NHS consultants run private firms charging to cut waiting lists at their own hospitals

Guardian/Observer February 12th 2023

Calls for a ban as health trusts award ‘insourcing’ contracts worth millions to tackle backlogs

Clinical hospital staff at work. ‘Insourcing’ deals are increasing NHS reliance on the private sector to cut waiting lists. Photograph: Neil Hall/AFP/Getty Images

Some of the country’s most senior NHS clinicians are earning a lucrative sideline running private firms that offer to cut waiting lists at their own hospitals, the Observer can reveal.

Top consultants in Manchester, Sheffield and London are among directors of “insourcing” agencies that charge the health service to treat patients at weekends and evenings and have won millions of pounds of work.

Some hold leadership roles at NHS trusts that have awarded contracts to their own companies, raising concerns about potential conflicts of interest.

One deputy medical director jointly ran a firm that provided “insourcing” solutions to his own NHS trust before it was sold in a £13m deal last year. Other consultants have set up firms that they and their colleagues work shifts through themselves, often at rates above NHS price caps.

The Centre for Health and the Public Interest, an independent thinktank, this weekend called for a ban on such arrangements. The General Medical Council said current conflict of interest policies did not always deliver “the transparency and assurance that patients rightly expect”.

An Observer investigation has found:

• Three senior consultants in Sheffield ran a private firm, Pioneer Healthcare, offering insourcing services to help the NHS cut backlogs. The company won a series of contracts with local hospitals before being sold to a major private healthcare provider in a £13m deal;
• At Manchester University NHS Foundation Trust, three top surgeons including a clinical lead and a former clinical director are the owners of Fortify Clinic , a company offering “end to end” services to tackle waiting lists. The firm was paid £1.3m by the trust for work in 2022;
• Two senior consultants at the Northern Care Alliance NHS Foundation Trust trust set up Venture Health Group in December and began contracting with their own trust that month to help it meet “challenging backlog targets”.

The deals are revealed as trusts ramp up reliance on the private sector to tackle record waiting lists, with the “insourcing” market alone projected to be worth £295m next year, up from £44m in 2019, according to analysts Mansfield Advisors.

“Insourcing” involves teams of doctors and nurses being drafted in to treat patients on NHS premises. Private companies offering insourcing solutions typically work outside normal hours and use spare theatre capacity. They may use their own anaesthetists and theatre staff but often rely on support staff and infrastructure from the host NHS trust.

Trusts say the services help clear backlogs and can be cheaper than outsourcing to private hospitals because the firms do not have the same fixed costs or overheads. But the growth of the sector has raised questions about value for money and potential conflicts of interest.

Pioneer Healthcare, which was sold last year to healthcare service firm Totally, is led by three senior consultants: Prof Prasad Godbole, deputy medical director at Sheffield Children’s NHS foundation trust; Hesham Zaki, lead paediatric neurosurgeon at the trust, and John McMullan, consultant neurosurgeon at Sheffield Children’s and Sheffield Teaching Hospitals NHS foundation trust.

In addition to its other contracts, Pioneer has an initiative to cut waiting lists at Sheffield Children’s hospital, running 64 all-day theatre lists since 2021. It has also been paid more than £6.5m by Sheffield Teaching Hospitals from January 2019 to December 2022, including payments for a tendered £752,000 contract starting in May 2021 for “healthcare on trust premises”.

Another insourcing firm, Gastro Teams Seven 7 of Durham, has been paid more than £770,000 since January 2022 by County Durham and Darlington NHS Trust, where two of its directors work as consultants.

The trusts say all rules were followed and interests were publicly disclosed and managed appropriately, but the findings have led to calls for a review of conflict of interest rules for healthcare professionals

Alan Clamp, chief executive of the Professional Standards Authority, which oversees regulation of health professionals in the UK, called for a cross-sector review of managing conflicts in healthcare and urged regulators and employers to “tackle business practices” that “risk undermining public confidence”.

David Rowland, director of the Centre for Health and the Public Interest, said the current rules were “woefully weak” and called for a ban on arrangements of the sort identified by the Observer. He questioned whether potential conflicts could ever be effectively managed “if you’ve got money going from an NHS trust to a company owned by senior employees”.

“Even the perception of a potential conflict is damaging,” Rowland said.

A whistleblower at one trust where consultants run an insourcing firm said there had been “a lot of complaints” about the arrangements internally and called for greater scrutiny. “This is backdoor privatisation,” he said.

The growth of insourcing has also led to concerns about value for money for the NHS. Several firms have reported substantial profits and offer consultants £2,000 per 10-hour shift, higher than the £137.58 an hour maximum they could receive if paid in line with the NHS’s approved rates.

Prof Colin Melville, medical director at the General Medical Council, said patient trust could be damaged “if a doctor’s interests affect, or are seen to affect, their professional judgment”. “We know that current arrangements for managing conflicts of interest don’t always deliver the transparency and assurance that patients rightly expect,” he said.

Totally, which acquired Pioneer Healthcare in 2022, said the firm used otherwise spare hospital capacity to treat patients at costs “equal to or below” NHS tariffs and had helped cut NHS waiting lists by 40,000 a year. All contracts were awarded through “formal and anonymous procurement processes” to eliminate conflicts of interest and “directors of Pioneer who hold decision-making roles within trusts” were not involved.

Sheffield Children’s NHS Foundation Trust said all potential conflicts were “thoroughly considered and managed”. Sheffield Teaching Hospitals NHS Foundation Trust said consultants who also worked for Pioneer were not involved in decision-making and there was no conflict of interest.

