Charity Sector lobbied Hunt not to Water Down Controversial NHS privatisation Regulations

Sir Stephen Bubb

Charity boss Sir Stephen Bubb lobbied alongside the head of a private healthcare trade group to persuade Jeremy Hunt to not water down highly controversial “Section 75” privatisation regulations, according to new documents revealed today.

The regulations - made under the Health & Social Care Act just as the bill was coming into force in April this year - were seen by many as confirming the determination of the government to hand over large swathes of the NHS to private companies. The regulations effectively force local health bosses to put all services out to tender unless they can prove there is just one capable provider.

As the debate raged over the implications of the regulations - with the RCGP, the RCN, and the BMA all coming out strongly against them - the Chairman of the Association of Chief Executives of Voluntary Organisations (ACEVO), Sir Stephen Bubb, teamed up with private healthcare advocates the NHS Partners Network to lobby the health secretary, Jeremy Hunt into not ‘watering down’ the regulations. 

The letter co-signed by Sir Stephen Bubb and Partners Network director David Worskett raised ‘deep concern’ at reports in the Guardian that the government was ‘contemplating substantive concessions over these important regulations.’ 

Bubb and Worskett urged the NHS to ‘embrace a new culture’ to include ‘opening the way’ for the potential contribution of ‘new providers…We strongly urge the government to stand firm.’

Earlier this year Social Investigations exposed how Bubb was at the heart of a network of lobbying around the Health and Social Care Act itself, along with Nick Seddon (now Cameron’s health policy advisor). The NHS Partners Network’s members include private healthcare companies with multiple financial links to MPs and Lords. These groups were instrumental in lobbying during the supposed ‘pause’ in the passage of the Health & Social Care Act last year, following near total discontent across the medical profession with the Bill’s proposals.

Sir Stephen Bubb was invited by then Health minister Simon Burns to head the Choice and Competition panel of the NHS Future Forum. The appointment made sense to the Conservatives as Sir Stephen Bubb had already been campaigning for a bigger role for the voluntary sector in the public services, a key part of the Conservative party’s ‘Big Society’ mantra.

David Worskett

Partners Network leader David Worskett praised Bubb for his determined approach to opening up the NHS to competition, informing his members of his ‘lengthy’ discussion with Sir Stephen Bubb where they had ‘agreed on the approach he would take, what the key issues are, and how to handle the politics.’ Bubb had ‘not deviated from this for a moment throughout the period.’

Stephen Bubb's ability to get the 'agreed' message across was appreciated by Worskett and was seen to be so supportive that he ‘often carried the day and won more support than we might have expected.”

The charity and voluntary sector make up over a third of the UK private healthcare sector, and according to Sir Stephen Bubb represent a ‘bigger player’ than people think. Bubb told a 2010 voluntary sector conference ‘The third sector could grow by £2bn a year by 2015, just through increased involvement in offender rehabilitation and public health.’

Shortly after coming into power the government met with the CBI to discuss privatisation strategy. Leaked minutes revealed that Francis Maude told the group that transferring services at least initially to “charities, social enterprises and mutuals” would be more “palatable” and carry less “political risk” than “wholesale outsourcing to the private sector”. However in reality charities cannot compete against the financial muscle of the private sector. Research conducted by campaign organisation the NHS Support Foundation shows that since April 1^st this year 100 clinical services worth £1.5 billion have largely gone to commercial companies. Last month the Bain Consultancy revealed how private sector companies are now engaged in an ‘arms race’ to win £5bn of National Health Service contracts. Third sector advocates should learn from the experienceof Surrey Central Health, where a much lauded transfer of NHS services to a “social enterprise” led within a couple of years to a takeover by Virgin, who were better able to raise bond finance.

Recent failings from private companies such as Serco fiddling data for their out of hours service, or G4S overcharging on their contracts, has down nothing to diminish the speed with which outsourcing is taking place. However, as the list of private outsourcing failures grows, the government will increasingly appreciate being able to emphasise the 3^rd sector as a more palatable alternative, even if their involvement is not sustainable. In fact, David Cameron has already turned towards the voluntary sector in his hour of need. When asked by Ed Miliband who supported the government’s legislation he cited Bubb’s ACEVO.

Does Bubb’s vociferous support for privatisation benefit the 1,500 ACEVO membership of charity leaders (the members of whom are currently hidden from public view). Or does it ultimately benefit the members of the NHS Partners Network, whose membership includes Virgin Care, United Health UK or Care UK?

A recent article in the Guardian written by Pam Lewis of CancerCare suggests some charities at least are willing to take part in the dismantling of the NHS. Ms Lewis stated how the changes to the NHS will benefit CancerCare and at the same time take the strain off of ‘traditional NHS care providers.’ In words that echo that of Sir Stephen Bubb, she said that ‘while maintaining their charity status, they can become a ‘serious and competitive player’ in the NHS, which would be a ‘huge step for their charity.’

