Read NHS for Sale: Myths, Lies & Deception Online
Authors: Jacky Davis,John Lister,David Wrigley
NHS for Sale: Myths, Lies & Deception (31 page)
This implausible line of argument to justify closures of A&E has been immediately and crushingly refuted. We noted in
Chapter 6
the collapse in A&E performance that immediately followed from the closure of two A&E units in north-west London, despite repeated promises that alternative services would be put in place beforehand.
The only serious ministerial approach to the issue of reconfiguration came from Lord Darzi while he was still a Labour minister. His five pledges, designed to reassure concerned communities faced with reconfiguration of local services, amount to the direct opposite of the way reconfiguration, set out in his 2008
Next Stage Review,
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has been approached, before and since.
- Change will always be to the benefit of patients.
- Change will be clinically driven.
- All change will be locally-led.
- You will be involved.
- You will see the difference first.
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David Cameron’s Tory party contested the last election opposing financially-driven closures, but almost immediately changed tack once in office, and through its planned ten-year freeze on real terms spending is forcing the pace in local cuts and closures, despite a total failure to win public consent. Where will the next government stand? Will they apply the Darzi pledges? Will evidence and good sense win out? Or will the myths and deceptions continue to prevail?
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The NHS Confederation has recognised this problem and produced a whole pamphlet written by spin-doctors, advising CCGs and trusts how best to push through their reconfiguration plans against the tide of local public opinion. It makes amusing reading. NHS Confederation (2014)
Reconfigure it out. Good practice principles for communicating service change in the NHS,
September, NHS Confed:
http://www.nhsconfed.org/resources/2014/09/reconfigure-it-out-good-practice-principles-for-communicating-service-change-in-the-nhs
.
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Calculations conservatively based on figures in Darzi,
Technical Report,
2007.
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Even Lord Darzi’s Technical Report back in 2007 estimated the cost of an A&E-type consultation in a Polyclinic to cost £66, compared with £81 in a ‘major acute or specialist’ hospital (2007:23). But another NHS London sponsored study of 6 London PCTs in 2008 estimated the average cost of an A&E attendance was just £68 (PA Consulting,
Study of Unscheduled Care in 6 Primary Care Trusts Central Report,
page 27
).
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According to official Treasury figures, the Trust has so far paid £387m for the hospital, but still has another £1.8bn to pay – costing a hefty 9.7 times the initial capital investment.
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Which some PCTs and now CCGs, together with NHS England’s chief executive Simon Stevens seem to have rather naively interpreted as enabling almost instant results from long-term preventive policies.
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One wag suggested that the pledges would better reflect the reality of reconfiguration if the word ‘not’ were to be inserted in each pledge.
What they don’t want us to know
The NHS is a huge and complex organisation with a UK budget of over £120bn. It employs 1.7 million people and only the Chinese People’s Liberation Army, Walmart and the Indian Railways directly employ more people. It is the most popular institution in the country and voters are attached to it for sentimental as well as sound practical reasons. No government can afford to be judged to have made a mess of it let alone begun a relentless privatisation programme that no one voted for or wanted. No politician wants to be associated with a downturn in its fortunes.
But since the coalition came into power, the passing of their Health and Social Care Act and the imposition of massive financial cuts have had a very damaging effect on the NHS. Their legislation has also opened up opportunities for big profits to be made and political favours to be called in. The resulting threats to the NHS, along with rumours of financial conflicts of interest, have required some nifty public relations footwork by the coalition government. It really does not suit them for the voters to know the truth about what is being done to the NHS, by whom, and how much money they are making out of it.
The Tories have never been honest about their real intentions for the NHS, but in January 2011 former contender for the Tory leadership Michael Portillo made a startling admission
to the BBC’s Andrew Neil. He let slip that in the run-up to the 2010 general election the Tories had not been entirely honest about their intentions for the NHS: ‘They did not believe they could win an election if they told you what they were going to do because people are so wedded to the NHS.’
