Labour Used Virgin 'Restricted' Report to Open NHS to Healthcare Companies

A hitherto restricted report commissioned by Labour back in 2000 has revealed how Virgin overstepped their remit – advice on improving customer service in the NHS - by promoting an increase in the use of private companies. Further inclusions written into the report by mystery authors also reveal a fledgling policy idea that would later become part of Virgin’s expansion into the healthcare market. The document also sheds light on New Labour’s wider programme of marketising the NHS – the job the Coalition has now seen to conclusion.

The document, which was meant to focus on customer service, extended into areas of regional pay, consultant contracts and staff salaries, elements that would later be included as part of Labour’s ‘NHS Plan’. Under Tony Blair, Labour welcomed private companies into the NHS like never before, and in doing so helped spawn a new organisation that would go on to be key to maintaining competition in the recent Health and Social Care Act.

Now, with the Coalition’s Health & Social Care Act 2012 hammered through parliament, the NHS is being fragmented at an ever-increasing rate and some of those involved in handing out the new contracts include the very same architects behind this previously unseen report.

Asking for Virgin’s help
In 2000, the Labour party asked Richard Branson’s Virgin to advise on how to make hospitals a more user-friendly environment. Virgin, in the eyes of the Labour party, were a standard-bearer for customer service which could teach the NHS a thing or two about how to improve service quality.

Alan Milburn, the then Secretary of State for Health who commissioned the report, explained his decision to the BBC: "When people get into hospital they want to know that the basics are right - that the wards are clean, the food is good, the care is there. That is why I have now asked Sir Richard Branson's award-winning Virgin Group to advise us on how hospitals can be made consumer-friendly."

Completed in June 2000 and titled, ‘Customer Service in the NHS’, the report had a narrow remit to make recommendations on various areas of customer service: ‘Staff training to improve customer focus; systems for spreading best practice in customer service, guidance to improve the environment in NHS building and staff roles and responsibilities.’

Yet despite the report focusing on the seemingly uncontentious area of customer service, the Labour government chose to classify the report as ‘restricted.’ Now, following a FOI request made by Keep Our NHS Public activist, Mr N Csergo, the document has been made public for the very first time.

In order to carry out the task, a project team was formed, made up of the questionable healthcare expertise of ‘a General Manager of Cabin Services, Virgin Group Brand Quality Director’ and an ‘external consultant who has worked extensively with Virgin Atlantic.’

We do not know the exact identity of this team because their names have been redacted from the document. However, it seems certain that whoever the authors were, they had nothing to do with large parts of the report, which regularly strayed from the customer service parameters into government policy with remarkable accuracy.

Promoting private interest
On page eleven of the report, under ‘A National Hospital Building Plan’, it says: ‘New buildings provide a great rallying point for beleaguered staff and dissatisfied customers.’ There should, it states, be ‘a number of specialist hospitals concentrating solely on elective surgery, requiring 1 to 5 days stay. Private hospitals could be utilised for part of this work.’

Providing advice on how to keep a patient happy is one thing; suggesting the most effective way to carry out surgery for the UK population appears to be quite another. In two parts of the report, the authors did make it clear when it was beyond their remit. These areas included the issue of consultants’ pay, which at that time was considered too low to encourage long-term retention of quality staff. ‘A new contract for consultants is required. Not in our brief, but on the face of it…Perhaps consultants should be given the choice of doing private work only.’

Who wrote Appendix 4?
A further recommendation made by the ‘Virgin customer service team’ and which also overstepped their remit, was considered important enough to be given its own appendix. 

Under ‘Poly-Clinics (Combined GP Clinics and Day Surgery Hospitals)’ Appendix 4 provided a detailed list on what these new health centres should look like. The categories were listed as ‘Key characteristics’, what it ‘provides’, what it ‘must have’ and ‘costs and benefits’. In the latter category, the mystery author informs us that a benefit of a Poly-Clinic is that it ‘offers choice for patients. Including choosing to pay.’ 

Appendix 4 appears to be the beginning of a new policy idea, and seven years later it was to become one. But why was this included in the report? Virgin PR director Nick Fox, suggested ‘Appendices were included for ease of reference.’ Maybe so, but on the question of who wrote them and what have they to do with customer service, Mr Fox was unable to explain further. ‘We have no more information and there was no follow up from our side,’ he said when contacted for this article.

Whether it was Virgin or the Department of Health that introduced this appendix is important because in 2007, Ara Darzi, Labour’s then Secretary of State for Health, introduced Poly-Clinics as policy. The government ordered all 152 Primary Care Trusts in England to have a GP-led centre, a third of which were run by private companies.

