Change.org petition to keep Weston Hospital out of private hands

Please sign the petition to keep Weston as part of the NHS.

It reads:

NHS Trust Development Authority: We want our local hospital, Weston General, to be partnered by an NHS trust and we want reassurance that a full 24/7 A & E Department will remain at Weston General.

A big petition from local people will be very effective indeed because this whole fiasco began with the decree that all hospitals should become Foundation Trusts, so that they would be more responsive to local needs. If local people reject the privatisation of Weston services, the Trust Development Authority will have difficulty explaining the logic of privatisation.

Serco Lose Cornish Contract

Serco, one of the potential private bidders for Weston Hospital services, has lost its contract to provide out of hours services in Cornwall following evidence that it has been falsifying its performance data to pretend it was meeting targets. This is in addition to its criminal investigation for claiming to be tagging prisoners who did not exist.

This makes it increasingly likely that it will have to withdraw from the Weston franchise, although we do not yet have any firm indication of this. Weston's MP John Penrose, who is clearly pro-privatistation, has taken a hands-off approach with regard to Serco so far, but even he must be feeling uncomfortable at the prospect of handing local health services over to such an flawed corporation.

Assuming that Serco is rejected, this leave four corporations still circling over the hospital -
Interserve, Capita, with its conflict of interest, tax-dodging Care UK and - excuse the pun - Circle, who are getting into difficulties over their take-over of Hinchingbrooke Hospital..

Update 3.1.14
 The Serious Fraud Office is currently looking into whether Serco have been charging the Ministry of Justice for tagging offenders who did not exist.. This may take many months or even some years. So unless Serco is asked to withdraw its expression of interest, the franchise contract for Weston Hospital may be handed to a company who could later face legal prosecution for fraud.

Some surgical activity down in North Somerset

The BBC has an NHS activity monitoring chart here.

Cataract operations for North Somerset are down 7% in 2012 compared to 2010.
Hips are up 7% in the same period.
Knee ops are up 0.95%

Overall they are down 2.8%, because cataracts are much more numerous than the others.

Why the change? It is suggested that the ops are being rationed, possibly to save money.
But we would need to have more detailed information to get any significant knowledge.

Cabinet ministers with financial interests in private health corporations

This is an amalgamated version of info that is spread on 3 pages of this site

Interest of Cabinet Ministers, and those with access to Cabinet, in private heath corporations

Prepared for John Penrose MP by Dr Richard Lawson
Friday, 06 December 2013


1 David Cameron  (DC) Prime Minister 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  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.


2 George Osborne (Chancellor of the Exchequer) 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.


3 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 performance.


4 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.

5 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.

6 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.

7Oliver 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.

8 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.

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


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

Source: http://socialinvestigations.blogspot.co.uk/2012/02/nhs-privatisation-compilation-of.html

Weston PB4Profits makes formal complaint over CCG Chair's Conflict of Interest

Today the Campaign has made its formal complaint to the NS Clinical Commissioning Group against the conflict of interest of its Chair, Kathy Headdon, who is also a consultant for one of the corporations interested in WGH. Here is the text:

Dr Mary Backhouse
North Somerset Clinical Commissioning Group
Post Point 11,
Castlewood
Tickenham Road
Clevedon
North Somerset
BS21 9BH


Dear Mary

I am sorry to have to make a formal complaint against the Clinical Commissioning Group on behalf of the Weston Hospital Patients Before Profit Campaign. I know that complaints are distressing for the recipient, and we do not undertake this lightly, but only because we believe that the long term medical interests of the people of North Somerset will be benefited by our action.

Our complaint is that there is a clear conflict of interest for Kathy Headdon in holding the chairmanship of the NSCCG (and also the Stakeholder and Quality Assurance Group, though this does not concern the CCG directly) while also holding a consultant position within Capita Symonds Ltd, one of the corporations who have expressed an interest in the WGH franchise, as a consultant. There is a clear and direct conflict of interest here. In addition, as Chair of the NS CCG she has to have "Experience of giving an independent view on possible internal conflicts of interest", and her own CoI will clearly inhibit her discharge of this role within the CCG.