Fortify Clinic said it was on an NHS framework for insourcing and had complied with NHS rules. Manchester University NHS Foundation Trust said: “We undertake all non-pay procurement in accordance with public procurement contracts regulations, our governance framework and the Chartered Institute of Procurement & Supply guidance.”

County Durham and Darlington NHS Foundation Trust said work undertaken by Gastro Teams Seven 7 had been “key to its pandemic recovery” and there was “no conflict of interest.”

Venture Health Group said it had followed processes around conflicts of interest. The Northern Care Alliance NHS Foundation Trust said the contract had been awarded directly to the firm during a “very challenging period” and that “a full procurement exercise to seek a longer term partner” would be undertaken in April.

The Department of Health and Social Care is considering a UK-wide system for doctors to declare their interests.

NHS England said: “While it’s in part thanks to the use of the independent sector that the NHS in England has already virtually eliminated two-year waits for elective treatment, guidance is clear that insourcing should not be used where temporary workers are paid escalated rates and suppliers must be registered with the [regulator] CQC.”

NHS becoming ‘cash cow’ for consultancy firms as contracts quadruple in value

Open Democracy February 10th 2023

Exclusive: NHS England allocated £83m for outsourced consultants last year – enough to train more than 1,600 new nurse

NHS England more than quadrupled its budget for outsourced consultancy work to £83m last year, new figures obtained by openDemocracy show.

The combined value of the health service’s consultancy contracts in 2022 could have trained more than 1,600 new nurses or paid for almost 14,000 hip operations.

Campaigners said the “ludicrous sums” are proof that the government has failed to learn from the billions the Department of Health and Social Care wasted on consultants for its ineffective NHS Test and Trace scheme during the pandemic.

Several of the consultancy firms that worked on the £37bn Covid testing programme were awarded NHS contracts last year, despite an inquiry finding the scheme failed to slow the pandemic and was “overly reliant on contractors”.

In total, NHS England awarded £83m worth of consultancy contracts last year – a fivefold increase on the £16m it awarded in 2021, according to data supplied by Tussell.

This included a contract worth up to £21m awarded to seven top consultancy firms in 2022 to help provide “short-term analytical and planning support” for tackling its post-Covid backlog.

The seven firms – which include Deloitte, Boston Consulting Group, KPMG, PriceWaterhouseCooper and McKinsey – could each be paid millions to help the 42 boards that manage NHS England services regionally to draft plans aimed at reducing waiting lists.

But campaigners have questioned whether the consultants can be trusted to put patient’s interests first.

“The more reliant NHS management becomes on management consultants, the less it focuses on patient care and public accountability, and the more emphasis it places on business methods, markets, profits and finding new roles for even more private contractors,” said John Lister, co-founder of the Save Our NHS campaign.

NHS England bosses have already told regional boards that their plans “need to include specific detail on how the system will maximise use of independent sector provider (ISP) capacity.”

In 2020, DHSC paid staff at two of the seven firms, Deloitte and Boston Consulting Group, as much as £6,600 a day to work on Test and Trace. The overall value of consultancy and auditing contracts handed to Deloitte by the NHS in 2022 increased from £590,000 in 2021 to £10m.

The data provided by Tussell shows how much NHS England – the national organisation responsible for running the NHS in England – budgeted to spend on each consultancy contract it awarded, but the actual spend could be lower or higher. The total consultancy budget for every NHS body in England will be higher, as local NHS trusts can also contract consultants but are not included in the data.

‘Ludicrous sums of money’

PA Consulting Group topped the list of NHS consultants in 2022, receiving a total of £22m worth of contracts, including £10m to support the Covid vaccination programme.

Consultancy firms appear to have increased their overall involvement in the vaccination programme, receiving NHS England contracts worth £23m in 2022 – compared to £14m in 2021.

“This government’s eagerness to funnel public money into private companies in a variety of ways, while they starve public services of funding, is deeply concerning. It is also illogical. One report published in 2018 showed that employing consultants within NHS Trusts in England made things less efficient, not more,” said Dr Julia Patterson, chief executive of campaign group EveryDoctor.

“If the government wants to improve the service, they will start listening to healthcare leaders, clinicians and patients at a national and local level to create meaningful solutions, instead of paying management consultants these ludicrous sums of money.”

Dr John Puntis, a retired paediatrician and co-chair of Keep Our NHS Public said: “People often think of NHS privatisation in terms of selling off patient care services. In fact, the main area of action at present is backroom office support, embedding private companies within the NHS and extending their influence over the service as a whole.

“The government is highly susceptible to lobbying by private firms as was highlighted during the Covid pandemic with the test and trace and PPE fiascos. These generous contracts to consultancies provide further confirmation of this. Increasingly, the NHS is seen as a cash cow for private companies.”

On Tuesday, the Guardian revealed that the government have quietly dropped restrictions on consultancy spending, allowing Whitehall departments to potentially spend millions more on big consultancy firms.

The changes come despite past warnings from ministers that consultants waste taxpayer money and “infantilise” civil servants.

While NHS England increased the total value of contracts it awarded to consultants in 2022, the total value of Department of Health and Social Care consultancy contracts dropped. In 2021, the department awarded £456,650,548 in largely Covid-related contracts to consultants, while last year it awarded £42,190,706.

An NHS England spokesperson said: “The NHS continues to deal with the effects of a once-in-a-generation pandemic, and while the actual spend is likely to be lower than the maximum amounts described, it is right that local teams are able to access additional expert support in their efforts to restore and improve services for patients.