In 2008, Sir Richard Branson planned a network of Poly-Clinics in which GPs would be given a percentage of the profits on top of their NHS salary. In the 2000 report under the heading ‘Staffing’ it says the idea of Poly-Clinics would be ‘Attractive to entrepreneurial GPs’.

Then in early 2010, Virgin Care purchased a 75% stake in the healthcare arm of Assura and took over their Poly-Clinics. The Poly-Clinic system collapsed, however, following the Coalition government’s move towards “GP-led” commissioning. 

Virgin denied they had used the report to promote policy for a potential future revenue stream, saying, ‘Virgin Atlantic and Virgin Group were asked by the Labour Government thirteen years ago to provide practical suggestions to address a range of issues flagged up by the Department of Health from the point of view of a company with a reputation for providing excellent customer experience in the travel industry.’

 

NHS Plan

A clue about who the report’s architects might be comes from the authors of ‘The Plot Against the NHS’ written by Colin Leys, and Stewart Player. In an article for Red Pepper they inform us how a Dr Penny Dash ‘was appointed head of strategy and planning in the Department of Health, and co-authored the NHS Plan of 2000, which initiated the marketisation process.’ Later, Penny Dash joined McKinsey & Co as a partner, the global consultants responsible for coming up with the £20 billion worth of savings the NHS is now having to endure, and which was partly used to justify the need for the Health & Social Care Act 2012. McKinsey, were also responsible for the financial modeling of Poly-Clinics, and Penny Dash was involved in two Darzi reports when Sir Ara Darzi was Secretary of State for Health. One of these reports promoted polyclinics in every part of the country. Was it Dr Dash and the team who pushed for Appendix 4 to be included in the Virgin report? Certainly her fingerprints are on the document.

Further possibilities of involvement in the development of Appendix 4 came from Simon Stevens. In 1997, Stevens became an adviser to Alan Milburn and co-authored the NHS plan. He went on to lead the European division of US health insurance giant Unitedhealth and then become the global president. In his film, Sicko, Michael Moore's accused them of routinely denying patients care who became critically ill.

With the content of the report under Labour’s control, the media only wrote about the findings they were allowed to see. The Guardian carried a piece that focused on the cleanliness of the hospitals with the headline ‘Virgin team highlights NHS shambles’. The Telegraph reported that ‘NHS hospitals are ‘dirty and poorly run’. In an extensive interview with Peter Sissons on the BBC Breakfast show, Alan Milburn had ample opportunity to mention the Poly-Clinics, but did not. Nor did he mention other contentious points that were in the report, such as ‘flexibility in all clinical staff salaries to reflect regional differences’.

The dirty hospital stories made for uncomfortable reading, but not anything that the media-savvy government couldn’t handle. Equally, it provided an opportunity for the Labour party to bring in sweeping changes, part of which was to introduce the regular use of private hospitals in order to reduce waiting times.

One month following the June 2000 Virgin report, Labour launched the ‘NHS plan’. Several of the key points announced by the Department of Health were taken straight from the Virgin report. There was a need to ‘Create new roles and responsibilities and better training for NHS nurses’, ‘new consultant contracts’ and perhaps most controversially of all, to ‘Foster an agreement between the NHS and the private sector for using private facilities’.

The move from using private hospitals in peak times such as for winter flu epidemics, to a new permanent partnership had begun. In October 2000, Alan Milburn signed an agreementwith the private healthcare representative organisation, the Independent Healthcare Association. The concordant established a new deal, with a host of measures that included setting up specialist diagnostic and treatment centres. 

Independent Sector Treatment Centres
The use of these specialist elective care units became Independent Sector Treatment Centres (ISTCs). The ISTCs were key to providing an established foothold for private companies in the NHS, some of whom went on to form a private healthcare group called the NHS Partners Network (NHSPN).

The argument put forward by Andy Burnham’s team is that Labour’s use of ISTCs was simply to bring down waiting times. In a debate on the use of the private sector in the Commons on January 16^th, 2012, Andy Burnham said, ‘We introduced the Independent Sector Treatment Centre initiative to help reduce waiting times for treatment at busy NHS hospitals while increasing patient choice.’ However in an interview to the Guardian in 2005, Paul Corrigan, a member of the 2000 strategy team alongside Penny Dash during the introduction of the NHS Plan, suggested the use of private hospitals was part of a wider plan. ‘…the idea behind these independent sector treatment centres (ISTCs) was always something much bigger. We were always looking beyond the capacity hump. We never saw it as one big push and then waving goodbye to the private sector.’

