Communications reveal 2020 Health working with Lord Howe to make the NHS a"UK Plc Asset"

Documents released by the Department of Health under the Freedom of Information Act reveal a healthcare think tank with multiple links to coalition peers wants to turn the NHS into an “asset” of “UK Plc” - and which suggests the government needs to “charm” private healthcare “international corporations”

2020health calls itself an ”independent, grass roots think tank” whose purpose is to “create the conditions for a healthy society through research, evaluation, campaigning and relationships.”

Correspondence between the health minister Earl Howe, former patron of 2020 Health, and the think tank’s founder Julia Manning reveals some of the nature of these ‘relationships’.

At Julia Manning’s invitation, Earl Howe was a guest speaker at a ‘high-level discussion breakfast roundtable’ with key clinical and industry leaders back in February 2011, during the ‘listening pause’ in the passage of the Health & Social Care Act through parliament. After the meeting, Ms Manning wrote to thank Earl Howe. In the letter, which has been obtained by Social Investigations, she noted that Earl Howe had told the meeting that the message of the UK health being open for business was “not getting through.”

Manning had asked what should be done to attract “global companies to the UK.” She pushed for a “radical message” to make the NHS part of the “UK PLC”, an “asset” and “driver of economic growth.”


Manning warned that historically, the NHS had been good at “repelling business” and that investment in healthcare was “much easier in the USA.”

She laid the blame for the lack of movement at the door of the last Labour government, who she said had gained a reputation for “bureaucratic obstructions to market access.”

Such correspondence adds to the concern that the Health and Social Care Act was less about improving services and more about opening up the public-funded health service to big business. In other words, the ‘UK PLC’ Ms Manning envisages and has so earnestly promoted to Earl Howe. Throughout the progress of the Health and Social Care bill, Manning acted as a champion for private healthcare involvement in the NHS and wrote several articles that promoted the ‘benefits’ they bring into the NHS

In order to open up the NHS to a market, Julia Manning also advised Lord Howe that ”international corporations” should be met with a “charm and diplomatic offensive by high level officials.”

Many may baulk at the idea that our elected government should beg for corporate attention within the NHS. But prior to the Health bill being passed into law, Earl Howe told a forumhosted by healthcare market researchers Laing and Busisson that ‘‘The opening up of the NHS creates genuine opportunities for those of you who can offer high quality, convenient services that compete favourably with current NHS care… There will be big opportunities for the private sector”.

In later correspondence, Julia Manning went on a charm offensive of her own. In March this year she asked Earl Howe to become a member of 2020health and to ‘join us and share in this adventure’. Whether Earl Howe accepted her offer is currently unknown. (Update, 2020health have recently released their supporters and funders). Click here.

2020 Health already has strong links to both the Conservative Party and the health insurance industry. Ms Manning herself was a formerConservative parliamentary candidate and has a background in health insurance. 2020health’s former chairman was Tom Sackville; a former Conservative minister under the Thatcher government is the Chief Executive of the International Federation of Health Plans, which represents one hundred private health insurance companies in 31 countries.

Aside from Earl Howe’s former patronage, four other peers are listedas current patrons - Lord Clement-Jones, Baroness Cumberlege, Lord McColl and Lord Rennard have connectionsto companies or organisations involved in private healthcare. The popularity in patronage might be because the House of Lords rules allow for patronage to take place without this having to be registered in their personal interests. But this patronage is used by 2020health to attract corporate members, who can become ‘Silver’ or ‘Gold Partners’ and receivean “opportunity to network with 2020health staff, patrons and associates”.

The identity of companies that have taken up this offer is as yet unknown, but what is known is that - despite their claims of independence - many of their reports are funded by big business. The policies these reports promote to “create a healthy society” may raise a few eyebrows.

In January 2010 - when Earl Howe was still both a patron of 2020 Health and opposition health spokesperson - 2020 produced a report sponsored by Bayer healthcare entitled‘Responsibility in healthcare: changing the culture’. The report advocated the end of free treatment for minor or for ‘repeat offenders’ under a section on ‘lifestyle’ illnesses. It suggested that electronic records could facilitate a penalty system for those who repeatedly turn up to A&E drunk or ‘high’. In addition, the report bemoaned that “the culture of people being deterred from seeking help because they are worried about ‘being a burden’ is fast fading”.

