NHS problems 'at their worst since 1990s'.

Services in the NHS in England are deteriorating in a way not seen since the early 1990s, according to a leading health think tank. The King's Fund review said waiting times for A& E, cancer care and routine operations had all started getting worse, while deficits were growing. It said such drops in performance had not been seen for 20 years. But the think tank acknowledged the NHS had done as well as could be expected, given the financial climate. Professor John Appleby, chief economist at the King's Fund, which specialises in health care policy, said: "The next government will inherit a health service that has run out of money and is operating at the very edge of its limits. There is now a real risk that patient care will deteriorate as service and financial pressures become overwhelming." He said in terms of how standards were slipping - not how low they had reached - the situation was the worst it had been since the "early 1990s". The report noted much of the deterioration has happened in the second-half of the Parliament with many measures of performance being maintained in the first few years

VICTORY!!

This Campaign has succeeded. Weston Hospital Trust has announced that it is no longer at risk of being franchised out to a private "Health" Corporation.

It now looks as if the Tories' plan to give 5 small hospitals over to their corporate chums in the healthcare sector has crashed. The original scheme was to kill off 5 NHS hospitals in this way :

1. Hinchinbrook
2. George Eliot, Nuneaton
3. Whiston
4. Epsom
5. Weston

Of these 5, only one, Hinchinbrooke, has been sold down river. All the rest have been pulled back from the brink.

The question is - why? Why have the Tories dipped out?

I wish it could be said that they trembled before the onslaught of this very campaign, but that would be a bit f an exaggeration. Although the fact that the Bristol Clinical Commissioning Group lost a legal case brought by our Bristol campaign colleagues may have played a part.

Weston Trust claim that it is because the Trust has got better marks in its latest assessment. Congratulations are due to everyone who helped bring about that improvement, but it is not really the reason. Better marks just means that it is a more profitable concern to take over.

The reason is probably down to electoral politics. With a General Election due in a year's time, with the economy less and less of a major preoccupation for people, and with health rising as an issue in people's minds, the Tory campaign managers may have decided to chuck some heavy baggage overboard.

(Incidentally, I love the comments of John Penrose MP, con, Weston super Mare, welcoming this decision. I have a pile of letters from him lauding the private sector as ideally placed to administer health care. "this should kill off any lingering fears that the hospital might be privatised for good", he says. In my correspondence, he denies that franchise means privatisation).

So politics is one factor. Economics may be another. The corporate bean counters will have been doing their sums, and must have realised that they simply do not add up. Weston is under bedded and under funded, the real investigations reveal this, and so they have all lost interest.

At least until the next election. If the Tories win, they will be back with another scheme to benefit their shares in the private sector. So this campaign will continue to monitor the situation closely.

5 steps to privatise the NHS

Excellent cartoon animation: clear and factual.
5 simple steps to privatise the NHS:

Has the Project Board been acting within the Law?

The Health and Social Care Act 2012 is the cause of much of the grief in the NHS. This top-down reorganisation is more voluminous than the Act that set up the NHS in the first place. It is generally loathed. However, it does have a section that the local WGH Procurement Board do not seem to have looked at, or if they did, did not understand, or if they did, they did not bother to implement. it is section 14Z2. It goes like this:

14Z2 Public involvement and consultation by clinical commissioning groups

(1) This section applies in relation to any health services which are, or are to be, provided pursuant to arrangements made by a clinical commissioning group in the exercise of its functions (“commissioning arrangements”).

(2)The clinical commissioning group must make arrangements to secure that individuals to whom the services are being or may be provided are involved (whether by being consulted or provided with information or in other ways)—

(a)in the planning of the commissioning arrangements by the group,

(b)in the development and consideration of proposals by the group for changes in the commissioning arrangements where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them, and

(c)in decisions of the group affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact.

(3)The clinical commissioning group must include in its constitution—

(a)a description of the arrangements made by it under subsection (2), and

(b)a statement of the principles which it will follow in implementing those arrangements.

(4)The Board may publish guidance for clinical commissioning groups on the discharge of their functions under this section.

(5)A clinical commissioning group must have regard to any guidance published by the Board under subsection (4).

(6)The reference in subsection (2)(b) to the delivery of services is a reference to their delivery at the point when they are received by users.

I included the whole section to block any claims that it was taken out of context.Now it is very clear that the Weston Project Board has not held public consultations. There is therefore a serious question of whether they are acting, or have been acting (this legal language is infections) within the law. 
The Campaign has a team of solicitors looking at this question. Our solicitors feel that we have a strong case.
 

