NHS privatisation

http://www.marcuschown.com/THE%20HEALTH%20...cus%20Chown.htm

A succinct account of the Health and Social Care provisions and their likely effects

www.guardian.co.uk/business/2012/sep/16/health-firms-nhs

Article from the Guardian about how much of the NHS represents an "opportunity" for the private sector. £20 billion, apparently

The Hospital Corporation of America (HCA) is a big private health care provider. It runs 173 hospitals and more than a 100 outpatient centres in the USA and Europe. Its overseas division is based in the UK and it runs some of the most expensive private medical facilities in this country. It is now moving into NHS outsourcing, just as you might expect. So it is interesting to learn that the American company is subject to investigation for performing unnecessary treatment in order to make more profit.

The allegation was made in 2010 by a nurse, and that nurse's contract was not renewed. Nevertheless an internal investigation concluded that it was true that unnecessary heart procedures were being carried out at the hospital the nurse worked at. Moreover the New York Times reports that this was known to be going on in several hospitals in Florida from as early as 2002.

It seems that the company did not reimburse the US public health services Medicaid and Medicare, as required by law. Naturally enough the company denied this and also denied that the findings of the investigation were conclusive.

www.nytimes.com/2012/08/07/business...-work.html?_r=0

Private Eye reports that the US Justice Department is to review billing and medical records at 95 HCA hospitals: more than half of the total run in America by this company. Private Eye also states that the company was also investigated by the Justice Department in 2003 and at that time it was announced that "HCA Inc has agreed to pay the US $631 million in civil penalties and damages arising from the false claims the government alleged it submitted to Medicare and other federal health programmes". The same magazine also states that HCA had already paid $1 billion before that, after pleading guilty to "substantial criminal conduct" relating to fraud and abuse of programme funds.

That is confirmed in the linked NYT article


This is another outfit which is "too big to fail" and it is obvious that the impotence of the criminal law as applied to financial institutions (referred to in Michael Hudson's article I linked in its own thread) is also impotent in relation to large private health care companies in the US. As the NYT article also notes the underlying pattern is exactly the same as that for private care homes already extensively discussed on this board: involvement of large private equity firms and huge borrowing which needs to be repaid

The shape of things to come....

On another board someone has drawn my attention to news about Hinchingbrooke Hospital. As you will recall, the hospital was privatised about 6 months ago because it was losing money (see upthread). This was all over the mainstream press at the time: so it is a little curious that the latest results are not so widely reported: I could only find an article in the Daily Mirror amongst the mainstream newspapers (though I may have missed it elsewhere): the other reports I did find are in local outlets, and in such specialist (and arguably biased and so to be dismissed) publications as the nursing times and union/activist blogs.

Anyway it seems that Circle has asked for an advance on the funds it is to be paid by government of some £4 million because it has made losses in the first 6 months of trading. That has been granted.

www.huntspost.co.uk/news/latest-new...onths_1_1675926

As this blog points out, the same indulgence is not granted to health care facilities which remain in the public sector. Curious that.

http://eoin-clarke.blogspot.co.uk/

Circle is spinning this as being due to a focus on increased quality rather than financial improvement, in the early part of their contract. Shame that this was not the basis on which the privatisation went ahead. The losses are far bigger than they said they would be: despite cuts in nursing staff. And, as I mentioned before, they rely heavily on "patient satisfaction" to justify themselves: which has also fallen since they took over.

In the long run I still do not see how this can fail given the financial arrangements in place: but now we see that it is not going to be allowed to fail no matter what happensl.

Edited by FionaK - 31/10/2012, 08:37

A man called Jim Easton was, for most of his career to date, an executive in the NHS. In 2009 he was appointed as the "NHS National Director of Improvement and Efficiency". This ridiculous title covers the fact that his role was to deliver the "efficiency savings" demanded by government. That means cuts (to the tune of £20 billion), but let that not detain us. It also means that he was heavily involved in the privatisation (which is called "commissioning" so we don't immediately realise that) represented by sub contracting services to the private sector.

In October 2012 Mr Easton resigned from his position to become the managing director of Care UK, a private company which is a major provider of long term care with substantial contracts to run NHS services and an expressed interest in obtaining "management franchise deals" for NHS hospitals.