“The NHS is one of the most efficient health services in the world, and while our life-saving Covid-19 vaccination service was found by the Public Accounts Committee to be a great use of taxpayer money, expenditure on this – as well as in other areas – is set to dramatically reduce in the next financial year.”

‘POLICY AND REGULATION BRANDING AGENCY HIRED TO HELP ‘CULTIVATE NEW PERSONALITY’ FOR NHSE’

Health Service Journal February 7th 2023

NHS England will attempt to ‘cultivate the right personality’ as an
‘empowering coach-like leader’ in part to ‘rebuild lost trust’ with the
service.

The strategy has emerged from work undertaken by branding agency Thompson.
It has been engaged by NHSE to help “position” the “future role” of the
organisation after its merger with NHS Digital and Health Education
England.

The “interim update for senior leaders” presented by Thompson and senior
NHSE comms managers last month, and seen by HSJ, seeks to put forward a
“central narrative” and “messaging framework”, for the “new NHS England”.

Thompson carried out research among senior NHSE figures, including
director of transformation Tim Ferris, Health Education England chief
executive Navina Evans and deputy chief operating officer Mark Cubbon
during the last three months of 2022. It also studied a range of NHSE
strategy documents and interviews given to HSJ by NHSE director of
strategy Chris Hopson and departing NHSD CEO Simon Bolton.

The research concluded that “many stakeholders” felt it was “important to
rebuild what they see as lost trust [in NHSE]”.

The leaders surveyed said they wanted “the new NHS England” to be
“positioned primarily as a facilitator of improvement”, and for the
organisation to be seen as “part of the solution, rather than part of the
problem”.

Stakeholders felt this could be achieved by a “shift in tone” from an
“authoritative” approach to a “collaborative one”. They recommended NHS
become “a servant leader”, able to effectively communicate what “system
working means”.

They also wanted to “allay the fear” that HEE and NHSD’s “functions are
being related to positions of lower authority”.

In response to the research, Thompson made a number of recommendations.
These included that NHSE:

  “Reframe” its “core function” away from “regulation, policy and budget
control” to focus on “collaboration and system working”.
  “Cultivate the right personality” of an “empowering coach-like leader”.
  “Adopt a ‘down to earth’ type of voice… to avoid the perception that
NHS England is an ‘ivory tower’.” The new NHSE should be “able to
communicate on the same level as its audience”.
  Build “credibility” and avoid being seen as “disconnected from
frontline realities” by developing “messages that demonstrate empathy
with “concerns on the ground”.
  “Actively combat the media-driven narrative of NHS England being made
up solely of bureaucrats”.

The information seen by HSJ said these recommendations would “become the
core requirements” of a campaign to be launched in April.

NHSE chief executive Amanda Pritchard has stressed on a number of
occasions her wish to establish a more collegiate relationship with the
service. She has, for example, brought a range of senior trust chief
executives into part-time roles within the organisation. The ongoing
Hewitt review is expected to recommend that NHSE give more autonomy to
integrated care systems, and the latest planning guidance to the service
featured far fewer detailed requirements than in previous years.

An NHSE spokesperson said: “We have always been clear, as set out in our
operating framework, NHSE is changing the way that it works to reflect the
move to system-based approaches and stronger partnership working. As we
bring together three large organisations and with any merger of this
scale, complex and detailed work is needed to establish how the new
organisation will operate – this piece of work was undertaken to support
that.”

The branding and digital design agency Thompson has worked closely with
NHSE in the past. For example, in 2016 it helped “develop a comprehensive
identity policy” for the service.

Exclusive: Ambulance service will collapse by August, predicts its nursing director

Health Service Journal May 25th 2022  https://www.hsj.co.uk/west-midlands/exclusive-ambulance-service-will-collapse-by-august-predicts-its-nursing-director/7032502.article?mkt_tok=OTM2LUZSWi03MTkAAAGEmQAX6Npiu_dzUnqyayYtP1ollSxmFRLVxDhwF0Un0-n410CYmkiILW30HBJXT5tcagX6fFcLEHwVBoAa25ZBUtqU_MFk53eW6AnOb4SNOK2Kb88

West Midlands Ambulance Service chief calls out NHSE and CQC over ambulance delays

·       Mark Docherty claims patients dying every day as over 100 deaths are linked to SIs

·       Nursing director predicts system will collapse in August, with no ambulances available

·       Hospital discharge delays branded “criminal” when teenagers “dying on the street”

A struggling ambulance trust could face a ‘Titanic moment’ and collapse entirely this summer if the region’s worsening problems with hospital handover delays are not taken more seriously, its nursing director has told HSJ.

Mark Docherty, of West Midlands Ambulance Service, said patients were “dying every day” from avoidable causes created by ambulance delays and that he could not understand why NHS England and the Care Quality Commission were “not all over” the issue.

He revealed that handover delays at the region’s hospitals were the worst ever recorded, that rising numbers of people were waiting in the back of ambulances for 24 hours, and that serious incidents have quadrupled in the past year, largely due to severe delays.

Shropshire, Staffordshire and Worcestershire are experiencing particular problems – Royal Stoke University Hospital recorded the highest number of handover delays over an hour in April with 1,588, while Shrewsbury and Telford Hospital Trust was not far behind with 1,263.

More than 100 serious incidents recorded at WMAS relate to patient deaths where the service has been unable to respond because its ambulances are held outside hospitals, according to the minutes of the trust’s March quality and safety committee.

Mr Docherty said the situation was now so serious that he is predicting the service will collapse in August.