The ISTCs, which are often located in NHS hospitals but run by private companies, led to accusations by the British Medical Association of ‘fragmenting the NHS, cherry-picking of cheaper surgeries, and failing to improve a quality of care.’ In 2007, a leaked document from the Health Care Commission (HCC) raised serious questions over the quality standards within the ISTCs, stating that the national data on the clinical quality of ISTCs was “incomplete and of extremely poor quality”. The NHSPN, which was formed in 2005, had by this time been voted into the NHS confederation, the main membership body of the NHS, offering them an increasing legitimacy. 

They used this platform to ensure that a report on the ISTCs was less critical than it otherwise would have been. In the NHSPN annual 2007/08 report, they boasted: ‘Earlier in the year a leak of the HCC document had resulted in some ill-informed criticism, but (the) NHSPN was able to exert influence to make sure that the final version was a fairer representation. This included submitting comments on the final draft, preparing a response and devising a media handling strategy in advance of publication.’

The influence of the NHSPN and the private companies that make up their members didn’t stop there, and in fact grew increasingly influential. In the same 2007/08 annual report they informed their members of how, in October 2007, they had a ‘Meeting with Andrew Lansley on the Conservative Party’s draft bill.’  This ‘bill’ went on to become the infamous White paper, ‘Equity and excellence: Liberating the NHS’, and in turn the Health and Social Care Act 2012. The NHSPN used their influence to play a key role in maintaining competition in the bill, by lobbying the Head of the Choice and Competition team of the NHS Future Forum, Sir Stephen Bubb

Such was the farce of the listening exercise that Sir Stephen Bubb, who was installed in his position by David Cameron, admitted on his blog towards the end of the period:  ‘just as I was signing off our Panel's report on " Delivering real choice" I get sent a copy of the PM speech announcing he is accepting many of our key recommendations although we haven't actually given him the report yet!’.

Revolving door
The expansion of elective care, as recommended in the Virgin report, also led to increased opportunities for private companies, including NHSPN member, Care UK. In their 2011 Annual report for bondholders, a section under ‘capital expenditure’ reveals just how beneficial the elective surgery programmes have been. ‘Care UK currently intends to finance all of its projected capital expenditure through a combination of operating cash flows and the ISTC Wave I buyback proceeds, totalling £54.0 million.’ In an article this year, the Guardian revealed how the company intends to  ‘increase the £190m a year it earns for delivering healthcare services to NHS patients through 35 new contracts it has won under AQP (Any Qualified Provider) to provide diagnostic services, elective surgery and diagnosis treatment…’

Alan Milburn

It is worth noting that the chairman of Care UK, John Nash, gave £21,000 to run Andrew Lansley’s office when he was shadow secretary for health. Furthermore, Alan Milburn, the commissioner of the Virgin report, is the Chairman of the European advisory board for private equity company, Bridgepoint. In 2010, they purchased Care UK for £414m. Alan Milburn has a history, having worked as an advisor to Bridgepoint Capital betweenMarch and September 2004, when he was an advisor. Six months after his appointment, a subsidiary of the company won a £16 million NHS contract. 

Despite repeated requests to obtain a response regarding Alan Milburn’s role in the report, cooperation from his Bridgepoint office has not been forthcoming.

A report, written by both Virgin and the Department of Health included policies that had nothing to do with the customer service remit. Labour turned many of the recommendations by the ‘cabin crew customer service team’ into policy and a decade later Virgin bought out a company delivering that very same policy. Now, two years later, Assura have been rebranded as Virgin Care, who recently won a lucrative contract of £500 million to run community services in two areas of Surrey.

In a recent speechmade at the healthcare think tank the King’s Fund, Labour’s shadow health secretary Andy Burnham stated clearly that Labour would “repeal the Health and Social Care Act 2012 and the rules of the market.” Mr Burnham described a skeleton idea for a more integrated NHS, and offered an open invitation to “build a genuine alternative.” He said “I don’t want to do the usual politician thing of pulling a policy out of the hat at the time of the next manifesto that takes people by surprise.”

Certainly, they would do themselves no harm by accepting responsibility for the part they played in marketising the NHS and admit that their policies cleared the path for the Health and Social Care Act 2012. A move away from the market will be welcome news to the many Labour voters who feel effectively disenfranchised by their closeness with corporate interests in the Blair/Brown years. 

Furthermore, Labour will need to show that underhand policy-making, written by unaccountable corporations on restricted documents, no longer takes place. And while they are at it, they could turn their attention to the 1 in 6 Labour Peers who have recent or current financial links to companies involved in private healthcare.  

This article also appeared in Open Democracy

Union pass Motion to ask Chief Executives to leave ACEVO in protest at Head's behaviour During Health bill 'pause'

This text below is from an Emergency motion passed by Unite on the behaviour of Sir Stephen Bubb, the Head of Choice and Competition in the NHS Future Forum, which was set up during the Health bill's so-called 'listening exercise'.