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Portillo was of course alluding to the Health and Social Care Bill – the most controversial piece of NHS legislation in recent generations. The Conservative manifesto and indeed even the coalition agreement made no mention of the assault on the NHS that had been planned for many years by Tory politicians.
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But anyone who had been paying attention should not have been surprised when a massive piece of privatising legislation appeared within weeks of the 2010 Tory-led coalition taking power. They had already heard Oliver Letwin, the Tory policy guru, claim there would be no NHS within five years of a Tory government,
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and had read his book
Privatising the World
(see
Chapter 9
). However abhorrent Letwin’s sentiments they did at least have the virtue of being honest.
The same could not be said of David Cameron’s lies before the 2010 election. In a speech at the Royal College of Pathologists on 2 November 2009, Cameron promised an end to further ‘re-disorganisations’ of the NHS and a steady ship after a Tory victory: ‘With the Conservatives there will be no more of the tiresome, meddlesome, top-down restructures that have dominated the last decade of the NHS.’ He repeated the promise, and was even captured for posterity on YouTube at a Royal College of Nursing congress, basking in prolonged applause from the audience when he told them:
First I want to tell you what we’re not going to do. There will be no more of those pointless re-organisations that aim for change but instead bring chaos. Too often ministers have rearranged the NHS as if they were shuffling a deck of cards and not the nation’s largest employer … The recent history of the NHS reads like a wretched bowl of alphabeti spaghetti and it has got to stop.
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His reception might have been less enthusiastic if he had told the cheering nurses that within two years thousands of their members would have lost their jobs while he presided over the biggest ever reorganisation of the NHS. Little wonder that each year politicians come out as the least trusted profession.
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The coalition certainly didn’t want the public to know the purpose behind the HSC Act, but others were more forthright. Kingsley Manning, business development director at Tribal in 2010, welcomed the proposed legislation saying it ‘could lead to the denationalization of health care services in England’.
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He went on to be appointed Chair of the Health and Social Care Information Centre.
The HSC Act was a stark betrayal of Cameron’s clear promise that he would not reorganise the NHS but, worse than that, it was a betrayal of the NHS itself. Messing with the NHS and failing goes against all political advice, but those who wondered why the Tories would take such a risk with the nation’s favourite institution didn’t have to look very far. No further indeed than the financial interests of their MPs and peers and the pressures from donors and lobbying organisations.
In 2012 the website ‘socialinvestigations’
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published a compilation of the financial and vested interests of those who voted on the HSCB (updated in 2013). They were unapologetic about the long list of over 200 parliamentarians who had voted and who had present or recent past connections with companies involved in private health care, seeing it as a reflection of the ‘tragic reality’ of current politics. They pointed out what should be obvious even to an ethics class of five year olds – that having a Register of Members’ Financial Interests doesn’t excuse parliamentarians’ interests, but merely highlights why they should not have been allowed to vote on important legislation from which they stood to profit.
It is worth listing some of its findings:
- Some 225 parliamentarians had recent or current financial interests in private health care.
- 145 peers had recent or present financial connections to companies or individuals involved in health care.
- One in four Conservative peers had recent or present financial connections to companies or individuals involved in health care.
- One in six Labour peers have recent or present financial connections to companies or individuals involved in health care.
Although 78 per cent of the MPs listed were Tory it became apparent that the issue was a cross-party one, although (with the notable exception of former health minister Lord Warner), Labour parliamentarians opposed the health reforms. The conflicts of interest they exposed constitute a running sore in a country with pretensions to democracy.
The investigation revealed a tangled web of offshore
companies, donations, consultancies, directorships and shares held in companies likely to profit from the legislation’s privatisation agenda. ‘Socialinvestigations’ asked whether these people were public or corporate servants, a question which the reader will not find hard to answer after they have read their report – highly recommended but not for the squeamish or faint hearted.