‘Titanic moment’

“Around 17 August is the day I think it will all fail,” he said. “I’ve been asked how I can be so specific, but that date is when a third of our resource [will be] lost to delays, and that will mean we just can’t respond. Mathematically it will be a bit like a Titanic moment.

”It will be a mathematical certain that this thing is sinking, and it will be pretty much beyond the tipping point by then.”

He added: “It would make me the happiest person in the world if everyone in the system proves to me that actually the ambulance service in the West Midlands isn’t going to fail on 17 August, and I’ve got it completely wrong.”

Mr Docherty said there needs to be a focus on discharging hospital patients who are fit to leave in order to free up beds for those arriving by ambulances.

He described the large number of medically fit patients occupying hospital beds as “criminal…when I’ve got teenagers dying on the street from things that are completely reversible”.

The nursing director claimed NHSE officials had downplayed tackling the problem of delayed discharge, stating that the trust needed to “focus on things they can control”.

Mr Docherty also queried why the CQC had issued improvement notices about hospital corridor care, but not about handover delays.

Deaths ‘entirely predictable’

WMAS was one of the first trusts to bring national attention to the issue of handover delays when it raised its risk rating for handover delays to 25 in October, the highest in its history.

“The 25 reflects that patients are dying every day that shouldn’t be dying every day,” said Mr Docherty.

“Their deaths are entirely predictable, and of a scale that means we need to be taking this really seriously.”

He added: “All of the issues that we’re building for the future are huge. And I don’t know why the CQC are not all over this, I don’t know why NHS England is not all over this.”

Previous national responses to handover delays have included telling all trusts to “immediately stop delays” in October, while regionally, a top-level summit is planned this summer to tackle delays in Shropshire.

In April, the Association of Ambulance Chief Executives called on NHSE to “accelerate their activities to find immediate solutions to delays” after it emerged 40,000 people were put at risk while waiting in ambulances.

Last week, it emerged ambulance trusts would be getting £150m to aid with response times.

An NHS spokesman said: “The NHS has been working hard to reduce ambulance delays and £150m of additional system funding has been allocated for ambulance service pressures in 2022-23.

“There is no doubt the NHS still faces pressures, and the latest figures are another reminder of the crucial importance of community and social care, in helping people in hospital leave when they are fit to do so, not just because it is better for them but because it helps free up precious NHS bed space.”

The spokesman also highlighted other measures being used to tackle handover delays, including an investment of additional £130m since September 2021 in 999 and 111 services to improve timeliness of response to patients in the community.

Systems across the country are also being encouraged to take a range of actions, including increasing numbers of hospital beds within infection control guidelines, bespoke support for challenged trusts, and the development of escalation plans to identify delays and risks as they happen, they added.

Victoria Vallance, CQC’s director of secondary and specialist healthcare, said the regulator is continuing to support efforts by providers through its programme of system-wide urgent and emergency care service inspections.

She added: “There is no doubt that the current impact of escalating pressure on the NHS is severe – with unacceptably long delays for patients waiting for ambulances or waiting for admission to hospital clear manifestations of the problems services face.

”There are very real concerns about the significant risk to patients and the impact on paramedics and hospital staff as they do all they can to deliver safe care under the most demanding circumstances, and we have highlighted these concerns in our public board meeting. We will continue to monitor services and use our regulatory powers where necessary.

“The problems of capacity in urgent and emergency care services have been building over many years, and we know from our work with frontline emergency department clinicians that currently patient flow is incredibly challenging. There are no simple solutions, but close working between providers, commissioners and all other parts of the health and care system will be essential to safely manage risk going forward.”

Representatives for the Shropshire and Staffordshire systems and trusts highlighted various upgrades and investments to emergency departments, enhanced triage, and same-day emergency initiatives which have been rolled out to help reduce handover delays.

‘Catastrophic’ patient harms to be raised at summit

Mr Docherty is due to raise the case of Jamie Rees, who collapsed on New Year’s Eve 2021 while out with friends in Rugby, at a safety summit later this week.

The 18-year-old died of a cardiac arrest after delays led to an ambulance responding in 17 and a half minutes instead of the target of seven.

His mother, Naomi Issit, said her “selfless” son, whom she described as “cheeky, laidback but very clever and witty”, deserved better.

She told HSJ: “All we can do for Jamie now is to get something changed. The thought that this could happen to someone else just strikes fear in us. They [the NHS] don’t seem to be able to come up with a solution to these delays. Surely somebody somewhere eventually is going to sit up and say, there are young people dying.

“It’s bad enough when elderly people are dying needlessly but he was 18. He had his whole life ahead of him, and it’s just torn away from him, and nobody seems to want to change anything to put that right.”

His case is set to be raised alongside that of a 52-year-old from the Shropshire area who has been left disabled for life after a delay led to him not being able to quickly access a thrombectomy.

If you believe in a public NHS, the new health and care bill should set off alarm bells

Allyson Pollock and Peter Roderick

The government is easing the way for the privatisation of the health service – where is the opposition to their plans?

Guardian December 7th 2021

Ten years ago, Andrew Lansley’s health and social care bill to reorganise the NHS in England faced enormous opposition. The current health and care bill, which has its second reading in the House of Lords today, has received far less attention. But it is no less significant. The new bill will continue the dismantling of the NHS, this time by adopting more features from the US health system. For anyone who cares about the NHS, this should set off alarm bells.