We have read the response of the Group, which is that she will absent herself from discussion when Capita is under discussion, and we are not satisfied. There is much more to the dynamics of a committee’s thought processes than the precise words spoken in specific debate. There is an ethos and an emotional undercurrent at play at all times in any group of people, but especially with a decision-making committee. One of the most onerous decisions that your committee and the Project Board face is whether the partner organisation chosen for WGH should be NHS or private. We cannot be persuaded to believe that is it possible that such a decision could be made in a neutral and balanced way when the Chair of the Committee is known to be a consultant for a private corporation.

If, despite our representations here, Kathy Headdon stays in position, and ultimately the decision is made to give the franchise to a corporation, the campaign will not accept the decision, and will request a Judicial Review. The Committee should also consider that a rival corporation might also request a Judicial Review. I do not need to remind you of the financial and opportunity costs implicit in defending your decision in a Judicial Review, costs which will diminish the service that the Hospital can offer to the community.

It is for these reasons that our Campaign is making a formal complaint, and having exhausted all local processes, is prepared, regretfully, to take our complaint to the NHS Ombudsman.

Sincerely


Richard Lawson

Public opinion is 47-42 against privatisation of NHS

Public opinion is turning against the Tory/LibDem plans to give more and more contracts to private health corporations. Over the last 3 years, those against privatisation have gone up from 36% to 47%, and those who do not care are static at the 41-42% mark.

The amount of taxpayers NHS money that has gone to corporations has risen by 55% in 5 years, from £5.6 billion to £8.7 billion.

So the WGH PB4P campaign now represents majority opinion. Which is nice.

Petition launch covered by Weston Mercury

Thanks to Weston Mercury http://www.thewestonmercury.co.uk/news/petition_launched_to_protect_hospital_s_a_e_1_2982297

The Weston Mercury has kindly reported on our petition launch here.

Correspondence with the Trust Development Authority

I have had a reply to these questions that I sent to the Trust Development Authority, the body that will take the final decision on Weston's fate. 

I asked: 

– 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 TDA answer:

Dear Dr Lawson 

Thank you for your correspondence of 17 October 2013 which has been forwarded 

to me from North Somerset Clinical Commissioning Group (CCG) for response. 

You will be aware that, like many other small hospitals, Weston Area Health NHS 

Trust has faced, and continues to fact a number of challenges to ensuring that 

services provided are financially and clinically sustainable. Over the last few years 

Weston has explored all the options to meet these challenges, ranging from 

achieving elite Foundation Trust status to developing an integrated care Trust. None 

of these options could be made to work. The do nothing option is likely to require a 

circa £80 million subsidy over the next five years and this position is clearly not 

sustainable or affordable to the local health economy. This work has, 

understandably, taken considerable administrative and clinical time and effort. 

Starting in October 2012 the Trust and local stakeholders conducted a further option 

appraisal. In March 2013 the Strategic Health Authority together with the Trust 

concluded that after having exhausted all the other possible options, the best 

solution to reduce the need for future financial support was to run a competition to 

find an innovative partner to improve the quality and safety of services and to help 

run services more sustainably. This decision now frees the Trust managers and 

clinicians to focus during the transaction and transition period on the delivery of high 

quality services. 

The procurement process being undertaken is intended to get the best local solution 

for local people. This is why both the NHS and the Independent Sector will be asked 

for their best ideas to run sustainable services. If the project is given authority to 

proceed, the NHS is expected to put forward proposals to acquire the Trust and the 

Independent Sector to manage the hospital and run services. This process will allow 

us to test any proposed franchise model against other models such as an NHS 

acquisition to ensure that the right solution for the Trust and for the patients that it 

serves is identified. 

In the event that the preferred solution is a franchise, it is important to note that any 

Independent Sector provider will not own the hospital. There would be no change of 

ownership or transfer of assets and staff out of the public sector. All staff and assets 

would remain within the NHS. 

Any potential partner would not be able to make a profit at the expense of NHS 

patients. In a franchise arrangement, any franchisee would only be paid as the Trust 

is currently paid for services ie at NHS prices. National and local service quality 

standards currently required of services would continue to be demanded and 

monitored by the CCG and NHS TDA as is currently the case. It is therefore for any 

potential franchise bidder to determine how, through the introduction of innovation in 

service delivery, they will meet any shareholder requirements whilst ensuring that 

service targets and standards and patient and staff safety are maintained to the 

required standards. Any franchise arrangement will make clear that a franchisee will 

only be paid if the contract is delivered; unlike the current Independent Sector 

Treatment Centre arrangements, the contract would give no guarantee of funding. 