In the past there were rules which restricted public servants from taking employment in related industries when they left their public service employers. The reasons for those rules were obvious and they served us well. But they clearly no longer exist, and conflict of interest is not seen to be a problem nowadays: the "revolving door" is presented as a helpful thing, and it is paranoid to worry about corruption, apparently. But that is an aside.

Care UK started life as Anglia Secure homes in 1982, and it became Care UK in 1994. At that time it was a public limited company. In 1997 it acquired a company called Care Solutions Limited which ran 59 homes for those with learning disabilities: and in 1998 it bought another company called The Care Partnership adding a further 7 care homes in the process.

In 2010 the company was the subject of a management buyout: and it is no longer listed on the stock exchange in consequence. Since then its major shareholder has been something called Bridgepoint Capital. Bridgepoint is a private equity investor and it does not seem to have much interest in health: at least judging from other things it has invested in, such as Pret a Manger ( a sandwich chain) and Leeds Airport.Their website says


Bridgepoint bought Care UK for £423 million in cash. In the process the company went from being a publicly listed company to a purely private enterprise, though, as noted this was presented as a management buyout: it is a bit difficult to see it as such given that Bridgepoint put up the money. Presumably that was lent to the management to allow them to buy it: but it is not clear. The justification was that this was long term finance and the public markets were not very keen on investing in this sector at the time.

At the time of the acquisition Care UK had turnover of £410 million a year and pre tax profits of £21 million. 90% of the business came from local authorities and the NHS. In addition to care homes it also operates GP out of hours services; some GP practices; some treatment centres; and some prison health care. Bridgepoint issued a bond to fund the acquisition and so Care UK owes them £250 million and pays interest at 9.75%. At the same time Care UK raised loans in the channel islands and it pays interest on them at 8%. £4 million a year is deductible for tax purposes because of this. £8 million a year goes to the owners in the form of dividends on their preference shares

When Bridgepoint bought Care UK it set up another company called Silver Sea Holdings: and guess what they do? Why, they own the care homes and lease them back to Care UK. Does that remind you of Southern Cross at all?

Incidentally, Care UK's chairman also donates money to the tory party and it is reported that before he became secretary of state for health Andrew Lansley got £21,000 from him.

In another part of the forest, a company called Harmoni won 12 contracts with the NHS to provide out of hours care for people who need urgent treatment but do not need to go to a hospital in an ambulance. This used to be done by GP's but there were problems with that and this is supposed to be cheaper and more efficient. Mr Easton was a prime mover in the development of this new approach and he said


Care UK, in conjunction with Capita. also bid for those contracts but seems to have pulled out quite early in the process, for some reason. It is reported in the press that they "lost out" to Harmoni but I have not been able to find details of what happened there

Harmoni was owned by ECI, which is another private equity company, and it seems to have been doing very well. It has increased sales by 39% since 2008, which is a measure of how fast privatisation is going, when you consider that this amounts to approx £100 million turnover all of which comes from the NHS. In November 2012 ECI was "delighted" to announce the sale of Harmoni..... to Care UK, for £48 million. According to reports at the time this was beneficial to all concerned. The combined companies would have turnover of £700 million and those who awarded the contracts to Harmoni (and not to Care UK) were said to be content with this. The chief executive of Care UK, a Mr Mike Parrish said:


So that is all right.

It is a bit unfortunate that Harmoni is not delivering a decent service though.

http://www.guardian.co.uk/society/2012/dec...P=ILCNETTXT3487

According to reports in the press today, senior doctors allege that the service is regularly unsafe, and putting patients at risk. It is also charged that they are fiddling their records to hide the fact that they are regularly missing targets and are unable to provide a service at all some of the time


The company denies all of this: or rather


So it seems the lack of medical staff, at a clinic which is not even open when it should be, has no significant impact on that health service. Astonishing !

And of course those pesky patients must bear some of the responsibility, for it seems they are not willing to travel miles for an appointment in the middle of the night, when they are ill. Some people !

Never mind: none of the allegations are true, and even if they were Care UK (which, I repeat, did not even win the contracts) is on hand to sort it all out. What could possibly go wrong?