The proposals mean that for the first time since 1948, parliament will not determine to whom NHS services must be provided. The bill removes the requirement for emergency services to be provided for everybody present in an area. No explanation has been given for getting rid of it.

Over the past three decades the funding, planning and provision of health services have become disconnected from each other and from people living in local areas. The bill takes this further. It gives a single budget pot to 42 new integrated care boards (ICBs) to commission most health services. These won’t serve all people living in a local area, but a “group of people” who can be drawn from anywhere in England. The group will be allocated to the ICB under rules made by NHS England, without parliamentary process.

Each ICB will have “core responsibility” for its group of people. This new concept closely resembles the US definition of a health maintenance organisation (HMO). In the US, contrary to popular perception, the government funds most healthcare, much of it through private health companies such as HMOs and other “managed care organisations”. These are responsible only for providing limited free services to a group of people who enrol as their “members”, not a local population. They provide a core or basic package of care paid for under a health plan. Additional services are paid for through more insurance or user charges.

US private health companies such as Centene (Operose) and UnitedHealth (Optum Health) offer publicly funded health plans in the US, and already operate in the NHS. After a takeover earlier this year, Centene became one of the largest primary care providers in England, with 58 practices and more than 500,000 patients. Within weeks of the deal, Samantha Jones, the CEO of Centene in the UK, had resigned and was appointed Boris Johnson’s health adviser. UnitedHealth has received a range of NHS contracts for more than a decade, and in 2019 Optum was one of two companies awarded a four-year prescribing support contract up to £100m. The chief executive of NHS England was until recently Simon Stevens, the former vice-president of UnitedHealth. Stevens became a peer this year, and the bill is his brainchild.

After a weasel-worded amendment from the government, which failed to rule out private companies sitting on the ICBs or their committees, the new bill will still allow these multinationals, together with private health insurance companies such as Bupa and Spire, to join the ICBs. These ICBs will decide how the budget should be distributed.

Still, despite the focus on ICBs, much of the real power and decision-making will lie with four groups that already exist but are not mentioned in the bill: provider collaboratives, place-based partnerships, primary care networks, and companies accredited to the Health System Support Framework. Provider collaboratives are groups of public and private providers that NHS England has said will be responsible for designing services. ICBs will be able to delegate their functions to them. The bill also proposes that commissioning contracts can include “discretions … in relation to anything to be provided under” the contracts. In practice this will allow providers to decide what, where and how services will be provided. So much for our so-called rights under the NHS constitution.

More than 40 collaboratives are listed on the NHS England website, including several private companies such as Cygnet, Priory and Elysium. There are echoes here again of the US. In the byzantine US healthcare system, private insurance companies sell health plans to individuals, some of whom may be eligible for public funding. The private insurance companies enter contracts with a limited number of providers to buy services for their plan members, known as “provider networks”. An ICB will be able to operate similarly, with similar effects, for its group of people. The Northern Care Alliance is already reported to be doing this. In effect, this leaves the principle of a universal and comprehensive NHS in tatters.

And let’s not forget the many private companies already accredited to the health system support framework, including Atos, Capita, Operose, Deloitte, Ernst & Young, McKinsey, PWC, Serco and Optum. The bill says nothing about these, but they will be providing population health management, digital and other support services. In other words, the private sector will be present at every level of the health service.

These changes and more build on three decades of incremental chipping away by successive governments at the founding principles of the NHS as a universal and comprehensive service based on public funding, accountability and ownership. In the wake of the pandemic, the public is being softened up to expect fewer NHS-funded services and to be pushed into paying for them. Already, the NHS-partnered patient access website for GP appointments, repeat prescriptions and “discovering local health services” is reportedly offering mostly private healthcare with lists of tests and treatments to be paid for.

This bill will help ease the way for more private funding and provision of health services. MPs and local authorities will have little influence over the decisions of ICBs, as ICBs will not be established to meet the needs of the local population. Provider collaboratives will be even freer to make their own decisions. Yet the handing over of power to non-statutory groups has received less scrutiny than one would expect from MPs in the Commons. The spin that ICBs will deliver “integration and innovation” has been swallowed by too many.

This bill cannot be defeated by MPs, and it is highly unlikely it will be defeated in the Lords. The government’s Commons majority is too large and there are too many MPs and peers with interests in the private health sector. But there’s still time for the public to realise what’s happening. Anyone who believes that health services must be publicly funded and provided should oppose this bill.

• Allyson Pollock is clinical professor of public health at Newcastle University and author of NHS plc: the Privatisation of Our Health Care; Peter Roderick is a principal research associate at the Population Health Sciences Institute, Newcastle University

People’s Covid Inquiry – main finding: Misconduct in Public Office

Here are the findings of the People’s Covid Inquiry.

On Wednesday 1 December, the People’s Covid Inquiry organised by Keep Our NHS Public presented our finished report.In the absence of a formal public inquiry into the pandemic, The People’s Covid Inquiry began in February 2021 and concluded it’s hearings in the summer. It covered all aspects of the government’s handling of the pandemic and heard testimony from a wide range of people and organisations. These included previous government advisors and key academics, as well as frontline workers and bereaved family members. The Inquiry was chaired by world renowned human rights barrister Michael Mansfield QC who, together with a panel of experts, have now delivered their findings and recommendations on all main aspects of the pandemic to date.KEY FINDINGS INCLUDE: 1. The depleted state of the NHS and other public services prior to the pandemic was a determining factor in poor outcomes and led to avoidable deaths. 2. The government was poorly prepared for the pandemic and moved too slowly, which led to avoidable death. 3. The government adopted the wrong strategy leading to loss of life and growing mistrust in its advice. 4. The government’s poor record on inequalities has put the most vulnerable at risk from illness and death from Covid-19. 5. Misconduct in public office: There has been dismal failure in the face of manifestly obvious risks. The report received a huge amount of press interest just a section of which you can read by looking at the press page on our People’s Covid Inquiry website.