Stephen Bubb, the Director of the Association of Chief Executives of Voluntary Organisations, has played a major role in imposing the doctrine of “Any qualified provider” on the NHS.

He referred former Health Minister Andy Burnham to the Cooperation and Competition Panel when Burnham publicly stated that the NHS should be the “preferred provider” of NHS services, forcing Burnham to back down publicly on this principle. A document recently discovered by online journalist Andrew Robertson shows quite clearly how he used his role as chair of the NHS Future Forum to ensure that the interests of private healthcare companies were served in the carrying through of the Health & Social Care Act.

To quote NHS Partners Network/NHS Confederation Director David Worskett in the document: “I had one lengthy, very early discussion with Sir Stephen Bubb at which we agreed on the approach he would take [on the Health & Social Care Act], what the key issues are, and how to handle the politics. He has not deviated from this for a moment throughout the period.“ (NHS Partners Network/NHS Confederation is the major confederation covering private healthcare companies looking to profit from commissioning for NHS services).

David Worskett also says in the same document: “I also have the impression that the arguments in favour of choice, competition, plurality and economic regulation [i.e. privatisation] put forward by the small handful of like-minded members ably led by Sir Stephen Bubb have often carried the day and won more support than we might have expected.”

He has done this on the basis that the voluntary sector (as well as the private sector) who could gain financially through bidding to carry out public services. All the evidence now emerging shows that voluntary sector groups are being driven out of the bidding wars for the provision of public services – for example the Work Programme – in favour of the private sector, thus proving the truth of the prediction made several years ago that the voluntary sector simply serves as a “stalking horse” or a cover for private companies in the privatisation of public services.


This conference resolves:

1. To ask Unite to publicise the activities of Stephen Bubb in pushing forward the break-up and marketisation of the NHS to all our members in the organisations which make up the membership of ACEVO.

2. To ask Unite to publicise his activities to all the member organisations of ACEVO (including their Chief Executives and Board members), and call on them to leave that organisation in protest.

Note 1: The Futures Forum was the body which oversaw the carrying out of the Coalition government’s so-called listening exercise when the outcry against the Health & Social Care Bill forced a pause in its high-velocity passage through parliament.


APPENDIX 1

More information on Stephen Bubb’s role in the “pause” and listening process forced on the Coalition government by the outcry against the Health & Social Care Bill

Stephen Bubb is head of the voluntary sector organisation “Association of Chief Executives of Voluntary Organisations (ACEVO).

He is convinced that the way forward for funding for voluntary sector organisations (in the face of spiralling funding cuts to the sector) is through voluntary sector organisations bidding to provide public services. (NB: there are some elements of state funded provision e.g. legal advice which have historically been supplied by the voluntary sector).

He is oblivious to the fact that voluntary sector organisations cannot compete against private companies in these bidding wars, and that even if voluntary sector groups win such bids they soon find that the money they get does not cover the provision of a good quality service. They either have to abandon the quality of the services (by driving down wages and conditions of workers, as well as the service itself) or abandon the service to private sector companies (witness what happened with the government’s Work Programme. All the voluntary sector groups initially involved have now been forced to walk away).  

Bubb has therefore consistently fought to open up public services to the voluntary sector – and in so doing he has also been more than happy to open them up to the private sector also. Successive governments have tried to sweeten the poison of public service outsourcing by featuring the fact that it is not only private companies who will be bidding, but also the voluntary sector. The voluntary sector which bids is of course something which take on more and more the characteristics of private companies.

Andy Burnham and the NHS as “Preferred Provider”

In 2009 Secretary of State for Health Andy Burnham ( in the face of mounting union protests over NHS privatisation) said that “the NHS should be the preferred provider” in any tendering process.

Stephen Bubb reported Andy Burnham to the Cooperation and Competition Panel, and Burnham was forced into a humiliating reversal of his position. See this article http://www.wavocc.org.uk/department_of_health_principles_and_rules_for_c

Private companies recruit Bubb to push through the privatisation provisions of the Health & Social Care Act

After a huge outcry from health professionals and health campaigners as the Health & Social Care was forced through in 2011, the government arranged for an unprecedented “Listening pause” while a carefully selected group was appointed to run the “Futures Forum”. (This carefully selected group chose to ignore the array of valid criticisms of the Act which emerged even from their carefully selected forums - including the policy of “Any Qualified Provider” which has resulted in the taking over of £100s of millions worth of health services by the likes of Virgin Healthcare, and Care UK.)

Simon Burns (health minister 2010-12) requested the okay from David Cameron to make the appointment of Sir Stephen Bubb as chair of “Choice and Competition” on the NHS Futures Forum^.1This was revealed in the book ‘Never Again?’ by Nicholas Timmins of the King’s Fund.

