April 6, 2011 : Wolves cry wolf: selling competition in the NHS

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Even before the government’s Health and Social Care Bill has passed through the House of Commons, private healthcare companies are increasing their influence within the NHS. Pulse magazine reported last week that private company bosses are set to be handed seats on the new NHS Commissioning Board, which, come June, will oversee commissioning of all primary care services and allocate budgets to GP consortia. The magazine also reported that 10% of GPs on the boards of the already established consortia also hold an executive-level position with the same private companies that will be bidding to be commissioned by them.

And yet much of the media coverage over the past week has been more concerned with private companies not being allowed to do their business in the NHS. The BBC’s health correspondent Nick Triggle reported on 29th March that, “many English trusts are introducing steps that make it harder for patients to opt to have NHS care done by private hospitals.” These steps, Triggle explained, included, “reductions in the range of treatments that private hospitals can offer NHS patients, caps on the number of people they can treat and promising NHS hospitals set numbers of patients” and that, “as many as 70 of the 151 [Primary Care Trusts] are employing such tactics.” This was repeated by other news sources, providing a platform for companies to complain about bias against them.

The evidence for the BBC story came from the Co-operation and Competition Panel, which had published the interim findings of an inquiry it was conducting on behalf of the Department of Health. The Panel's report confirms in its early pages that “certain PCT [Primary Care Trust] practices, as well as other factors, are creating an incentive for PCTs to limit patient choice" and the chairman of the panel commented in an accompanying press release that, “both NHS and independent sector providers are being hampered in their efforts to deliver the kind of choice that is expected by patients.”

All very authoritative sounding stuff. However, reading further into the report, it turns out to be based on allegations by the very same private companies claiming a bias against them. The findings, the report explains, are based on submissions from NHS providers, GPs, Primary Care Trusts, Strategic Health Authorities, and independent and third sector providers and representative organizations. While the panel will not disclose exactly who has said what, the eagerness of companies to comment on its findings suggests the bulk of submissions were from independent (i.e. private) providers.

The report then gives us eight pages of evidence submitted by the providers, in which a series of allegations are listed. The inquiry provides no evidence that it has gathered independently to either confirm or deny these: it simply repeats what the providers have told them. We’re then informed that the Primary Care Trusts accused of wrongdoing “have not yet had the opportunity to respond to the issues that have been raised.”

So the BBC has not “learned that in some areas Primary Care Trusts are making it more rather than less difficult for private companies to get involved” as John Humphreys said when introducing the story on the Today programme. It has learned that allegations have been made, by private companies, that private companies are being treated unfairly by the NHS. The Primary Care Trust network responded to the report, saying there was “little evidence to back any of the claims that private providers were being deliberately sidelined by commissioners”.

Conclusions from this cannot be made until the PCTs submit their evidence, and in any case the more important question is whether private companies should be paid by the NHS to deliver care at all. But the PR damage has already been done: the NHS has been presented as standing in the way of the choice and competition represented by private companies, the introduction of which is implicitly suggested to be the best way to reform the NHS.

What is this Co-operation and Competition Panel anyway? Set up by the Department of Health in January 2009, it investigates and advises the Department of Health and Monitor (the body that regulates Foundation Trusts) on potential breaches of the government’s rules regulating competition and co-operation in the NHS.

Like the evidence in its report, its chairman and director are from the private sector. Chairman Patrick Carter, or Lord Carter of Coles to give him his full title, was the founder of Westminster Health Care, a leading private nursing home company. He is also the Chair of McKesson Information Solutions Ltd, which delivers IT to “virtually every NHS organisation”, the chair of Primary Group Ltd, a Bermudan based private equity company, and a substantial shareholder in, among other companies, B-Plan Information Systems Ltd, which has also benefited from the increased need for large scale IT systems that the introduction of an internal market to the NHS has brought with it (see the interview with Frank Wood, of King’s foundation trust, where B-Plan has worked, in the last news update). Carter’s register of interests in the House of Lords also lists him as an adviser to Warburg Pincus International Ltd, a private equity firm, which has significant investments in the healthcare industry. It even rescued United Healthcare from financial ruin in 1987 and helped it to become one of the largest healthcare companies in the world. He can now help it to become one of the biggest beneficiaries of the government’s reforms.

The Panel's director, Andrew Taylor, cannot boast quite such an impressive list of interests, though stints as a consultant to London Economics, which did very good business advising the government on the privatisation of water and energy services, and Stone and Webster (now Shaw) consulting, another expert on service “reform”, will stand him in good stead. Having people with such backgrounds in an “independent” advisory body will not hurt the chances of those companies who feel they deserve a few more contracts (and no matter how many they have, they will always want more), especially if the Panel’s work continues to be accepted and presented so uncritically by the media.

Growing opposition, backed by an impressively comprehensive soundtrack, has forced the government to delay the passage of the bill, though it has not announced significant changes to it. The attempts of bodies like the Cooperation and Competition Panel to move the debate on to how best to increase the scope of private companies in the NHS, rather than whether or not they should be involved at all, distorts and confuses the issue and diverts attention from the already increasing encroachment of the private sector into positions of influence in the NHS.

See also:

Co-operating and competing to privatise the NHS

August 12, 2011

Under the microscope: pathology gets the Serco treatment

November 9, 2011

The vultures circle: private equity and the NHS

May 10, 2011

Signs of things to come: The privatisation of the NHS

February 10, 2011