People’s Covid Inquiry chair Michael Mansfield QC, said:This People’s Covid Inquiry report is unequivocal – dismal failure in the face of manifestly obvious risks…This Inquiry performed a much-needed and urgent public service when the nation was hit by a catastrophic pandemic coincident with an unprecedented period of democratic deficiency. It afforded an opportunity for the beleaguered citizen to be heard; for the victims to be addressed; for the frontline workers to be recognised; and for independent experts to be respected. When it mattered most and when lives could have been saved, the various postures adopted by government could not sustain scrutiny.”“It was plain to Keep Our NHS Public (the organisers of the People’s Covid Inquiry) that Government words were bloated hot air, hoping to delay and obfuscate. Within this narrative lies a theme of behaviour amounting to gross negligence by the Government, whether examined singularly or collectively. There were lives lost and lives devastated, which was foreseeable and preventable. From lack of preparation and coherent policy, unconscionable delay, through to preferred and wasteful procurement, to ministers themselves breaking the rules, the misconduct is earth-shattering.

Dr Tony O’Sullivan, Co-Chair of Keep Our NHS Public and retired Consultant Paediatrician, said:We are proud that our Inquiry filled the deafening silence from Government and set out to learn the lessons that could save lives in this and future pandemics. We are shocked at the avoidable loss of tens of thousands of lives through the neglect of pandemic planning, the run down of the NHS, and the intense inequality in this country. We heard the pride of NHS, care and other frontline staff and we heard about their pain, exhaustion and moral injury. The level of government cronyism and resultant profiteering has been blatant and in plain sight. Our overall conclusion is that there has been misconduct in public office. This has to be addressed. If we ignore it, the country cannot learn the lessons from today to face the challenge of tomorrow.

The pandemic is not over, and despite previous improvements, infection rates and death tolls are once again rising. As winter approaches and the Omicron Variant takes hold, the government must act now or more avoidable deaths will occur.With political will and public support, there is no reason we can’t still emerge from the pandemic with an NHS that is not on the brink of collapse as it is now, but having learned lessons, gained experience, and seen proper investment in a publicly provided health-and-care service, in order to keep the nation safe as and when another crisis like this occurs.The Executive Summary and the Full Report of the People’s Covid Inquiry is available to download here.

Consultation on DCMS proposals on weakening GDPR protection of our data

The Department for Digital, Culture, Media & Sport (DCMS) proposes to ‘reform’ the General Data Protection Regulations (GDPR), which are EU-wide, to a new, UK data regulatory framework, the UK GDPR.

See Open Rights for more details.

See also the Open Rights group statement of September 2021:

WHY ON EARTH IS THE GOVERNMENT MUCKING ABOUT WITH OUR PRIVACY LAWS?

Thursday evening, the UK Government published their long-awaited proposal for a new UK data protection regime. The new framework is the peak of a journey Open Rights Group has followed closely, starting from the National Data Strategy and down to the TIGRR report and the Digital Regulation Plan.

We will thoroughly analyse and react to Government consultation, but there is already enough that confirms our worst fears. Behind the fig leaf of ‘tougher penalties and fines for nuisance calls and text messages’, the UK Government has put forward a deregulating approach that would enable data uses based on commercial viability, with little regard of the externalities and resulting harms for UK residents. The UK Government will also try to game the EU adequacy system and allow international transfers of EU data to third countries with lower data protection standards, in an attempt to gain a competitive advantage against EU Member States.

This proposal marks a quite fundamental departure from the principles, enshrined in the data protection frameworks of the European Union and the Council of Europe, that innovation and the use of personal data should be centred on human rights and designed to serve mankind. If implemented, it is also likely to undermine the already weak UK adequacy decision — an outcome that would harm local businesses and damage UK aspirations to become an international standard-setter in this field”.

The Department for Digital, Culture, Media & Sport (DCMS) published a 146 page consultation document on its proposals, with a closing date of November 19th 2021. The proposals had almost no publicity, so it is likely that very few people participated in the ‘consultation’.

However, Anna Pollert, secretary of South Warwickshire Keep our NHS Public, sent an email in response to the consultation on November 16th, which was acknowledged by the DCMS.

It is published here:

Dear DCMS,

I do not have time to complete the extremely long formal consultation document on revising the GDPR. It is far too long for the majority of the population and so is not really a viable public consultation. I see no efforts on your part to publicise the plans to engage citizens.
I wish to make a marker here on my objections:

At present, the GDPR protects individuals from harmful or discriminatory uses of their data. It does so by imposing a duty on organisations to use our data in a legal, transparent, and fair way.

The DCMS proposal, instead, frames human dignity as an obstacle in the way of innovation. Organisations are given leeway to harm and discriminate under the guise of “unleashing the power of data across the economy”.

It will allow organisations to re-use personal data for commercial use, particularly by broadening the definition of ‘research’ to include market research for commercial purposes. This allows for the commercialisation of our health data. 

The proposals to liberalise the further use of data for reasons of “substantial public interest” begs the question of what “public interest” means. It would give the Government unprecedented power to apprehend records and data being stored by public or private organisations and look for “suspect” activities. Migrants are likely to be incredibly affected by such a regime, as they routinely hand over bank statements, utility bills and other documents to prove their right to work, to reside, or to rent in the UK.