Good News - George Eliot Hospital to stay in NHS

George Eliot Hospital in Warwickshire was at risk of being privatised, because of poor performance which led to it being placed in "special measures". However, thanks to a huge effort to improve services, the threat has now passed.

This victory, together with the decision that Cambridgeshire and Peterborough CCG did not follow its duty to consult the public, and the victory in Lewisham, prove that it is possible to save Weston Hospital from private sector, provided that local people fight for it.

Your New NHS explained

http://www.cartoonkate.co.uk/nhs-plc/

Petition to save Weston General Hospital from privatisation

We have a petition. It says simply

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.

Please sign the petition here.

Funding: is it a level playing field?

Two letters to MP sent off today.
First:

John Penrose MP
House of Commons
London SW1A 0AA






Thank you for your letter of 13th December regarding Weston Hospital.
I would like to raise the question of whether the tendering process for WGH services is equitable, and also whether it is legal.

My understanding is that any NHS providers tendering for partnership will be working under annual budgets which mean that they have to use up the allocations for that specific year. Any unused monies are clawed back and the amount allocated in the subsequent year is reduced by the amount of under-spend. This was the case when I was involved in hospital budget allocation in the past, and I am not aware of any changes.

I believe also that private companies are free of this constraint. They can vary their spending according to the circumstances of that year, holding money over, or drawing on future allocations.

I expect that the exact arrangements are more complex than I have outlined above, but if it is broadly correct, any NHS provider tendering for the WGH contract is clearly in a disadvantageous position. It is absurd to suppose that cash requirements will be the same from year to year. If NHS providers are indeed disadvantaged in this way, the tendering process is inequitable. Assuming that there are legal requirements for the tendering process to be even-handed, funding differences of the sort that I have outlined above would be illegal, and unless the situation is made even, any decision could be potentially subject to judicial review, with all the costs that would entail.

I would be very grateful if you would be so kind as to find whether there are indeed discrepancies in the funding mechanisms available to tenders from NHS partners vi a vis tenders from private corporations.

Thank you

Second

Dear John

Thank you for your letter of ...

In this letter I want to deal with your last point about ideology, because it is fundamental to this correspondence, and raises one important question which I pose at the end of this letter. You allege that in opposing private for-profit contractors for what you believe are ideological reasons, I could be insisting on an inferior level of care for patients.

In theory it is possible to conceive of a situation where the same patient with the same condition receives better treatment and care at the hands of a private corporation compared with treatment and care provided by a public service, even though the level and provision of funding in the two cases were identical. 

On the other hand it is equally, if not more, possible in theory to conceive the opposite, where public service provision is better than private, especially in a situation where the funding levels were the same. 

However, as I am sure you will agree, we are not dealing with theory, but with political and economic realities. 

The first reality to acknowledge is that the NHS is more efficient than private provision, as evidenced by the fact that health care in the UK comes in at nearly half the cost of health care in the USA, despite the fact that US health care excludes the poorest (and therefore most needy) section of the population.

The second reality is that for ideological reasons, the NHS is being slowly but surely being pushed towards the American Health Maintenance Organisation (HMO) insurance based system. Each of the 13 or 14 top-down reforms that have taken place in my time in the NHS has made the organisation more oven-ready for privatisation. The purchaser-provider split, fund-holding practices, the imposition of Foundation Hospital status, the whole sorry gamut of reforms, they have all nudged the health service towards privatisation. The current news is that 70% of health service contracts issued are going to private corporations. The Transatlantic Trade and Investment Partnership, if adopted, will legally open the NHS to competition from US health corporations.

Therefore, in a few years’ time, we can realistically envisage that Weston Hospital, having been taken over by Serco or similar organisation, and the NHS having been transformed into an insurance-funded rather than a tax-funded organisation, discovers that a patient referred to their services has, for whatever reason, no insurance cover and no private wealth. The patient is rejected, and dies shortly afterwards. This situation is a stark example of where private care is inferior to public care. 

In short, your theoretical scenario where private is better than public is first neutralised by the opposite scenario, and is then trumped by the case where the present franchising operation has given way to full blown privatisation and care is denied to patients on financial grounds.

To put it clearly and simply, the present situation for Weston is the thin end of the wedge, a step towards a situation where health care is allocated on financial and not humanitarian grounds.