Ali Parsa, chief executive of Circle, which took over Hinchingbroke hospital, has stepped down in order to fulfill "his passion for social entrepreneurship". Given his big talk about all Circle would do for Hinchingbroke, (see this article in the Telegraph in August of this year www.telegraph.co.uk/finance/newsbys...-hospitals.html, for example), it is somewhat disappointing to find that his commitment to this lasted not much more than a year.

It is not as if Circle has delivered any of the good things promised; despite the advertising feature posing as news linked above, they have not met their financial plan, posting a deficit for the first half year of roughly double what they said they could achieve and asking for an advance of government money to cover it. As the reason for passing Hinchingbroke to this venture capital funded firm was the deficit, you might think he would want to direct his "passion" to sorting that out before swanning off to other projects. I certainly don't want my health service run by folk who are not in it for the long term, though I cannot say I am that surprised: it is a pattern I have seen before. Come in, make changes, then get out quick before the consequences are apparent. Success means never having to say you're sorry, and never accepting any responsibility for the mess you leave behind you.

As I noted, I did not see how this could fail given the way the thing was financed but it may be that I continue to underestimate the sheer incompetence and greed of the UK private sector. Certainly it seems that others have serious doubts and the National Audit Office said in November that it was concerned that the contract was awarded without full consideration of the risks. I never did find out how Circle became the preferred bidder....

We shall see. But it is interesting that Mr Parsa has gone before they have a replacement for him: his job is to be done by one Steve Melton, currently head of "mobilisation" at circle (whatever that means), while they look to recruit a new CEO. Especially since the Financial Times recalls that in June 2011, when Circle was listed on AIM, the prospectus said that Mr Parsa

ETA: Private Eye reports that the contract with Circle has a clause which enables them to walk away if the deficit reaches £5 million: it is currently £4 million....

Edited by FionaK - 27/12/2012, 16:19

Steve Melton, who is temporarily doing Ali Parsa's job at Circle, has all the credentials one would wish for someone running health care....so long as you imagine that "management" is a skill in itself and that there is no need to understand the thing you are running. According to Circle's website his degree is in chemical engineering and he has "22 years of experience of leading large scale operations.."

Mr Melton started as a management trainee at unilever: they sell soap powder and stuff
He then worked for Asda: they sell groceries
Then Faberge: perfume and things like that
He was supply chain director at Scottish Courage: beer
Then supply chain director at Argos: household goods

It fits with what Mr Parsa said in the puff piece linked in the last post: he is sure to understand the business plan and that means he knows what the hospital is trying to do....er, not what I might think a hospital is trying to do, but then I am old fashioned and I think it is something to do with health care .

Our Government is now considering a recommendation to make private health care providers exempt from tax. Apparently it is unfair that they should have to pay tax on profits when the NHS doesn't. They appear to have missed the fact that the NHS does not actually make profit.....

In case anyone has any remaining doubt that the aim is to abolish our NHS, there is an interesting report about the service in Northern Ireland, prepared by Mckinsey, who are management consultants and who seem to have a finger in every privatisation pie, for no very obvious reason.

www.dhsspsni.gov.uk/2010-hsc-spendi...mplications.pdf

The introduction includes the usual warm words, serving to disguise the actual intent. It talks about


and


I hate the way these people always talk of "Vision" and "Improvement", when they mean cost cutting and dismantling.They seem to have some small awareness of the impact of those words because they actually bother to say what they mean by some of them. Except that it is not what they mean: but hey ho.

In the executive summary it says:


Well there is an interesting sentence which illustrates what I mean. Is it likely that there will a growing demand for care by 2014 (that is next year) so big it is going to mean that there is not enough money next year? Hardly. That is just smuggling in the narrative of demographic timebomb into this paper and you are not supposed to notice it is nothing to do with this at all. They suggest that the "ageing and growing population" accounts for about 1.5% growth in demand
Hmmm. They say that more than half of the increase will be in people over 65: so what? 65 is not even the retirement age any more. and "less than half" are presumably working age people who will contribute to the tax base available. There is no mention of the upside of that growing population: they are portrayed solely as a cost increase, and that is no accident either
Even if you accept that narrative it is at best disingenuous here.

