Read NHS for Sale: Myths, Lies & Deception Online
Authors: Jacky Davis,John Lister,David Wrigley
Alan Milburn graduated from being a health minister pushing NHS privatisation to jobs in the same private sector which benefited from his policies. His story exemplifies the ‘revolving door’ between the public and private worlds which has spun faster and faster of late, seeing politicians and civil servants moving into lucrative posts in what Milburn tellingly calls ‘the health industry’ and the ‘health market’. Former health ministers seem to be particularly liable to go through the door into the private sector, using contacts they made while public servants to further their private interest. The following examples are taken from the Alliance for Lobbying Transparency web site:
In 2012
The Guardian
reported that Sean Worth, Cameron’s advisor on NHS privatisation, had moved to a group whose clients included a number of firms involved in selling services to the NHS. Peter Campbell, another special advisor in No. 10, moved to the Business Services Association which represents outsourcing companies including those interested in health. The Advisory Committee on Business Appointments which decides whether top civil servants can move to the private sector, reported that 213 senior civil servants moved from government into the private health sector between 1996 and 2011.
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There is of course traffic in the opposite direction, albeit usually temporary, as those with their feet firmly in the private sector embed themselves in the NHS to advise ministers and influence policy. At one stage the NHS Commercial Directorate (set up as early as 2003 to help introduce private providers into the NHS) contained 190 staff, 182 of whom were ‘interims’ i.e. people recruited on short-term contracts from the private sector (at a daily cost to the NHS of £1000-£2000
each).
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In 2011 the DoH sued the head of the Directorate, Ken Anderson, for accepting gifts, and the case was subsequently settled out of court.
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Others migrate comfortably back and forth between the two sectors. Simon Stevens was policy advisor to two health secretaries, Frank Dobson and Alan Milburn, and then to Tony Blair himself. He then moved into the private sector, ending up as executive vice-president of UnitedHealth group, one of the biggest US multinationals.
In 2003 he told a US conference ‘the era of English exceptionalism in healthcare is over’. He pointed out the similarity between UK trusts now set up to ‘buy’ health from doctors and hospitals, and US ‘managed care’ organisations such as UnitedHealth. ‘Indeed’ he said, ‘pilot programmes are now testing the partnering of US managed care plans with primary care trusts.’
He promoted choice: ‘Freestanding surgical centres run by international private operators … are a first step. Private diagnostics and primary out-of-hours services are next.’
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Since April 2014 he has been back in the UK as CEO of NHS England.
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On the first day of his new job he laid out his stall and upset many by praising the innovation value of new providers (i.e. the private sector) in the provision of health services.
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He has subsequently produced a heavyweight report
(The NHS Five Year Forward View)
looking at how to fund the NHS without so much as a suggestion that the English NHS market might be unnecessary and expensive or that doing away with it could save billions of pounds a year.
Lynton Crosby is an Australian political strategist, described as ‘master of the dark political arts’ and the ‘wizard of Oz’. He masterminded successful election victories in Australia and the Tories 2005 election campaign and in November 2012 was brought back as campaign consultant to the Conservative Party for the 2015 General Election.
Crosby has close links to the tobacco industry, having been hired by Philip Morris International, makers of Marlboro cigarettes.
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There were accusations that just before his appointment Crosby lobbied a minister against the introduction of plain packaging for cigarettes (a policy felt by public health experts to significantly reduce the attractiveness of cigarettes to younger smokers and those being tempted to smoke for the first time). Crosby denied the accusations despite an e-mail trail, but the government postponed its plans to introduce plain packaging until early 2015.
As negative headlines about the NHS appeared with monotonous regularity in 2014 Cameron must have rued both his slovenly attitude to Lansley’s flawed legislation and his earlier claims that his priorities could be summed up in three letters: NHS. By June 2014, with the NHS moving up into second position among voters’ concerns, the
New Statesman
reported that Crosby had advised Cameron and the party not to mention the NHS.
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As a result of the toxic ‘reforms’ and swingeing cuts it had become a vote loser for them and Crosby must have calculated that a period of silence was the best they could do.
Presumably on Crosby’s advice there was no mention of Cameron’s erstwhile top priority in that year’s Queen’s speech. In his 2014 pre-election conference speech Cameron made no attempt to address the NHS and its problems but
instead disgracefully used his personal family tragedy to suggest that he was beyond suspicion when it came to the NHS. In a faux rage he demanded ‘How dare [Labour] suggest I would ever put it at risk? How dare they frighten those who rely on the NHS?’ It was a cheap shot but the media let it go unchallenged, as with so many of his other dubious assertions. Round One to Crosby.
In 2003 the Department of Health asked computer firms to design a system that would automatically upload patients’ confidential GP medical records to a centrally held database, the ‘Summary Care Record’ (SCR). This would happen regardless of whether patients wanted their data shared in this way. The taxpayer-funded multi-billion-pound NHS project soon ran into trouble and in 2006 Accenture (the world’s largest management consultancy firm) pulled out of contracts worth £2bn.
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They could have been forced to pay penalties of up to £1bn but the then director general of NHS IT, Richard Granger, decided to charge Accenture just a trifling £63m.