The GDPR empowers individuals to know if and how an organisation is using their data, for what reason, as well as to delete, correct, or object to the use of this data.

The DCMS proposal, instead, treats our rights to know, choose and complain about how their data is used as an annoyance to get rid of. In particular, the proposal to charge for obtaining our data is a fundamental affront to our civil rights.

There is a great deal more to say, but, like most of the population, I do not have the time to spend hours on a 146 page document.

Yours sincerely,

Professor Anna Pollert

UNISON fights new subco plan at South Warwickshire Foundation Trust and George Eliot Hospital

The Lowdown November 15th 2021

Many campaigners remember the privatisation of Hinchingbrooke Hospital.  It was claimed far and wide as the answer to turning around a hospital which had posed problems for years.

But after awards were handed out the truth emerged.  The whole sage was a total failure, and the many claims were bogus. The whole exercise was rigged and better NHS solutions were not properly considered.

But when the privatisation model was still being pushed, George Eliot Hospital in Nuneaton also tried to go down that route.

Despite confronting a dishonest and intransigent management, the trade unions and campaigners once more won the day, and the whole deal fell through; other solutions were found. You would have thought someone would learn – but no.

As the peak of the pandemic appeared to recede, management at George Eliot along with partners in South Warwickshire were back on the privatisation/outsourcing bandwagon in April this year, this time trying to hive off IT staff into a “wholly-owned subsidiary”.

Yet again we have management trying to transfer staff out of the NHS into some dodgy subco so the Trust can get tax advantages.  Many thought we had seen the end of that saga too.  Much-vaunted schemes at Bradford and Frimley were both successfully resisted by the trade unions despite massive pressures from NHS management.

Yet again we have management refusing to abide by their legal duties under the NHS Constitution.  They refuse to consult over plans or to have any meaningful discussions over what exactly the problem is that having a subco will solve.  The decision is made, and staff are then ‘consulted’ only over the details of the transfers.

With such an appalling approach by management the subco plans have now had to be confronted by industrial action.  Staff resent being told they will be better off outside the NHS, that they are no longer part of the team – not like doctors or nurses.

IT staff at George Eliot Hospital and South Warwickshire NHS Foundation Trust (SWFT) in Warwick have staged a 2-day strike against plans to transfer them on December 1 against their will and without consultation to Innovate Healthcare Services, a new private subsidiary company set up by the trusts.

George Eliot and SWFT share a chief Executive, Glen Burley, who somehow also manages to hold the CEO job at Wye Valley NHS Trust – and is making no concessions as he pushed forward with the project, claiming that the new wholly owned subsidiary would provide “protection from external providers” and somehow “keep staff within the NHS family.”

However even a Warwick Tory councillor has warned that SWFT is being unfair to those staff who have ‘proudly and loyally’ worked for the health service for years, and this could lead to ‘privatisation of part of the NHS by the backdoor’.

Mr Burley also claims that “Throughout all stages of this process we have worked closely with Union representatives to address their concerns and we are having on-going conversations regarding arrangements with them post transfer.”

UNISON regional organiser Mike Wilson refutes this, insisting that the only offer to negotiate has been on the TUPE transfer of staff out of the NHS, not on the issue of whether or not the company should be set up.

“Like many of their colleagues in healthcare, these staff actively chose to work for the NHS to serve the public. And they’ve done so through the toughest of times during the past few months of the pandemic.

“Now their employers have turned round to say they don’t want them and are forcing them to become a kind of private contractor.”

One staff member told the Coventry Telegraph: “We started work in the NHS, and want to continue this. People are just so disappointed, we are not being listened to. We do not want to work for this private company – we want to stay in the NHS, we are proud to be in the NHS.”

Further action is planned on November 23 and 24.

Where did the £37 Billion on Test and Trace Go?

Posted on October 24, 2021

Do we wonder where the £37 billion on Test and Trace is spent?

On March 4^th 2021, the House of Commons Public Accounts Committee COVID-19: Test, track and trace (part 1) Forty-Seventh Report of Session 2019–21 Report, was published https://committees.parliament.uk/publications/4976/documents/49795/default/

Here are some quotations from it:

There is still no clear evidence to judge NHST&T’s overall effectiveness. It is unclear whether its specific contribution to reducing infection levels, as opposed to the other measures introduced to tackle the pandemic has justified its costs.

Professional bodies, such as SAGE and BMA, have raised concerns about the effectiveness of the programme in reducing transmission. NHST&T publishes weekly performance data, but these do not provide an overview of the speed of the process from beginning to end (“cough to contact”) and thus do not allow readers to understand the overall effectiveness of the programme.

The percentage of total laboratory testing capacity used in November and December has remained under 65%, at the lower end of what NHST&T states is best practice (between 60% and 85%). Even with spare capacity, NHST&T has never met the target to turn around all tests (in face-to-face settings) in 24 hours

At the beginning of November 2020, a ministerial announcement said there were 2,300 consultants and contractors working on NHST&T. When we took evidence in mid-January the Department estimated that from Deloitte alone there were still around 900 contractors on the books. In early February NHST&T said it was still employing around 2,500 consultants, at an estimated average daily rate of around £1,100, with the highest daily rate paid of £6,624. It is concerning that the DHSC is still paying such amounts—which it considers to be “very competitive rates”—to so many consultants.