Early on after his appointment as chair, Bubb met with NHS Partners Network’sdirector David Worskett and  ‘agreed on the approach he (Bubb) would take, what the key issues are, and how to handle the politics.’ NHS Partners Network includes the likes of Assura, Circle (which took over Hinchingbrooke, the first NHS hospital to be privatized), Care UK (see information in this article on Care UK) and many more predatory private equity company owned private healthcare companies.

David Worskett held a second lengthy meeting with Stephen to discuss the position with him, under the auspices of "Reform", with only a handful of other (all like-minded) people present, including David Bennett, the chair of Monitor. David Worskett says: “He has also consistently taken the same line as us throughout.” “A number of members secured individual meetings with him, thus reinforcing and validating the messages.”

There are 17 members of the NHS Partners Network - these include several with financial connections to Lords and MPs, including Circle (Mark Simmonds MP) and Care UK (John Nash the chairman donated money to run Lansley’s office when he was shadow health secretary).

Mr Bubb describes another meeting with the NHS Partners Network on 1 June 2011 in his blogunder the title ‘listening (not?)’. Bubb says: ‘went to a good meeting today with the NHS Confed Partners Network the CEO is the dynamic and amusing David Worskett )’.

Bubb informs his readers how ‘for political reasons the private sector were excluded from the Future Forum so in my area I feel its only right to ensure I hear their views.’ He concludes: ‘And very balanced and sensible they are.’ (The private sector was excluded from the Futures Forum as even the Coalition could see that their naked self-interest would have provided a field day for the media and those opposed to NHS privatisation.)

At the meeting on 1 June according to Bubb himself: ‘David later sends me some polling results they did. Worth repeating it here’. The data refers to a research project done in 2009, which Worskett told Bubb, was ‘fully validated to industry standards.’ The report showed that 74% of respondents strongly agreed (51%) or agreed (23%) that they "don't mind who owns or runs my NHS services as long as the quality of care is right".

This is important as Bubb included this in the Final report produced on 13^th June by his working group even though it was out of date and produced by the NHS Partners' Network. In addition, it was produced before the Health and Social Care bill was introduced. Bubb said it was: ‘in line with a number of other surveys done since’, which unfortunately he couldn’t ‘dig out in the time available, but I am certain that the point which can be made with complete confidence.’ He also couldn’t find any more surveys in time for the final report.

In his book ‘Never Again?’ by Nicholas Timmins of the King’s Fund, Mr Worskett said: ‘throughout the forums deliberations, Bubb was “our only real route in”. He “fought valiantly to ensure that an element of competition remained in the system”, resulting in what David Worskett saw as a “pretty pro-competition…and that was mostly, though not entirely down to Steve Bubb.”

For more reading:
The Unedited document here 
Stephen Bubb's collusion with the NHS Partner's Network here
Lansley meeting with NHS Partner's Network director before parliament had seen bill here

Revealed: Head of Monitor Has Ties with Private Healthcare Lobby Group Who See Tax, Pensions and NHS Brand as Barrier in 'Fair Playing Field' Review.

The latest unholy mess taking place due to the undemocratic, unnecessary and complicated Health and Social Care Act, is the ‘Fair Playing Field’, review being undertaken by the new NHS regulator, Monitor.

A nine-month process has now seen all the submissions handed in and each organisation is wondering what is going to be the result of the review, come the end of March, this year.

April the 1^st is the time when the Clinical Commissioning Groups (CCGs) are due to takeover, from the Primary Care Trusts, abolished thanks to the new legislation. The ‘Fair Playing Field’ findings, which will conclude in time for this date, will mark the end of the NHS as we know it and increase the fragmentation of services across the country.

Social Investigations can now reveal a private healthcare group’s submission, which brings to the attention of Monitor the barriers the private sector perceive to achieve a Fair Playing Field, which include corporation tax, VAT, pensions and the NHS brand. The only problem is, this same lobby group were heavily influential in maintaining competition in the Health bill during the sham of a 'so-called 'listening exercise'. Furthermore, this same lobby group had previously met with the head of Monitor in a 'like-minded' meeting, bringing the impartiality of the review into question.

The NHS Partner's Network (NHSPN) is made up of private providers who provide NHS services and whose membership includes companies that include Care UK and Virgin Care. The submissionmade by the NHSPN was handed to Monitor in the early stages of the Fair Playing Field review last year, titled: 'NHS Partners Network response to Monitor's Call for initial submissions.'

On the subject of 'economic components', it states: '...to achieve any given post-tax rate of return, on an investment a corporation tax paying entity would have to charge higher prices than an NHS body or charity...the estimated average magnitude of this is that it now adds between 2% and 3% to independent providers.'