Clearly, the same standards and requirement to deliver to contract would be placed 

on any NHS acquirer should this be the preferred solution. Clear failure regime 

arrangements would be put in place to ensure that if any potential partner is not 

delivering, there would be safeguards to ensure that patients do not suffer and to 

ensure the continuance of essential services. 

Any Independent sector organisation will only pay tax on any surplus they deliver. It 

is recognised that for any organisation, NHS or Independent Sector, the ability to 

generate a surplus will require significant innovation and service delivery 

transformation and will be incredibly difficult to achieve in the current fiscal 

environment. 

With regard to your final point, there is evidence that franchising is more efficient 

than the public service model both in the NHS and in rail services. 

Hinchingbrooke represented the first franchise arrangement in the NHS. The 

Hinchingbrooke process suggested that without the procurement process the local 

NHS would have needed an £80 million subsidy or services would have had to close 

Whilst it is clear that lessons can be learned from both the transaction process and 

the contractual arrangements established, and that the financial position is taking 

longer to improve than would have been hoped for, is clear that financial 

improvements will take place over the course of the franchise agreement and that 

significant improvements in clinical quality have been achieved. 

There is also research evidence that franchising in the rail services is more efficient 

than a public service model. 

The important point to emphasise however is that by exploring both an acquisition 

and franchise model, we can consider the skill, creativity and the flexibility of other 

organisations to innovate, meet patient expectations and keep costs down and so 

ensure that we find the right partner organisation to manage the services at Weston 

Area Health NHS Trust. 

I hope that this answers the questions that you have raised. 

Yours sincerely 

Dr Stephen P Dunn 

Director of Delivery and Development South 

_________________________________________________

My answer today:

Monday, November 25, 2013

Dear Dr Dunn

Thank you for your letter of 15th November. Your letter raises a number of interesting questions, but in this letter I will focus on your belief that “franchising is more efficient than the public service model … in the NHS”.

Efficiency is a term that needs close definition. For instance, Weston General Hospital provides training for medical students and nurses. If this provision is deleted from any emerging contract with a private company, the costs will not be comparable.

You offer the Hinchingbrooke franchise as evidence of increased efficiency. It is doubtful that a robust claim of success can be made 21 months into a 10 year contract. While it is true that welcome improvements have been made in A&E waiting times and orthopaedic inpatient times, and consultants have been prevailed upon to start their day on time, there have also been costs and failures. You accept that the financial situation has taken longer to settle than was hoped for, since Circle had to apply for a £4.1 million capital loan a few months in to the contract. It is noteworthy that the House of Commons Public Accounts Committee described Circle’s savings plan as ‘over ambitious’ and ‘unachievable’. It seems that Circle’s plan is to make savings by reducing staff, but this runs counter to the Government’s recent plan to make hospitals publish ward staff numbers in order to correct under-staffing. Of particular concern is the news that cleaning staff numbers have been cut.

Another cost is seen in terms of lower staff morale which is appearing at Hinchingbrooke.

Also the patient satisfaction ratings for Hinchingbrooke fell each month from May to October 2012.

It seems that the financial contract will be different in the case of a public or a private provider. My understanding is that it is still the case that if a public provider has a surplus at the end of a financial year, that surplus is lost, and may even result in less funding next year. I have witnessed rushed, unnecessary and ill-considered purchasing actions taking place as a result of this policy. In the case of a private contractor, from what you have written, they will be able to retain some of the surplus as profit, and plough the rest back in to the organisation. If I am not misinformed, then is it not the case that we are comparing apples and oranges, and that the private companies benefit from a more efficient funding model?

Therefore, the Hinchingbrooke case cannot be put forward as evidence that private provision is more efficient than public provision.