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Particularly difficult to stomach are the excerpts from the speeches of those with direct financial conflicts of interest. ‘Extraordinarily’ warm welcomes were extended to the Bill along with calls for more use of management consultants and the ‘independent’ sector. Apart from the light it sheds on MPs extra-curricular activities, the whole report stands on its own as a damning indictment of the House of Lords, and the cat’s cradle of political and financial influence wielded by unelected peers.
Meanwhile Tory party donors have done nicely under the new regime. In 2013 the coalition government awarded a controversial contract to treat brain tumours to Hospital Corporation of America (HCA), just days before responsibility for such contracts passed to NHS England. HCA were already at the centre of a scandal about overcharging the NHS by millions of pounds, and had a record of paying over $1bn in fines in the US for mis-selling health care, but regardless of their history the highly specialised work was taken away from University College Hospital (UCH) and given to HCA and another private company. Patients who were already being treated at UCH were told to move to the private company as their treatment at UCH would no longer be funded. An investigation by
The Mirror
revealed that HCA was a Tory party donor, and had given them ‘at least’ £17,000 since the election.
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Lord Popat is a Ugandan born British Asian businessman
who has donated over £320,000 to the Conservative party and was subsequently made a peer in July 2010. He supported and voted for the Health and Social Care Act and was made a Government Whip and Minister of the Crown in 2013. He founded the company TLC which owns a string of care homes offering services to the NHS, and gave the Tories £25,000 just a week after they unveiled their healthcare reforms. Unite the Union discovered Lord Popat’s wife now owns the company which has won contracts worth £4.43m since the HSC Act was passed in 2012.
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In October 2014
The Guardian
published an article (based on a Unite report) about links between Tory MPs and NHS contracts awarded to the private sector. Private companies with financial links to 24 Tory MPs and peers had won NHS contracts worth £1.5bn under the new legislation. A Conservative spokesman was suitably outraged at the implication and denied any wrongdoing: ‘Any suggestion of impropriety is malicious and defamatory and will be treated as such.’
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Len McCluskey of Unite was not deterred: ‘How can we be in a situation where dozens of [Cameron’s] MPs voted for the sell-off act and had links to private healthcare companies, knowing this would open up new opportunities for the companies that pay them?’
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Andrew Lansley
Andrew Lansley was the architect and driver of the HSC Act, labelled by the
BMJ
‘Lansley’s monster’. In November 2009 John Nash, chairman of Care UK, donated £21,000 to Lansley’s private office.
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At that stage Care UK had
contracts worth £400 million derived from the NHS – 96 per cent of their total income. An article in
The Telegraph
noted that Mr Nash, a private equity tycoon, stood to be one of the biggest beneficiaries of Conservative policies to increase the use of private healthcare providers.
Lansley denied that the £21,000 donation would have swayed him or the party in any way whatsoever, and the usual spokesperson was wheeled out to say that ‘donations from private individuals in no way influence policy making decisions’. Clearly believing otherwise, John Nash and his wife donated almost £300,000 to the Conservative party. In January 2013 Nash was rewarded with a life peerage – Baron Nash, of Ewelme in the County of Oxfordshire – and was subsequently made Parliamentary Under-Secretary of State for Schools in the Cameron coalition government – an appropriate appointment for an enthusiastic sponsor of the loathed academy programme.
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Lord Warner
On the other side of the House on the Labour benches sits Lord Warner (although after the passage of the HSC Act many wondered if that was quite where he belonged). Warner was made a life peer by Tony Blair in 1998, since when he has been, among other things, Minister of State in the Department of Health from 2005 to 2007. Of more than passing interest is that he also sits on the advisory board of Reform – a right-wing ‘think tank’ funded to the tune of around £1m by private companies that stand to benefit financially from a privatised NHS.
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Warner had a reputation as a Blairite on the right of the Labour Party, and true to his colours he announced in April 2013 that he would break ranks and vote with the coalition
on section 75, a crucial piece of NHS legislation. Section 75 regulations were designed to push CCGs down the route of tendering out NHS services, making tendering in effect compulsory. Section 75 thus meant private companies would have many more opportunities to bid for high value NHS contracts in the future.