There is now a widespread roll-out of rapid tests (primarily lateral flow device (LFD) tests, which give results in 30 minutes) for local authority use and in other community settings, such as schools and workplaces. To support this roll-out, the government allocated a further £7 billion to NHST&T in December 2020 on top of £3 billion already budgeted. The Department had already purchased 384 million LFD test kits. However, a number of reports have raised concerns about the effectiveness and risks of mass testing using LFD tests, given their lower accuracy compared to laboratory processed tests, particularly the higher risk of ‘false negatives’ (people who actually have the virus getting a negative result).

The Government is now accelerating the roll-out of vaccines across the country, but we have not seen a future strategy for test and trace in response

In September 2020, SAGE concluded that “test and trace was having only a marginal impact on transmission”…..NHST&T’s model [also] suggested that only around 10% of the total reduction in the “R number” could be attributed to NHST&T’s contact tracing activities. We are also aware that the interim report on the Liverpool mass testing pilot did not find clear evidence that the pilot reduced positive COVID-19 cases or hospital admissions.

Protestors and doctors’ union call on MPs to block new English health bill

Open Democracy July 14th 2021

The British Medical Association has come out in opposition to the Health and Care Bill, piling pressure on government

The British Medical Association (BMA) has “overwhelmingly” voted to oppose the Health and Care Bill ahead of its second reading today. The group, which is the main group representing doctors in the UK, called on MPs to block the bill, warning it poses “significant risks” to the NHS.

The news raised cheers from campaigners who gathered outside Parliament this afternoon to call on MPs to vote down the profound new reforms to the English NHS.

Speakers including Labour’s Jon Ashworth, the shadow health secretary, said that the bill did nothing to integrate the NHS or improve provision. Instead, he said, it made it easier for NHS contracts to be awarded to private health firms without proper process or advertising.

Ashworth also said that the bill would also allow private firms to sit on new local boards that will decide what services are provided and whether they are privatised or even cut altogether – risking serious potential conflicts of interest.

The BMA’s intervention, coming in advance of today’s second reading, is particularly significant as the doctor’s union did not oppose the last major NHS reforms, in 2012, until much later in the process.

Tony O’Sullivan, co-chair of Keep Our NHS Public, also read out messages of solidarity from supporters and cross-party MPs.

Labour MP Margaret Greenwood warned: “This bill will lead to a postcode lottery, increased local rationing of healthcare and the deregulation of medical professions. It hands the NHS, our most treasured institution, over to big business and is a betrayal of our shared vision of the NHS as a comprehensive universal public service.”

‘Conflict of interest’

Philippa Whitford MP, Scottish National Party health spokesperson and a member of Parliament’s health and social care committee, warned that the bill retained “perverse incentives” and that “the presence of private companies on the [new] boards creates a real conflict of interest.

“It would instead, have been good to see the return of a publicly funded and publicly delivered NHS in England as we are lucky enough to still have in Scotland.”

Green Party MP Caroline Lucas said: “The Health and Care Bill… risks handing out NHS contracts to private companies without tendering and more privatisation by stealth. We know beyond a doubt that this isn’t how to help our National Health Service recover from the effects of the pandemic.”

Jon Ashworth added: “This top-down reorganisation allows the private sector a direct say in the design and delivery of local health care. After a year in which cronyism and outsourcing has seen billions wasted on duff PPE and failing contact tracing, patients and staff know this is the last thing the NHS needs. Labour will be fighting NHS privatisation and urging MPs to vote against this bill.’

Campaigners also highlighted measures that weaken the NHS’s legal duty to provide healthcare to people in England – and that apply stringent new financial rules.

The British Medical Association – which represents doctors across the country – has rejected the government’s argument that the bill is necessary to help the NHS recover from COVID, while also stating it is “concerned about the wide-ranging excessive powers the bill would confer on the health secretary”.

Louise Irvine, a Lewisham GP and a member of the BMA’s ruling body, told openDemocracy (speaking in a personal capacity) that she was “delighted the BMA had come out in opposition to the bill early and can now have a real influence on the course of events” and that she hoped other unions representing health workers would join the campaign now.

The BMA today tweeted that the timing of the legislation is “particularly unwise… while we are still tackling #COVID19 and resulting backlog of care” and that “the Bill addresses none of the problems the NHS is currently facing”.

In a press statement, the BMA highlights “many concerns” about the plans, many of them covered by openDemocracy, noting that it “fails to address chronic workforce shortages or to protect the NHS from further outsourcing and encroachment of large corporate companies in healthcare, and significantly dilutes public accountability”.

The BMA also says that “despite its title, the bill does nothing to address the serious failings in social care that needs urgent attention”.

“The Bill addresses none of the problems the NHS is currently facing,” David Wrigley, deputy chair of the BMA, said in the statement.

“This is not the right time to be making such widespread changes to our health service,” he added. “What’s more, the bill addresses none of the problems the NHS is currently facing – too few resources, too little funding, a crisis in social care and a huge shortage of staff.”

Wrigley also says the bill fails to take into account the “exhausted and depleted” workforce which is now battling another COVID wave.

“Healthcare workers have led from the front throughout this pandemic” but their concerns had not been addressed, he said, noting that the bill “undercut” clinical voices and raised the “threat of private health providers having a formal seat on new decision-making boards, and wielding influence over commissioning decisions”.

Instead, Wrigley has called for the government to think again and “make the NHS the default option for NHS contracts and to only tender competitively where this is not possible”.

He said this was “vital” in avoiding contracts “without scrutiny to private providers at huge expense to the taxpayer, as was seen with the procurement of PPE and Test and Trace during the pandemic”.

Read more!