On the other hand, your belief is contradicted by Pritchard C, Wallace MS. Comparing the USA, UK and 17 Western countries' efficiency and effectiveness in reducing mortality. JRSM Short Rep 2011;2:60. They found by comparing GDP expenditure with mortality rate outcomes 1979-2005 that “the USA healthcare system was one of the least cost-effective in reducing mortality rates whereas the UK was one of the most cost-effective over the period”.

Unless you have further evidence, it is clear that that privately funded health services are less efficient than the NHS, and therefore it is in the interests of the population served by Weston General Hospital that the partnering organisation to be chosen should be one of the NHS Trusts who are interested.

Sincerely

Richard Lawson

________________________

My further response, on the subject of rail privatisation:


Tuesday, December 03, 2013
Dr Stephen P Dunn
Director of Delivery and Development South
Trust Development Authority
London
SW1E 6QT





Dear Dr Dunn

Efficiency of rail privatisation

In your letter of 15th November you assert that “There is also research evidence that franchising in the rail services is more efficient than a public service model”.

This is debatable. The McNulty Review found that there were excessive costs from privatisation arising from fragmentation and complexity of the 1994 rail reforms. Pre-privatisation costs were £2.4 bn/y, and post privatisation they have risen to £5.4 billion/yr. Fares have also increased, so that we have the highest fares in Europe.

The “Rebuilding Rail” Report (June 2012) builds on this finding. Its bottom line is that a programme of taking rail back into public ownership, gradually, as each franchise fails or comes to an end, could ultimately save the taxpayer £1 billion  per annum.

The increased costs are the result of
· higher private interest rates for debts
· fragmentation, which leads to higher administration and management costs to cover duplication and interfacing.
· Complexity, with tiers of contractors and sub-contractors, each with their profit margin to apply
· Dividends to investors

These costs add up to at least £1.2 bn/yr.

Rail manufacturing in the UK has also plummeted due to low investment and absent unifying guidance. This stands in contrast to the situation on the continent.

On the basis of this evidence, your belief that NHS privatisation can model itself on the success of rail privatisation is not justified.

Sincerely

Richard Lawson

________________________

[to be continued...]

[Health Service Journal briefing on hinchingbrooke]

Petition to Keep Weston General Hospital our of Private Health Company Hands

In 2012 the coalition government passed the Health and Social Care Act which effectively opened up the NHS to private health companies from across the world. 

The Weston General Hospital Campaign represents a large group of North Somerset's residents who are very concerned about the damage this could cause for the future of their hospital. 

Weston General is too small to become an NHS Foundation Trust Hospital under the new rules and must either be taken under the wing of a Foundation Trust like University Hospitals Bristol Trust or be run by a private health corporation which could reduce or run poorer services as it will put profit before patients. 

The decision on the future of Weston General will not be taken by the hospital's management, but by a national body, the Trust Development Authority, which reports directly to the Secretary of State for Health - the Rt Hon Jeremy Hunt.  To add to the confusion, North Somerset's Clinical Commissioning Group will decide which services should be run at the hospital.

The petition we are asking you to sign will be presented to the Trust Development Authority in  London on behalf of the people of North Somerset and will call on it to allow Weston General Hospital to become part of an existing NHS Foundation Trust Hospital and for the continuation of a 24/7 Accident and Emergency Department at the hospital.

Sign the change.org petition now:

 http://www.change.org/petitions/nhs-trust-development-authority-we-want-our-local-hospital-weston-general-to-be-partnered-by-an-nhs-trust-and-we-want-reassurance-that-a-full-24-7-a-e-department-will-remain-at-weston-general?utm_source=guides&utm_medium=email&utm_campaign=petition_created

Patients Before Profit

How much power does a hospital board really have?

Weston General Hospital

24.10.13 - 10:00hrs

Meeting between:

Chief Executive of Weston Area Health Authority - WAHT

Project Director for Procurement Process

and

Weston General Hospital Campaign.

The background to the meeting is that the coalition government had, as part of the 2012 Health and Social Care Act, laid out the financial constraints by which hospitals qualify as Foundation Trusts. Weston General (WGH) is too small to qualify and, therefore, has either to be acquired by  an existing NHS Foundation Trust or franchise the running of the hospital to an NHS Trust or a private health company.