Lord Warner denied that the regulations would mean compulsory competitive tendering in the NHS and claimed disingenuously to be ‘voting in the best interests of NHS patients’.
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Some felt his connections with private sector health care might have played a part in his decision to defy a three line whip, and one blogger simply stated that Warner stood to make ‘shedloads of money’ out of NHS privatisation and congratulated the peer on his chutzpah in not apparently caring whether anyone made the connection.
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Some saw Warner’s vote as an act of betrayal and there were calls for him to resign from the Labour Party and stick with Reform as his lobbying group of choice. Lord Philip Hunt (Shadow Deputy Leader of the House of Lords and spokesman on health) had worked hard to mobilise opposition to section 75 and tweeted on 24 April 2013: ‘Very disappointed with outcome of Lords vote on section 75 competition regulations. But a massive thanks to all who have campaigned on this.’ One of the authors, John Lister, tweeted back: ‘What will Labour do about Lord Warner who declared personal interests and then broke with the Labour whip to support the government.’ The answer was they would do nothing – Lord Warner remains on the Labour benches, having committed this act of betrayal and helped consign the English NHS to a further
expansion of privatisation.
In order not to disappoint his critics Lord Warner was back in the headlines again in March 2014. On this occasion he wrote a pamphlet for Reform, recommending charging for NHS services, an issue that for most is an NHS red line and not to be crossed. In a
Guardian
article he claimed without evidence that the NHS was poor value for money
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and called for a £10 a month NHS membership fee.
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Reform advocate patient charges,
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and given Lord Warner’s role as an adviser to them it came as no surprise that he was waving their flag, but he attracted the anger of his Parliamentary colleagues. Labour health spokesman Jamie Reed MP disavowed Warner’s recommendations: ‘This is not something Labour would ever consider … a Labour government will repeal David Cameron’s NHS changes that put private profit before patient care.’
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Alan Milburn
Alan Milburn’s name and reputation are well known in the field of health care. He went from firebrand opposition spokesman putting the Major government on the spot, to marketising health secretary, and then on to a directorship in private health (now coupled with a role advising David Cameron’s government on social mobility). Milburn was MP for Darlington from 1992-2010 and his role has been well documented elsewhere as the architect of the New Labour love affair with the private sector in health care, much of which was set out in the 2000 NHS Plan. It was Milburn (interestingly with Simon Stevens – now head of NHS England – at his side ) who signed the concordat with the private health industry in 2000 that opened up NHS services in England to the private sector,
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amongst other
things sending NHS elective patients for treatment (during winter peaks) in private hospitals at much higher cost. Milburn also pushed through many of the PFI deals which are still crippling NHS hospitals to this day, and he was also the inspiration behind turning hospitals into businesses and pitching them against each other – the foundation trust initiative.
The actions of New Labour ministers such as Milburn allowed the Tories to claim with some justification that with the HSC Act they were only carrying on with what Labour had started. In 2012, a Downing Street source was quoted as saying that Lansley should be taken out and shot for the mess he had made of the health reforms, and had to deny the rumour that Milburn could be given a peerage and asked to return to his old job to replace Lansley and steer the troubled reforms through parliament.
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Milburn went on to become a consultant to Bridgepoint, a venture capital firm heavily involved in financing healthcare firms moving into the NHS, including Alliance Medical, Match Group, Medica and Care UK.
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In 2013 Milburn was appointed by PriceWaterhouseCoopers (PwC), the world’s largest accountancy and consultancy firm, to head up a board overseeing its healthcare practice. Milburn commented: ‘The health industry in the UK offers strong opportunities for growth in the wider economy and for PwC. My aim is to bring together a panel of industry experts to help catalyse change across the health sector and to help PwC grow its presence in the health market.’
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