Monitor list 'tax asymmetries' as number four under 'Key Issues' to be looked at during the 'Fair Playing Field' review.  As well as corporate tax breaks, the NHSPN have also suggested the review look at the impact of VAT, stating, 'while NHS providers can claim back VAT on certain contracted-out services, independent providers cannot do so.' In addition, public sector providers are at an advantage because of the 'attractiveness' of the pension scheme ', which according to the submission, creates a barrier to workforce flexibility.'

Part 'C' of the submission, asks 'What do we already know about the elements of a fair playing field?' The response from the NHSPN points toward an 'illuminating piece of independent work' done in 2009 by the Office of Health Economics, partly paid for by the NHSPN.' The study builds on a previous work conducted by the University of York, but as the NHSPN funded study 'summarises the York study', they chose only to attach the study they helped fund. The NHSPN is however adamant that the study remains unbiased, stating: 'The report was co-funded by the NHS Confederation and the report itself makes completely clear that it was wholly independent. It went through OHE's normal peer review processes.’

In addition to providing this study, the NHSPN submission tries to weaken the element of public sector training and medical education, which is provided by the NHS. 'Most NHS education and training is 'funded centrally and separately from the main provision of care budgets and this does not therefore directly impact on the fairness of the playing field in the market'. However, as Mr Worskett admitted in a reponse to Social Investigations, when asked why this should be left out he said, 

'We do in fact recognise there is a legitimate discussion about medical education and training but there is a need for a much fuller and longer analysis of the issues before any conclusions can be reached.'

This is followed by a bullet point that states: 'A significant (but not yet quantified) proportion of independent providers do now participate in NHS education and training, in some cases at no cost to the NHS, and while this is doubtless only a small proportion of the whole, it must not be overlooked.'

A further disadvantage the lobby group highlights, is in the 'NHS' itself. Under a heading 'The impact of the NHS "brand"', they state, 'studies of the deregulated utilities markets have suggested that one problem, in developing a fairer playing field, was customer familiarity with and loyalty to the ex-public sector incumbent brands. There is a possibility that similar responses might work unfairly to the disadvantage of independent providers in the NHS market...'

Monitor are meant to be impartial, but the discovery of an internal memo written by NHSPN director, David Worskett reveals both he and Monitor chief, David Bennett met during the Health bill 'pause' under the auspices of free market think tank, Reform.

The document, which was discovered by research blog, Social investigations, was an update informing the groups members on the lobbying that had taken place during the so-called 'listening exercise'. Mr Worksett informs his members how: 'I had a second lengthy meeting...under the auspices of "Reform", with only a handful of other (all like-minded) people present, including David Bennett, the chair of Monitor. He has also consistently taken the same line as us throughout.'

Furthermore, the same memo informs us how David Worksett 'coordinated' the position of the NHSPN during the pause, 'carefully with Monitor...' When asked what this position was, the NHSPN claimed it was 'to establish that Monitor, like us, had not seen the introduction of competition as an objective in its own right but, instead, as a means of improving quality of care for patients.'

David Bennett distanced himself from the comments saying: ‘The comments made are the opinion and conjecture of Mr Worskett and Monitor cannot be held responsible for these. Mr Bennett did attend the same meetings as Mr Worskett during the NHS listening exercise but at no time has he referred to himself as a ‘like minded’ person to Mr Worskett. Similarly there was no coordination of position between Monitor and the NHS Partners Network. ‘ 

David Bennett's bias was brought into question previously when a FOI revealed an email from an unnamed McKinsey executive from May 2010, suggesting it was exploiting its privileged access. It stated: “We have been gathering our thinking on the implications of the new Government programme for the NHS (and) have started to share this with clients. Would you like to meet to discuss it?” The recipient of the email was David Bennett.

None of this would have been necessary if it hadn’t been for the Health and Social Care Act. The manner in which the services are being sold off, serves only to fragment services and pit providers against each other. David Bennett was a former senior partner at McKinsey & Co, the architects of the £20bn savings that are being justified to sell off large chunks of the NHS. The ‘Fair Playing Field is about to launch the NHS into a brave new world, and what’s the betting the outcome will favour the private sector?

Further reading

1. NHS Partners Network - Who are they? here

2. Unedited document of lobbying by NHS Partners Network here 

3. Statement from NHS  Partners Network on Telegraph article - here 

4. The Telegraph, the Think Tank and a Very Dodgy Business - here

5. Unedited response to questions related to above article from NHS Partners Network here 

NHS Partners Network Response Regarding Fair Playing Field

Social Investigations - contacted the NHS Partners Network over their submission to Monitor, regarding the 'Fair Playing Field' review currently taking place.