2020 Health is also a leading advocatefor ‘telehealth’ - the replacement of face to face contact with telephone and electronic monitoring devices. Its report, Healthcare without Walls was published just after the government had published its White Paper “Liberating the NHS” states that ‘the White Paper creates the environment in which the demand for telehealth-enabled services can be fostered”. The report was sponsored by private healthcare corporations including Tunstall (a leading provider in telehealth), Accenture, Vodafone, Pfizer and others. Despite 2020 Health’s stated emphasis on “research” and “evaluation” there have been a number of reports highlighting safety and cost problems with the telehealth model. The same report also pushes the use of personal health budgets…’ a move seen by manyas a step towards privatisation and an insurance model.

Manning’s letter to Howe reveals how she and her “consultative authors” lobbied Oliver Letwin hard on the point that David Cameron should be known as the “Technology PM”. This attempt to label Cameron “didn’t succeed” but Ms Manning is unperturbed. She ended her letter to the Earl by stating “we have to start firing up radical flares to attract investment and ensure resistance to change in the NHS is not tolerated.”

Such support for both big business, which funds their reports and Manning’s suggestions for David Cameron’s image suggests 2020health are anything but independent. Furthermore, the message turning the NHS into an economic arm of ”UK PLC” brings an end to the illusion that the Health and Social Care Act is about improving patient care.

This was co-published on Our NHS here.  

The 2020health membership just published and highlighted to me on 25th September 2013

Earl Howe - A Former Patron of Pro-Market Health Think Tank

The Parliamentary Under secretary for Health Earl Howe, who led the Health and Social Care bill proceedings in the House of Lords, was listed as a patron for pro-market think tank 2020health, just before the elections.

Knowledge of the Earl’s patronage has only just appeared after the discovery of a policy paperwritten by 2020health for the Spanish right-wing publication ‘Sanifax.’ The ‘Dosier Especial’ titled ‘a healthier nation’, was a Green policy paper produced in January 2010 and introduced in Spanish as having been created with the ‘support of David Cameron’ on the ‘necessary reforms.’

At the time of the report, the Chairman of the think tank was Tom Sackville, a former Conservative minister and Parliamentary Under –Secretary for Health who is the Chief Executive of the International Federation of Health Plans, which represents one hundred private health insurance companies in 31 countries.

2020health is now led by founder Julia Manning a former director of the UK Institute of Optometry and Conservative candidatein the 2005 election, has been vociferous in her supportof an increase in private health into the NHS.

2020health reports

The self-called ‘independent’ think tank has produced multiple reports funded by health corporations, which includeone titled ‘Responsibility in healthcare: changing the culture’. The report sponsored by Bayer healthcare was produced in January 2010, when Earl Howe was still a patron and advocated the end of free treatment for minor or for ‘repeat offenders’ under a small section on ‘lifestyle’ illnesses. Electronic records, the report suggested can facilitate a penalty system for those who repeatedly turn up to A&E drunk or ‘high’. In addition, the report recommendations bemoaned ‘the culture of people being deterred from seeking help because they are worried about ‘being a burden’ is fast fading’.  At the time, Earl Howe was the opposition spokesperson for Health and Social Services and still a patron.

Promoting Telehealth

A further reportwritten in the same period was published just after the government had produced its White paper Equity and Excellence: Liberating the NHS. The focus of this report was on the area of telehealth and was titled ‘Healthcare Without Walls’. This report was also sponsored by private healthcare which included Tunstall, a leading provider in telehealth, Accenture, Vodafone, Pfizer and others. The opening summary states how ‘the White Paper creates the environment in which the demand for telehealth-enabled services can be fostered…through personal health budgets…’

2020health is a leading advocate of telehealth technology, and have claimedthe technology can make huge savings. However, all is not clear about the benefits of ‘telehealth’. A trial in the UK run by the British Medical Journal revealed costs of running telehealth were higher than without and the technology failed to improve ‘quality of life’. Furthermore an analysisin the US suggested the telemedicine, which is part of a telehealth programme, ‘tripled’ the death rate in elderly patients.

2020health’s support for private healthcare involvement and sponsorship from big business for their reports may well indicate who makes up their membership. However, despite several requests by Social Investigations, 2020health have so far refused to publish their membership list and denied it contains health insurance companies.