There is now an established, formal process to be followed for this, much of which is outside the hospital's control. Project Director reported that lessons have been learnt from Hinchingbrook (now run by Circle and much criticised by the National Audit Office etc - there is also a debate on competition in The Health Service Journal - hsj.co.uk) and the George Eliot Hospital which has been going through the process ahead of WGH. There is no clear timescale for the WGH process and she does not want to release too much information into the public domain until this is clear. This is so that there is no risk of being open to misinterpretation.

Chief Executive described their roles as running the hospital until the procurement solution is delivered. Although he sits on the Project Board he is not responsible for the process. The body responsible for delivering the solution is the national body, the Trust Development Authority (TDA) which answers to the Secretary of State. Bronwen Bishop is the board director directly responsible to the TDA for the project and works to get the best outcome for the hospital. The board makes recommendations to the TDA which makes the final decision.

Project Director reported that, after consulting staff and stakeholders, they had decided that the right way to ensure the best future for the hospital was to test the whole market although they could have opted to pursue an NHS only solution, but there were 3 NHS Trusts interested. George Eliot looked for a joint NHS/Private approach.

WGH Campaign raised the issue of contract weaknesses, citing the Emerson's Green Treatment Centre's underspend as an example and asking why there was not a swingeing 'fit and proper person clause'. They emphasised that some of the private companies which have expressed interest in WGH have particularly obscure accounts, utilise off shore tax havens and are heavily leveraged to their Private Equity owners. Project Director noted these concerns and stated that the contracts were now being standardised nationally.

She reported that the George Eliot procurement process had gone to the stage beyond Expressions of Interest. She also emphasised that whatever solution was agreed for Weston, the hospital would remain as an NHS entity and staff would remain employed as such.

Once the TDA approves the Outline Business Case there will be an evaluation stage of the bidders to see if they are technically able to deliver on their bid promises and then short listing will take place.

WGH Campaign felt that the 'Outline Business Case' for the hospital had been too critical of the current management and that she cannot believe a new management team can come in and do anything about the £5 million deficit. Project Director reiterated that WGH has to find a solution and the process is about achieving this.

WGH Campaign raised the issue of the future of a full A&E service at the hospital. Chief Executive responded that this was an issue for the North Somerset Clinical Commissioning Group (CCG). WAHT has to ensure quality of delivery but it is up to the CCG what they commission. The WAHT board would inform the CCG if they were unable to provide services from within their resources.

WGH Campaign asked about the conflicts of interest involving John Underwood and Kathy Headdon. Project Director explained that Underwood had been brought in to give strategic advice and as the process moved to operational requirements his input would no longer be required as frequently. She explained that there is a requirement for a range of experience in roles such as Kathy Headdon's and that in the event of conflicts of interest due to prior or existing roles, they would be obliged to absent themselves from the process. WGH Campaign pointed out that the public perception of her role with Capita Symonds and position on the Stakeholder committee would be very negative.  Chief Executive disagreed with WGH Campaign’s ethical position on conflicts of interest. Project Director stated that terms of reference for committees would soon be up for review and they would continue to ensure proper governance arrangements were in place.

She wanted to reassure WGH Campaign that if the procurement process goes ahead that there will be a wide range of people evaluating the bids including clinical and nursing staff. The TDA will evaluate the financial information in the bids. She also said she is considering asking the short listed bidders to write a short statement, which will be included in a magazine for the public.

WGH Campaign mentioned that the Social Value Act now allows public sector bodies to look at how the social, economic and environmental well being of an area can be improved through a procurement contract.

WGH Campaign thanked Chief Executive and Project Director for their time and for clarifying so many issues for them

Victory in Lewisham

The people can defeat the Government. Take a look at this link about the victory in Lewisham.

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.

Sincerely

Dr Richard Lawson
Walnut House
Dolberrow 
BS25 5NT
01934853606

"I have seen the future and it pays"

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.

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.

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. 

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.

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.

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?

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

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.”

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:

Activities

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)

Structure

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.

Performance

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.

References

http://www.capita.co.uk

http://www.capitasymonds.co.uk/projects.aspx

http://www.capitahealthandwellbeing.co.uk/partnerships/health-clinics

http://www.capitasymonds.co.uk/projects/all_projects/north_bristol_nhs_trust_chang.aspx

http://en.wikipedia.org/wiki/Capita_Group

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.