In order to maintain openess - I have listed the entire response without editing here so readers can make their own mind up.

View the NHS Partners Network submission here.

Starts-----------

Let me make it absolutely clear that contrary to some reports at no point have we asked for relief from corporation tax. We have simply pointed out that in undertaking an analysis of the different economic factors that affect public and private sector providers of care, corporation tax is one of those factors that impacts on the private sector, but not on the public sector. We have also made clear that we recognise there are factors that work the other way and we now wait to see how Monitor's wholly independent and impartial analysis concludes the various factors "net out" and whether anything can or should be done about that overall, in the interests of patients not of providers", that being Monitor's remit.

You may not have seen Monitor's statement today, which makes their position on corporation tax clear and is indeed what we expected. It says:

"There is no draft report of the Fair Playing Field Review and Monitor does not intend to provide a running commentary on the review.  Monitor has yet to decide what recommendations it will make to the Secretary of State. However in the light of recent media speculation, Monitor has decided to clarify the position on one specific issue. While it is the case that corporation tax is one of many distortions that the review is looking at, Monitor will not be recommending that private sector providers should be exempt from paying corporation tax."

Answers to Questions

The Guardian recently revealed how tax breaks were part of the first draft of the review, seen by a 'source' -

The submission you made, which a source has handed to me shows your organisation pushed for this to be looked at as part of the review. Comment: Our submissions in response to public consultations are assumed to be in the public domain anyway and we are happy to share them with anyone who asks to see them.

You state how: 'The issues of a 'Fair Playing Field') must be viewed dispassionately through the lens of impartial and quantified economic analysis' However, despite the emphasis on 'economic analysis', no additional information was provided to suggest how they reached the 2/3% figure  stated in their submission. Q. To what do you base this figure on?  A.The full OHE study was provided as a formal annex to our submission and provides the basis for this analysis.

You also mention concerns over the NHS brand and how this may unduly lead to favourtism as the public trust the name. Q. This is why you attach the NHS to your name?  A. No, our name reflects the fact that we work in partnership with the NHS and are part of the NHS Confederation.

The NHSPN considers that the most illuminating piece of independent work on this complex subject was done in 2009 by the Office of Health Economics. This was part-funded by you. Q. Should this be seen as bias? A. No. The report was co-funded by the NHS Confederation and the report itself makes completely clear that it was wholly independent. It went through OHE's normal peer review processes. We played no part in the actual study and we have no doubt that OHE would take any allegations to the contrary very seriously.

You mention that various public attitude research has shown 'remarkably clearly' that patients are less concerned about who provides care provided it is free at the point of delivery and meets NHS standards. Q. Are you referring to a survey you paid for that was conducted by Brunswick?  A.Yes, supported by other authoritative independent reports which also indicate that most of the public are not worried about who provides their care as long as it is free at the point of delivery and is of high quality. For example, The Provider Diversity poll, (Confederation of British Industry, 2009); and British Social Attitudes 2009 (Sage Publishing, January 2009).

You state that private companies are subject to different regulatory regimes but fail to mention FOI. Q. Would your members be willing to be subject to Freedom of Information and thus being more transparent to the public? A. If there was a general application of FoI to all organisations that are not public sector but have dealings with the public sector, we would of course accept that position. Unless that is the case there is no reason for us to be treated differently to any other non-public sector organisation. The NHS Partners Network fully adheres to the NHS Confederation's policies and practices on transparency.

The submission, shows how you consider training and medical education as not being relevant to the 'Fair Playing Field' despite as you admit, many of your members benefiting from this training. Q. Why should this be left out? A. We do in fact recognise there is a legitimate discussion about medical education and training but there is a need for a much fuller and longer analysis of the issues before any conclusions can be reached. The independent sector also undertakes extensive medical education and training which has not been generally understood or recognised and this also needs to be taken into account.

Given your challenge to the public sector over the issues of pensions, training, medical education and the NHS 'brand' Q. Can you see why the public may view your behaviour as devisive and against collaboration? A. We have not "challenged" the public sector on these or any other "fair playing field" issues. We have simply sought to identify and quantify factors which may mean that, should commissioners wish in the interests of patients, to use alternative providers,  then economic factors do not prevent them from doing so in practice. Establishing a fair playing field will in practice facilitate collaboration.

Your document that was a feedback to members during the Health bill 'pause' stated: 'I had a second lengthy meeting with Stephen to discuss the position with him last week, under the auspices of "Reform", with only a handful of other (all like-minded) people present, including 'David Bennett, the chair of Monitor. He has also consistently taken the same line as us throughout.' Q. Are you confidant this connection you have with Mr Bennett will result in a favourable report? A.We are confident that Monitor will produce a properly considered and completely independent and impartial report and we will, like everyone else, have to wait and see what it actually says.

