In October 2010, Simon Burns (the Minister for Health), Earl Howe, and Andrew Lansley’s Special Advisor, Bill Morgan, attended two meetings with a private healthcare lobby group, NHS Partners Network (NHSPN). These meetings have just come to light, following the discovery of another document written 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 Government’s policy of Any Willing Provider (explained below) and moves towards greater patient choice.’
In addition, the members could express any ‘concerns about whether a level playing field would truly be created’.
So, the NHS Partners Network were able to access the very top of our political tree before our elected politicians had even been given a chance to debate the bill in the Commons. And no minutes were taken.
The meeting informed the network of a ‘command paper’ that was about to be published by the Department of Health, to set out the ‘principles of the NHS reforms more clearly’. They also ‘received assurances’ that the Government will make it clear to commissioners what the Any Willing Provider (AWP) policy means for them, and that they intend to ‘adhere’ to the reform timetable.
The update on where the government was in terms of action was backed up with further assurance that opposition to the AWP policy would not last long. The introductory paragraph of the document highlighted that both ministers and Mr Morgan expressed the view that any problems with the implementation of the AWP policy, such as opposition to commissioning of the independent sector from GP commissioners – were likely to be ‘short-term’ and ‘dissipate’ in the future.
However, several months after the meetings the situation had changed, because once the content of the white paper had been realised, a near total rejection from both the public and the medical profession resulted in the government taking a ‘pause’.
The so-called ‘listening exercise’ required a temporary group to be set up, called the NHS Future Forum which had Sir Stephen Bubb, a David Cameron appointment, in charge of competition and choice. We now know that Sir Bubb worked with the NHSPN, who together influenced the direction of discussion. The newly established forum meant a new set of lobbying was required, and the NHSPN made sure they were at the helm, as revealed in their annual 2010/11 summary report:
‘This (pause) prompted a major new effort to communicate our views to the NHS Future Forum, and to the top-level political decision-makers to whom the forum will report.’
Part of the concerns the lobby firm had now centred on the policy of ‘Any Willing Provider’ (AWP), which had changed to ‘Any Qualified Provider (AQP). It was a semantic difference that was hailed by the Liberal Democrats as a victory. In reality the AWP commissioning procedure is set by an EU procurement directive, and the term ‘AQP’ does not exist in EU law.
The British Medical Journal highlighted the significance of this change in an editorialaimed at the media, who at the time had failed to pick up on it: ‘If a future government wishes to bring a health or social care service back into public sector provision (say if the consequences of this reform turn out to be bad for patients) any existing or would-be provider may sue under EU law on anticompetitive practices.’
The NHSPN, however, did not want to take chances over any weakening of competition in the bill, and having ‘agreed on the approach’ to take with Mr Bubb in a previous ‘lengthy’ meeting, they turned their attention to Earl Howe, who would be leading the debate in the House of Lords.
On the 19th of May 2011, David Worskett, the director of NHSPN, set up another meeting with the Earl. A newly discovered document for the NHSPN’s members revealed that ‘Simon Burns also asked to join the meeting’. Mr Burns’ request to be included, according to Mr Worskett, indicated the recognition by the minister that NHSPN were ‘less than happy about things.’
The meeting went well for the lobbyists. The document revealed that although the ministers were ‘necessarily constrained’ by the fact that everyone was supposed to be listening, they gave ‘every signal possible that they understood and sympathised with our concerns and shared our view of the key issues and priorities.’
Indeed this understanding was absolute. Earl Howe offered a ‘depiction’ of the ‘Government position’, that meant ‘“choice” was a non-negotiable.’ This view led Mr Worskett to say: ‘He could have been delivering a précis of our briefing notes (which of course he had already seen)’. No wonder then that later in the day at a National Stakeholder Forum, Earl Howe ‘endorsed [Mr Worskett’s] arguments twice during the session on competition and regulation’.
The NHS Partners Network are not finished lobbying yet, having recently responded to the first stage of the health regulator’s (Monitor’s) review into the fair playing field for NHS providers. They held a meeting under the auspices of the right-wing think tank "Reform" with David Bennett, the head of Monitor who are running the review. A fair playing field has nothing to do with it. If that were the case, then Simon Burns et al would not have offered a reassurance on policy ahead of a debate in the Commons. The NHSPN’s press release announcing their submission to the review states: ‘We look forward to working with Monitor throughout the consultation process.’
I bet they do.
Unanswered questions
So why were the trio of Simon Burns, Earl Howe and Andrew Lansley’s special advisor, Bill Morgan, holding a meeting to reassure a trade and lobby group, before our elected MPs had even had a chance to debate the bill in the Commons?
Did Bill Morgan pass a message back to Andrew Lansley or did Andrew Lansley pass a message onto NHS Partners Network?
Further notes:
The newly appointed special advisor to Andrew Lansley, Bill Morgan. The former private healthcare lobbyist came under the spotlight in March 2011, following an investigation by transparency campaigners Spinwatch. Mr Morgan had received a list of GPs who were in favour of the reforms, who would represent a ‘public relations coup.’ The list was provided by an outsourcing firm called Tribal, who according to Spinwatch, had ‘£150 million worth of government contracts’, and were connected to some of the new GP Pathfinder Consortia.
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