Despite the grand ambitions of CancerCare, the evidence so far suggests charities are but a figleaf for the private equity backed corporations who can outbid them or offer them dubious partnerships. The carrot is dangled in front of the charities noses, which has led them to walk hand-in-hand with private healthcare giants.

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This article was co-published with ourNHS on openDemocracy

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.

David Cameron is accused of a 'sham listening exercise' on NHS reform after links to lobbyist are revealed

This article appears in the Observer. See Archive in July and August for more details on this research.

The coalition has been accused of presiding over a sham "listening exercise" on NHS reform last year, as a leaked document reveals how the private health lobby worked with Downing Street behind the scenes to ensure that the new legislation went ahead.

David Worskett, the industry's chief lobbyist, cleared his group's public statements with officials and was personally thanked by No 10 for arranging the publication of a letter from clinicians in support of the reforms during the key "pause" period last year, called to reflect on the proposed reforms.

A series of phone calls between the lobbyist and Downing Street's health adviser was followed by a welcome "addition" to a major speech by the prime minister, according to a five-page document written for members of the private healthcare lobby group. The government claimed at the time that it would call a temporary halt to its efforts to introduce more competition within the NHS through its controversial health and social care bill. The prime minister told doctors and nurses: "We are taking this time to pause, to listen, to reflect and to improve our NHS modernisation plans. Let me be clear: this is a genuine chance to make a difference."



But in the document, obtained by the website Social Investigations, Worskett, director of NHS Partners Network, the lobby group representing companies such as Circle and Care UK, wrote: "I did brief the new No 10 health policy adviser very fully, and indeed 'cleared' our materials with him. I have had several other 'stock take' phone conversations with him.

"We are certainly on No 10's radar – I received an invitation to the PM's big speech last Monday and went. (Incidentally, for those who had the pre-event text, he specifically added a sentence about the importance of patients being able to attend private hospitals if they wanted to, provided NHS standards and prices were being met)."

Intriguingly, Sir Stephen Bubb, whom the government selected to lead a review of the role of competition in the NHS, wrote on his blog at the time: "Just as I was signing off our panel's report on 'Delivering real choice' I get sent a copy of the PM's speech announcing he was accepting many of our key recommendations (although we haven't actually given him the report yet!) … I am unclear why he thought it was a good idea to pre-announce acceptance of much of our report, but it is welcome."

The briefing document also suggests that Bubb, who was chosen by the government to provide an independent report as part of the coalition government's listening exercise, met Worskett to help direct the approach that he would take.

The lobbyist also claimed to have been congratulated on his lobbying by the head of the NHS forum leading the listening exercise, Steve Field.

Worskett wrote: "I had one lengthy, very early discussion with Sir Stephen Bubb at which we agreed on the approach he would take, what the key issues are, and how to handle the politics. He has not deviated from this for a moment throughout the period.

"We organised a letter from our Clinical Forum, on behalf of the 45,000 clinicians who do NHS work from the independent sector, to Steve Field. This was powerful. Steve himself told me how useful and well argued it was and No 10 also thanked me for it."

Shadow health minister Jamie Reed said the document "confirms what many have long suspected to be the case – that the highest levels of government were in talks with cheerleaders for private healthcare on how to ram the privatisation of the NHS through parliament". He added: "We have it in black and white that David Cameron's 'listening exercise' was a sham – he wilfully ignored overwhelming concerns and stuck to his privatisation plans."

Bubb said it was a nonsense to claim that he was "engaged in some sort of conspiracy", adding that it was his role to talk to all parties.

A spokesman for the NHS Partners Network said there was agreement between the government, Bubb and the lobby group, but denied that the process was a sham. He said: "We 'cleared' points with No 10 in the sense that we sought to ascertain the extent to which they were consistent with the government's own thinking, not with the intention or need to secure approval.

"Sir Stephen Bubb has always been wholly independent, so there was absolutely no question of 'telling' him to do anything."

A joint statement from Downing Street and the Department of Health said: "It is nonsense to suggest that the NHS listening exercise was not genuine and robust. This government is committed to protecting an NHS that is universal and free at the point of use.

"Government ministers, officials and the NHS Future Forum met with a large number of representatives from all areas of health and social care during the listening exercise. As you would expect, this included representatives from the private sector."

Further reading:
Over 200 parliamentarians have financial links to companies involved in private healthcare: More
Telegraph's involvement in 'listening exercise' sham. More
Sir Stephen  Bubb and his collusion. More
NHS Partners Network: Who are they? More 
Attacks on the NHS: Article roundup. More