’s service.

A flavour of those Capita activities which have generated controversy can be found in its Wikipedia entry from which the following examples are taken.
In March 2006 Executive Chairman Rod Aldridge resigned in the aftermath of claims that contracts awarded to the Group were influenced by his loan of £1 million to the Labour Party.  Aldridge resigned saying that he denied the claims, but to avoid any lingering doubts about it, he was leaving the company.  Aldridge is a lifelong Labour supporter, and had overseen the company's growth from a small company in 1987 to a FTSE 100 member in 2006.

Capita manages the Criminal Records Bureau for the Home Office. In 2002, when mandatory CRB-vetting of all workers with children was brought in, a large number of teachers were temporarily unable to work after Capita's systems had difficulty with the workload and were subsequently overwhelmed, meaning that the start of the academic year was delayed in some places.

In 2006 Capita Financial Administrators (CFA) was fined £300,000 by the Financial Services Authority for having poor anti-fraud controls.


NHS Chief Says Government's Reforms are Harming Patient Care

Sir David Nicholson, the outgoing NHS chief, has said that the Coalition's health "reforms" are harming patient care because rules about competition stop trusts from doing what they want to improve services.

Meanwhile, Labour has pledged to repeal the NHS reforms. This means that if Weston is franchised to a private company, and Labour gets in, the whole thing will have to be unpicked. So the Weston Hospital Board would play it safer if they choose an NHS Foundation to take over Weston.