Lord Blackwell - How His Vote Opened New Opportunities for Interserve

Lord Blackwell

A company led by a Conservative Lord has just expanded into a new lucrative area of healthcare, made possible by the Health & Social Care Act.  The noble Chairman spoke and voted in favour of the bill, opening new avenues for the company he serves.

On June 14^th, 2011, The House of Lords met for a statement made by the Parliamentary Under Secretary of State at the Department of Health, Earl Howe, to mark the end of the now discredited ‘listening exercise’, set up by the government as a response to the near total discontent to their Health bill.

Following the opening statement, Conservative Peer, Lord Blackwell spoke of his concern at the direction the Health and Social Care bill was taking, and sought reassurances that the Health bill was heading in the direction that would open up large parts of the NHS for sale:

‘Can he (Earl Howe) elaborate a little more on the development of competition and choice to which he referred? Can I take it from what my noble friend has said that the Government continue to believe that competition and choice are key drivers of improving the interests of patients and quality in the health service?...how will the phasing of the introduction or further expansion of alternative providers evolve in a way that will give those alternative providers the confidence to make the investments necessary so that they can play their full part in providing quality services under the NHS?’

Lord Blackwell’s concern over competition was insincere, and was a question asked in his role as Chairman of construction and consultancy company, Interserve, where he has been in charge since 2006. He knew that once the Health and Social Care bill became an Act, the company, whose UK revenue largely comes from public sector contracts, would be in a strong position to take advantage of the inevitable contracts that would emerge from the NHS sell off.

Interserve is heavily involved in Public Finance Initiatives and Public Private Partnerships agreements, with contracts in Education, Justice, Defence and Health worth £2.36bn. The Health sector makes up over half of their revenue with contracts worth £1.269bn, all contributing to profits before tax in 2012, of £67.1m. An income that is set to increase thanks to a new contract awarded in December 2012, to run 550 NHS buildings in the area of Leicestershire and Rutland.

However, it is a recent purchase by Interserve of homecare company Advantage Healthcare for £26.5m that has marked a change in departure to their usual line of work and highlights the failure of the Rules that govern the behaviour of the upper chamber’s members.

The company’s move towards the community care market makes perfect business sense, as it was a key component of the Health bill, and there is thought to be around £10bn up for grabs in the community care market. Advantage health itself, provide social workers, medical staff and palliative nurses to NHS Trusts, with profits before tax of £41 million, an amount the CEO of Interserve expects to see increase.

"We see the healthcare and care at home sector as key growth markets and this acquisition both expands our capability, while also being a further step towards delivering the group's medium term strategy of greater front-line service provision.”

Lord Blackwell’s words of concern for ‘competition’ when speaking in the House of Lords was followed up by his votes, which he was able to make despite these clear conflicts of interest; and this he did loyally with the government in all key divisions of the Health and Social Care bill.

Lord Blackwell who was Head of the Prime Minister's policy unit under John Major from 1995 to 1997 and was previously a member of Margaret Thatcher's policy unit, was also a partner with McKinsey and Company, between 1978 and 1994. McKinsey were responsible for writing parts of the Health bill, and were the organisation who came up with the sum of £20bn in savings and cuts the NHS is now undergoing.

If there is any truth to the phrase, action speaks louder than words, then the deeds of Lord Blackwell clearly place him in the corporate camp. The House of Lords is meant to check and challenge any law that emerges from the House of Commons. Yet, if Lord Blackwell’s only contribution is to question where the money is coming from on behalf of his employer, and then voting for the benefit of his corporate employer, what is the point of his ‘noble’ existence? Interserve are making lots of money from the public purse through the utterly false and damaging economy of PFI. Now, an additional £300 million in contracts is being added to their already bulging portfolio, with a loss of jobs a real possibility.

Lord Blackwell’s contempt for the NHS was made abundantly clear when he produced a joint paper for the Conservative think thank, the Centre for Policy Studies, titled: ‘Better Healthcare for All.’  With no irony whatsoever he wrote:

‘It is the most vulnerable who suffer at the hands of the NHS. The system inevitably distributes its resources not according to who needs its services most, but by…special interest groups who can best manipulate the system.’

Now Interserve has expanded into a new area of community healthcare, new opportunities made possible by the Act on which their Chairman voted. An Act part written by business consultancy giant Mckinsey & Co who also came up with the £20bn cuts and savings the NHS is now forced to make. All he has done is turn up, ask questions on behalf of his employer, voted and buggered off again. Lord Blackwell, a former partner of McKinsey should not only have been unable to vote, but should not be a Lord at all.