NHS for Sale: Myths, Lies & Deception (36 page)

UnitedHealth is, in its own words, ‘committed to creating a strategic partnership with the NHS at various levels’.
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Time and money have been invested in building relationships with UK decision-makers to achieve this aim. For instance, it has courted senior health officials, flying them on all-expenses-paid trips to its US headquarters and facilities. The purpose of a five-day junket in 2014 was for British officials to understand how the ‘innovations and experience’ of this US insurance giant might help inform the development of the NHS.
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UnitedHealth has also led the way in securing itself a seat inside the NHS. In mid 2014, it was discovered that the US corporation chairs a discreet forum of private companies
that has been granted regular access to senior NHS officials and briefings on policies in which they have a commercial interest. Members of the group, which also includes KPMG, PwC, Capita and McKinsey, are competing for nearly £1bn of NHS contracts advising GP groups on how to spend their two-thirds share of the NHS budget. The group is co-ordinated by UnitedHealth’s chief lobbyist, Chris Exeter.
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This moves us on to another aspect of UnitedHealth’s lobbying: the hiring of well-connected insiders. Exeter is a former health official who, for a period around 2011, worked for the lobbying firm run by the wife of NHS reformer-in-chief, ex-health secretary Andrew Lansley.
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Exeter’s predecessor at the firm, Tony Sampson, was a Number 10 health policy advisor and private secretary to another pro-market health secretary, now PwC health advisor, Alan Milburn.
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For the past five years, UnitedHealth has also bought in extra lobbying firepower in the form of lobbying agency Hanover Communications, which is similarly well-connected in health policy circles.
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Not only has the agency recently been employed by NHS England,
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Hanover’s health practice is also headed up by Andrew Harrison, an ex-health official and a former close colleague of Simon Stevens, the current chief executive of the NHS.
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Then, of course, there is Stevens. Before returning to lead the NHS in 2014, he had spent nearly a decade working in the US for UnitedHealth.

There are, in addition to this, the very many lobbying groups of which UnitedHealth is a paid up member. These lobbyists have done a lot of the leg work to ensure the recent controversial changes to the NHS stay on track. The industry lobby group, the NHS Partners Network, for example, successfully lobbied for an official inquiry that publicly reprimanded ‘maverick’ local commissioners who
were intent on keeping the health service public (or who were ‘unreasonably restricting patients’ choice’ in the eyes of private health companies).
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The Network, on behalf of its members, also secured an inside track when it came to the government’s public consultation on its market reforms. It had private channels through which it could lobby both those that were supposed to be listening to public concerns and Number 10.
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The Network has also been a vocal defender of the for-profit sector in the press. On one occasion it orchestrated, with the free-market think tank Reform, the placing of a sequence of articles in
The Telegraph
that warned the government not to let up on NHS privatisation.
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UnitedHealth is also a corporate partner and donor to Reform, which has pushed hard to win Parliamentarians and the public round to the government’s health agenda.
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The think tank has substantial political clout: Reform’s deputy director, Nick Seddon, for example, moved on to become the Prime Minister’s health advisor. Its spokespeople are also regular champions of more competition in the NHS in the pages of our newspapers. In order to reach an even broader audience with its message, Reform also provided support for a ‘front group’ called Doctors for Reform. Its GP spokesperson sought to win round public opinion on, for instance, the popular BBC Radio 2 lunchtime Jeremy Vine show. The commercial interests behind the group, however, were never revealed to Vine’s five mIllion listeners.
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Another organisation that UnitedHealth sponsors is the Cambridge Health Network. This is an elite club for NHS leaders to meet and informally discuss policies with the forprofit health sector. Its regular talks, social events and private dinners provide, it says, ‘a place where business connections and relationships are forged’.
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Simon Stevens delivered
both the inaugural speech at the network’s first event in 2004, and on the occasion of its tenth anniversary.
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Access to this ‘confidential, closed forum’, however, is granted only to those who pass the strict vetting procedure of the network’s founders.

One of the co-founders, Penny Dash,
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is a partner at international management consultancy firm, McKinsey, which is also one of the club’s sponsors. The network has a commercial partner too, lobbying firm ZPB Partners, run by the wife of Simon Steven’s colleague, NHS England director and McKinsey alumnus, Tim Kelsey.
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Indeed, the Cambridge Health Network is seen by some as ‘essentially a McKinsey front’, one that provides valuable opportunities for private health companies and financial institutions to access and influence health officials.
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McKinsey itself, though, is in no such need. The US firm has long been embedded in our health system and for decades has played a central role in the reform of the NHS.