Lords interests
The dedicated promotion of telehealth by 2020health no doubt pleases Conservative peer Lord Patten, who is a senior advisor for Charterhouse Development Capital Ltd - who purchased leading telehealth provider and sponsor of the 2020health report, Tunstall. Further parliamentary interest in the new technology comes in the form of Conservative peer Lord Flight, who is the Chairman of Arden Partners plc, an investorin Deltex Medical Group who produce a telehealth productadopted by the NHS.

Other patronage

Patronage of 2020health is popular amongst peers. Liberal Democrat Peer, Lord Clement-Jones is a 2020health patron and a partner for DLA Piper, who provide lobbying, public affairs and trade policy services as well as advice on how to get access to public service delivery contracts. Another Peer and patron is Baroness Cumberlege, who runs her own training and consultancy company called Cumberlege Connection. The Conservative Peer moved herself into an alliance led by PwC, developing the new Clinical Commissioning Groups, prior to the Health and Social care bill becoming an Act. When a complaint was placed with the Commissioner for Standards she responded by saying 'Disappointingly since joining the alliance Cumberlege Connections has not earned any income through the alliance.'

Pushing the market

Earl Howe, a former banker has recently been threatened with expulsionfrom his advisory position at the Royal College of Physicians for having ‘mis-sold’ the health reforms. Earl Howe’s support for more private healthcare involvement is clear. When speaking at a forumhosted by healthcare market researchers Laing and Busisson prior to the Health bill being passed into Act, he told the audience ‘‘The opening up of the NHS creates genuine opportunities for those of you who can offer high quality, convenient services that compete favourably with current NHS care… There will be big opportunities for the private sector’.

His recent connection to 2020health is not severed and he remains a frequent guest speaker at events hosted by the think tank such as this one on further cuts to the NHS, an invitationonly event.

In his opening speech on the opening day of the Health bill in the Lords, Earl Howe said “We will support an active role for the independent sector working alongside the NHS in the provision of care” This ‘active role’ included his attendance at a top-level meetingwith a healthcare lobby group one year before his opening speech in the House of Lords.

In October 2010, Earl Howe, alongside Simon Burns (the then Minister for Health), and Andrew Lansley’s Special Advisor, Bill Morgan, attended two meetings with a private healthcare lobby group, the NHS Partners Network (NHSPN). These meetings one of which included a Care UK representative came to light following the discovery of a documentwritten by the NHSPN, which revealed the discussions took place three months before the Health and Social Care bill was introduced to parliament.

The purpose of the discussion, according to the document, was to give members an opportunity to ‘express their support for the policy of ‘Any Willing Provider’, which became ‘Any Qualified Provider’, and to give those present a chance to express any ‘concerns about whether a level playing field would truly be created’. Furthermore, the lobby group was informed that the government felt as if opposition to the ‘independent’ sector from GP commissioners would likely be ‘short-term’ and ‘dissipate’ in the future.

What was said is unclear, although meeting notes were taken and although visible from the NHS Partners Network’s website they were security protected for their corporate health membersonly. This restriction meant the members had privy to a key meeting in which information was discussed before both parliament and the general public.

Rules – not fit for purpose

The rules that the Lords have to abide by are plentiful, but under their Code of Conduct, it states that patrons ‘should not be registered’. Although it continues ‘There may however be occasions on which such interests should be declared.’ The Code of Conduct also states that Members must “declare when speaking in the House, or communicating with ministers or public servants, any interest which is a relevant interest in the context of the debate or the matter under discussion.”

However, if his patronage was not a conflict of interest worth mentioning, then why give it up upon the general election? The rules may be lax on this matter but surely his patronage of an organisation headed at the time by an individual in charge of a private health insurance body, which openly supports increased private healthcare involvement in the NHS warrants registration in his interests. Earl Howe was instrumental in aiding the pro-market Health and Social Care bill into Act. Lord Warner, the Labour former health minister, said“his silky skills got the bill through”.

What difference would it have made if his fellow peers had known about his patronage is unclear but they deserved to know; as too did the public. Thanks to flaws in the rules, his omission it would seem was one of choice, as was his decision to go to a meeting with private healthcare to reassure them before parliament saw the bill. All this raises further questions about what Earl Howe’s true intentions were behind his support for the Health and Social Care bill and may well bring his expulsion from the Royal College of Physicians back for discussion.