Lay Chair of North Somerset Clinical Commissioning Group Should Resign over Conflicts of Interest

On BBC West’s Sunday Politics programme this weekend, Health Correspondent Matthew Hill reported on the damaging conflicts of interest facing two board members of Weston Area Health Authority, John Underwood and Kathy Headdon.  

Mrs Headdon, who is also the Chair of the North Somerset Clinical Commissioning Group works as a consultant for Capita Symonds.  Capita Group is one of the private companies which has expressed an interest in bidding to take over the running of Weston General Hospital.

On Sunday’s BBC programme, Charlotte Leslie, Conservative MP for Bristol North West, described the conflict of interest for Mrs Headdon as “a huge problem”.  Mrs Headdon has a key role in the future of Weston General as Chair of the Stakeholder and Quality Assurance Group at Weston Area Health Trust which is supposed to provide an independent perspective to the project board on the bids, both private and NHS, to take over the running of our hospital.

Weston General Hospital Campaign spokesman, Steve Timmins, said: 

We are calling on Mrs Headdon to do the proper thing here and stand down from her posts as it is quite clear that she cannot be independent in her role in stakeholder and quality assurance in the tender process for Weston General Hospital if she is a consultant with one of the potential bidders.  Neither can she easily claim to be objective in one of  her CCG roles as representative for Patient and Public Engagement.

Malcolm Wing, a national advisor on procurement to UNISON, said:

It would clearly undermine public confidence in the impartiality of the procurement process at Weston General Hospital if Kathy Headdon remains as chair of the Board overseeing the tender process.  In fact she should step down from the Board completely.  Her continued presence creates a risk that her professional judgement or actions will be influenced by her employment by Capita.  Any perception that she is not completely independent and impartial will be damaging to the credibility of the decision finally made. 

As Chair of the NS CCG she has to have "Experience of giving an independent view on possible 
internal conflicts of interest". You could say that.

Article in Weston Mercury

Write to your MP

This letter was sent by one of our co-ordinators to our local MP on the urgent and worrying issues facing our hospital.  We'll publish the response as soon as we have it.

John Penrose MP

House of Commons

London

SW1A 0AA

cc Weston Mercury

Thank you for your letter of 14^th August.

I anticipated that we might have to have a discussion of the meaning of the word franchise. A franchise is a formal agreement for someone to sell a brand’s products or services in a particular place, in exchange for a payment or part of the profits, and/or it is a right granted to an individual or group by a public authority, such as the right to use public property for a business.

Clearly “franchise” refers to a business arrangement. It follows therefore that what could  happen to Weston Hospital is a symptom that health care there (and by precedent, everywhere in the UK) is making a transition from being a service (as in National Health Service), to a business arrangement, where a product is sold to customers by a private health corporation, who pay for the product first via their taxes, and later on, no doubt, by some form of insurance. 

If Weston is franchised out to a private health corporation, it is taking, inescapably and indisputably, a step in the direction of privatisation, even if you would deny or question that what is happening is an explicit and complete example of a privatisation.

So I must ask you – will you accept that franchise is at least a step in the direction of privatization?

The second question that I would put to you is – how can it be more efficient in cash terms for a private contractor to provide a product for the NHS, given

·      The turmoil and administrative work associated with granting the franchise, this present correspondence being an infinitesimally small part of this process?

·      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 or annihilate the amount of tax that they will pay in the UK?

Please explain how this can come about.

Third, I would like to put to you again a point I made in my previous letter. Several Cabinet members have financial stakes in private health corporations. Please tell me the exact number of Cabinet Ministers who have such financial interests, their names and their interests, and then tell me whether or not, in your view, their financial interests will influence their decisions regarding the way in which the future of Weston Hospital and the NHS will be handled?

Fourth, do you agree that Kathy Headdon should resign from her post on the North Somerset Clinical Commissioning Group on grounds of conflict of interest since she is also a consultant for Capita Symonds Ltd and her husband is on the board of UHB? 

Finally, I would be grateful if you will ensure that Serco is required to withdraw its interest in the Weston franchise on the grounds that Serco is under investigation for fraud.

Many thanks for your time and trouble in answering these five questions.