During the latest shakeup, McKinsey could be found advising officials on the reforms at every level of the system: inside the Department of Health, NHS England and the regulator, Monitor, as well as being paid many millions by the newly-formed local commissioning groups and commissioning support units around the country. From April 2013-14, for example, McKinsey earned over £2.5m advising Monitor and £2.7m from NHS England, which included in excess of £1m for advice on health services in just one corner of London.
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McKinsey alumni today also find themselves in positions of significant influence: there are two at the helm of Monitor; one among only eight executive directors of NHS England; the chair of the Health and Social Care Information Centre
(public custodians of our health data), as well as hospital chiefs and other key posts. The firm also hosts Department of Health meetings in their London offices, flies NHS officials on all expenses paid trips abroad, takes public servants and their families to West End shows, and entertains them at parties in exclusive venues like the National Gallery.
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McKinsey, however, devotes more of its energy to – and earns most of its revenue from – advising corporations: health insurers, private hospital groups, pharmaceutical companies, tech interests and investors. As the Coalition was embarking on its changes to the NHS, McKinsey was already gathering its thinking on the implications of the reforms and had ‘started to share this with clients’, it wrote.
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The firm also appears to be acting as a bridge between the public and private sectors. Internal emails from the Department of Health show McKinsey connecting the capital’s health officials with one of Germany’s largest private hospital chains, Helios, to discuss ‘potential opportunities’ to take over public hospitals in London. McKinsey also advised them how to minimise public resistance to the privatisation of hospitals: start ‘from a mindset [of] one at a time,’ it warned.
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McKinsey is famously tight-lipped about its private sector clients. Who they work for and what they do for them is confidential. It is not the only firm that occupies this powerful position, though, as advisers to both government and corporations, where the potential for conflicts of interest exists. The Big Four accountancy giants are in the business too.

Take KPMG. Its public sector work includes earning £3.5m in the seven months to March 2014 from the NHS bodies set up to provide commissioning services to GP groups.
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It is receiving, for instance, just shy of £200,000 a month from
the Greater East Midlands commissioning support unit for consultancy and other services.
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KPMG is also part of a consortium led by UnitedHealth that is in the running for an estimated £1bn of contracts in the same NHS market, providing these same commissioning support services.
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At the same time, KPMG is engaged with the private healthcare sector. Addressing a conference of healthcare companies and investors in New York in 2010, Mark Britnell, head of KPMG’s UK health division, spoke of the private sector opportunities presented by the UK’s health reforms: ‘The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years,’ he advised the attending companies. These included BUPA, private hospital firms, HCA and Netcare, and UnitedHealth.
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Britnell was speaking a year into his job at KPMG, which he joined from the Department of Health where he was director general in charge of commissioning.

Another of the Big Four, PwC, has similarly picked up many millions of pounds in consultancy work from across the public system. At the same time, PwC is looking to increase its position in what it sees as the UK’s growing, commercial market in healthcare. Tasked with this job is its Health Industry Oversight Board. This industry panel is chaired by former health secretary, Alan Milburn, just one of a long list of former ministers from across the political parties to now employ their expertise in the private sector.
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The ‘cosy club at the top’ that Cameron referred to should now be starting to come into view. The picture that emerges is of a largely corporate-funded closed network, peopled by commercial players, senior officials at the top of the NHS
and their former colleagues, lobbyists, think tanks and social networks, all operating with minimal public scrutiny.

This is by design. As one lobbyist notes: ‘The influence of lobbyists increases when … it goes largely unnoticed by the public.’
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Officials and politicians have more room to negotiate when their actions are not being scrutinised by the press. Also deliberate are efforts by lobbyists to occupy a public official’s environment, with invitations of corporate hospitality, social events, trips to facilities and discussions of ideas. The goal, over time, is that both parties – public and private – come to share the same set of values: the values of the market.

Above is just an outline of some of the access and influence enjoyed by just a few of the players in the UK’s healthcare market. Imagine them now being joined by lobbyists from the pharmaceutical industry. Swiss drug giant Novartis, for example, employs a dozen lobbying firms in the UK on top of its in-house team, including one established by Andrew Lansley’s former right-hand man, Bill Morgan.
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Then there are the countless patient groups funded by the drug companies that are seen by the industry as the ‘foot soldiers’ in its lobbying battles with government.
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The influential lobby group, the Association of the British Pharmaceutical Industry, even shares a building with NHS England, stewards of the £110bn NHS budget.

Add to these the construction companies and banks lobbying for more PFI deals; the private hospital companies seeking to expand their reach in the UK; temploy press officers and fund thinkhe medical technology firms, the IT and telecoms giants, the private equity companies and investors. All of them have a commercial interest in the government’s sweeping changes to the NHS. They also all have lobbyists with political connections; are
part of lobbying groups that petition government; are invited in to advise government; employ press officers and fund think tanks to shape public debate.

There is no way for the public to know the scale of the various lobbies, who is involved, or how much money has been spent pushing for the dismantling of our public health service. Unlike the US and Canada, the UK has no disclosure rules that require lobbyists to operate in the open. In the UK we only ever get a glimpse of what they are up to. But, if we did know, if discussions between private health interests and government were in plain view, we might choose to join in. We might probe and challenge their assertions. We might agree with their solutions, or we might not. Our priorities might be the same or different from theirs. But crucially, we could begin to have the public debate we deserve as taxpayers on where the NHS is heading. Rest assured, discussions are being had, we are just not party to them.

With thanks to Sylvia Davidson and Doug King Spooner

Many of the following fact and figures have already been covered elsewhere in the book and are gathered together and summarised here for ease of reference. They tell a powerful and depressing story and demonstrate that the policies that governments adopt can seriously undermine the NHS, sometimes making it seem as though the body itself is broken. The challenge is to recognise this and to transfer to policies that make the most of NHS strengths and further exploit its potential to provide care for us all.

The government does not hold central data on who has been awarded contracts to provide care to NHS patients. They say this because it is all organised locally. So to find out who is winning NHS contracts and pinpoint where public money is going takes considerable research.

Tracking NHS contracts

The NHS Support Federation has been monitoring the official website where tenders are advertised to find out which clinical services are being organised through the market. We followed this up with Freedom of information request to the clinical commissioning groups.
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