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Accenture must have been pleased with their ‘windfall’ of over £900m and it is interesting to note in passing that prior to Richard Granger working for the NHS his previous role was with Andersen Consulting, which changed its name to Accenture in 2001.
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The project, Connecting for Health, was initially supposed to cost the taxpayer £2.3bn but in the end it cost an estimated £12.4bn (with some putting the overall cost at nearer a staggering £30bn).
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The National Audit Office was highly critical, stating that ‘… it was not demonstrated that the financial values of the benefits exceeds the cost of the programme’.
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The resulting loss of confidence by the public and medical professions in NHS IT led the new coalition government in 2010/11 to come up with a different idea for sharing medical records – care.data. The coalition hid the new quango (the Health and Social Care Information Centre – HSCIC), which would oversee usage of confidential patient data, deep in the fiendishly complex Health and Social Care Bill.
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The new project would allow confidential medical information to be shared and initially ministers announced that once again ‘there would be no opportunity to opt out’ for patients – a truly astonishing proposition.
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Patients trust that the information they impart to their GPs will be treated as confidential, not shared with others outside the NHS and not used for purposes other than direct patient care. This forms the basis of the sacrosanct doctor/patient relationship and if patients lose trust in data confidentiality there is the risk that they will not be open with doctors which could in turn have an effect on the care they receive. In a short period of time the politicians and HSCIC moved to destroy that trust.
Jeremy Hunt (by then Secretary of State for Health after Lansley had been demoted to the Leader of the House) stated there was ‘enormous potential’ for care.data to improve patient care. Many professional bodies agreed and seemed unconcerned about the proposals – indeed the BMA actively
engaged with the process and initially went along with the proposed model whereby citizens would automatically have their data uploaded to a central database unless they actively opted out of the system. Given that there was very little publicity it was not surprising that very few did opt out. This fact was used by the government to justify care.data, but they neglected to mention they hadn’t actually told people about it.
The government was eventually forced to undertake an ‘information campaign’ and every household was supposed to get a leaflet, for which the Royal Mail was paid over £1m.
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Unfortunately the leaflets were often stuffed inside fliers for pizza shops and cruise brochures and ended up in the bin – so that many people were still none the wiser about care. data. Campaigners were angry that over £1m had been spent on a junk mail publicity campaign that had very little impact at a time when severe cuts were being made to frontline care elsewhere in the NHS.
The media became interested in the story and the public began to be concerned about their confidential information. They didn’t trust the reassurances from governments who had in recent times shown themselves to be totally incompetent at keeping data confidential.
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It became increasingly difficult for the HSCIC and government ministers to defend the opt out model and the fact that patients were so badly informed about the proposed medical data upload.
The final nail in the coffin came in January 2014 when
The Guardian
revealed that insurance companies, the pharmaceutical industry and other businesses could buy confidential patient medical data from the newly formed HSCIC to use for their own purposes. Mark Davies, HSCIC public assurance director, had to own up that there was a
‘small risk’ that harvested data could be identified down to individual patient level. He dismally failed to reassure patients by saying ‘it depends on how people will use the data once they have it.’
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With pressure mounting from all quarters a decision was made in February 2014 to ‘pause the process’ of care.data and convene an expert advisory group to learn lessons and work out the next steps. In a sensible intervention Julia Hippisley-Cox, professor of general practice at Nottingham University, said ‘there should be a clear audit trail that the patient can access and there needs to be a simple method for recording data sharing preferences and for these to be respected’.
Ministers and HSCIC leadership have yet to propose such a sensible approach to care.data – and suspicion about their intentions to make use of (and money from) patient data remains. With the Summary Care Record now being resurrected
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there is potential for a great deal of confusion over the role of the SCR and care.data – but perhaps this is the aim of politicians. Create as much confusion as possible and then slip through contentious policies in the hope that few will notice.
In September 2014 an alarming story emerged. News was leaked of secret meetings being held between the big five management consultants, multinational healthcare companies and Department of Health officials. Together they had formed the secretive Commissioning Support Industry Group (CSIG) who were looking to win £1bn worth of contracts to advise CCGs on purchasing patient care. The contracts involved would include drug purchasing, patient care reforms and outsourcing services to the private sector.
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UnitedHealth (UH), Simon Stevens’ previous employer,
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not only chaired the un-minuted meetings and provided the secretariat but had paid for senior health ministers to visit its care centres in the US on a five day ‘fact finding mission’. Dr Chris Exeter, UH’s UK lobbyist who had previously worked for a lobbying firm run by Andrew Lansley’s wife, helped coordinate the meetings. The story was the final confirmation of NHS campaigners’ fears – that far from GPs being at the heart of decision making, it would be management consultants and multinational healthcare corporations who held the NHS budgets and called the shots. The private sector would finally be in charge of advising about the purchase of NHS care from the private sector.
Type ‘politicians lies NHS’ into Google and pages of links come up. Successive governments have lied and lied again about the NHS and their intentions for it; they have had to. As Leys and Player point out in their book: ‘If the public had been asked whether they wanted to see the NHS broken up – run for profit by a variety of multinational health companies, private equity funds and local businessmen, they would have overwhelmingly rejected it.’
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