This is the reason why the WGH Patients Before Profits Campaign is set adamantly against franchising out Weston's services to a private corporation. 

You will say that this is not the intent, and that Serco or whoever will continued to be funded from the public purse. But you know as well as I that insurance based funding of the NHS has been under discussion. All it takes is for some future Government, even without an electoral mandate, just as your Government passed the Health Services Act 2013 without an electoral mandate, dictates that all who want to receive NHS care must take out health insurance. That is all it will take, and when it happens, we are in the inhumane situation I outlined above.

You have suggested that by rejecting the franchising of Weston Hospital to Serco or the like, I could theoretically be presenting patients with inferior health care.  I have shown that the whole trend of successive NHS reforms is leading the NHS towards the private US healthcare system, which means that people who have no means to pay will be denied health care.

Aneurin Bevan said "no society can legitimately call itself civilized if a sick person is denied medical aid because of lack of means". I am not a dogmatic socialist, but as a doctor I strongly agree with the truth and importance of that statement. 

Do you?

Victory in Cambridgeshire and Peterborough

Good news from the Health Service Journal

20 January, 2014  By Sarah Calkin (Reproduced without permission, but with grateful thanks)

A clinical commissioning group (CCG, the new local NHS governing groups led by GPs) leading one of the most high profile procurements in the NHS has agreed to publish commercially sensitive documents following a threat of legal action.

A law firm acting for campaign group Stop the NHS Sell Off in Cambridgeshire accused Cambridgeshire and Peterborough CCG of acting unlawfully by failing to allow opportunities for meaningful public engagement in the tender of a multi-million pound contract for older people’s services.

In a letter before action sent on 10 December Leigh Day said the CCG had been “preventing proper patient involvement” by refusing to let the public see tender documents that had been shared with bidders.

The firm argued that the CCG was in breach of its legal obligations to engage with the public, as set out by the 2012 Health Act.

It gave the CCG seven days to either share the documents or put the tender on hold - or face the prospect of judicial review proceedings being initiated.

HSJ understands the CCG has not conceded that it acted unlawfully. However it has agreed to publish the documents in question.

David Lock QC, who was instructed by the group, but who normally advises NHS bodies, told HSJ the case showed CCGs face conflict between commercial confidentiality and public engagement.

He said: “This tension must be resolved in favour of openness because those are clear legal obligations which have been imposed on the CCG by Parliament.

“It is not possible to run the NHS like Tesco’s supply chain where everything is kept commercially confidential.”

Other lawyers working in the NHS told HSJ it was a difficult area for commissioners.

A partner in one leading firm said they were caught between a “rock and a hard place”.

They added: “There are things commissioners can do to try and mitigate the risk of challenges, but if there are patient groups who may not like proposed changes then there are likely to be difficulties, and of course the bigger the procurement the greater the risk.”

Lawyers for the Cambridgeshire campaign group pointed to the fact that the value of the contract changed during the process and bidders had pulled out, as revealed by HSJ, as evidence that decisions had been taken about the shape of services without public involvement.

The letter said: “It appears to our clients that the CCG is only prepared to engage with patients at a very high level of generality… By the time details of the proposals are made available to patients and the public it may be too late for patients to influence decisions which have already been taken.”

The firm highlighted four areas where the CCG had not met its obligations. It said the CCG had breached its duty to have a patient involvement policy and a procurement strategy while its constitution did not fully reflect the extent of its requirements around engagement. Finally it said the CCG had not taken into account NHS England’s transforming participation in healthcare guidance.

At its governing body meeting on 7 January the CCG announced plans to refresh its communications, membership and engagement strategy and strengthen its constitution in relation to patient engagement.

The meeting also considered the procurement strategy which the CCG told HSJ was “in development” and would be published by the end of the month.

The CCG said it had now “reached a point in the procurement process” at which it was able to publish more information, including a pre-qualification questionnaire and its “prospectus”. It said information in the documents could be redacted if “necessary” due to commercial sensitivity.

Arnold Fertig, the CCG’s lead on its older people’s programme, insisted the group was “committed to openness and transparency”.

“It has provided information on the older people’s programme and the procurement at CCG governing body meetings, including the publication of documents from those meetings, through attendance at key meetings, forums and events, on its websites, in publications, and during engagement meetings with patient and carer groups,” he said.

See also: Victory in Lewisham.

We can keep Weston Hospital out of the clutches of Serco &c. But we need to fight for it.

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.