Similarly, "inflating costs" is interesting. Why is that, then? I wonder if it could be to do with the increasing involvement of private sector players in the NHS, like, to take a random example, McKinsey? Of course not: it is due to things like the working time directive which increases costs by reducing the hours staff are allowed to work (no mention of the productivity increases which may accrue from the fact that your doctor is awake); the availability and use of new drugs which were not available before (no mention of any substitution of cost nor of any productivity improvement from more effective care); and better diagnosis of conditions which were previously missed (no mention of the cost savings attendant on earlier intervention, which, curiously, are often promoted in other parts of the forest) It is always worthwhile, when reading propaganda, to try to have a think about what is NOT there. To be fair they also include
So there is acknowledgement that increased private provision, which we introduced because it was supposed to be cheaper,increases cost. Again that is the opposite of what is claimed in other parts of the forest and again it is put forward as an act of god and not as the political decison it undoubtedly is. If Tesco can employ in house pharmacists and opthalmologists for profit "we" can keep them in house for less money even if we pay them more, I suspect.

But most important is the constraint in the growth of the spend: like that was an act of god and not a political decision. All of those are blithely presented as inevitable. Of course the last is justifiable given that the government has stated it is going to cut spending, and if this executive summary is designed as recommendations for a pragmatic response to that reality fair enough: but the other two elements do not tend to support that interpretation.

So how to bring the costs down? No surprises there. They want "better management of long term conditions".That is a good idea because they say it will improve overall health and reduce the need for costly treatment. Sadly it does not say how, and that is typical of this outfit: for they are not medical people, they are management consultants.

They also blithely say that reducing hospital stays will save money. They always say that. The assumption is always that community based healthcare will expand to meet the need and that hospital stays are often too long or wholly unnecessary. I have touched on the reality of that in another thread in discussing another report about the elderly who stay too long in hospital, and this is codswallop, in the real world. But don't take my word for it. As Private Eye reported in its latest edition, McKinsey also drew up a report for the wider NHS in 2009, which forms the basis of the £20 billion cuts called "efficiency savings" currently being demanded. It also says that cutting hospital stays will save money and also assumes that community health will be cheaper and just as safe. There is no evidence for that at all in the report, and it is interesting to learn the reason for that. At a workshop on Community-Based Care, for health professionals a McKinsey partner called Penny Dash admitted "There isn't very much evidence base about models of community care". But that does not deter them from saying


Nor are there any firm and costed plans about those services which are to replace the hospital stays, though you might think that would be pretty much essential if you were producing a report of this kind, in order to make your case. Never mind: it must be so cos McKinsey says so: over and over again, no matter what they are considering: and they get paid for saying it every time too.

Then there is the proposal for "co-payments". There is a clue in that label: it is a term I have only come across in American arrangements. It is the antithesis of the principle on which our system is based "free at the point of need".

Cutting staff wages is in there too: quelle suprise!

They do acknowledge that this would require a "significant" change from current policy and principles (my bolding). Damn right it would. They acknowledge that what they are proposing is a different kind of health service altogether: they do not say it is american, preferring to focus on european models: but it is amusing to note that this report refers to "we" throughout: in such phrases as "where are we now" McKinsey do not, so far as I know, live in Northern Ireland nor do they use the health service. It is cute.

The breathtaking arrogance of these people is neatly illustrated in this sentence:


Remember it will become unaffordable because the government has the political will to cut the funding on the basis of a McKinsey report which says that they should: and now the Northern Ireland service will be unaffordable because of that decision. I do not think "unaffordable" means what they think it means.

But there is a bright side


I wonder who will get the contracts for the PR and the IT? Do you think it might be private sector management consultants and IT firms like the ones who have a proven track record in failure when providing public sector IT systems? I think it just might. They estimate the cost of that at £0.3 billion this year: and £0.1 billion a year thereafter.

Moving on, I am struck by the way these people spin things throughout this document. To give one example:

1. They say that Northern Ireland spends less than the same service in England. It rather undermines their credibility to see that they have only a very hazy idea of how much less - between 7% and 16% per head, they think, which translates to between £250 million and £600 million a year.

2. They acknowledge that this leads to worse outcomes
3. They conclude it is necessary to spend less

I can't see the logic of that, but then I am not a management consultant.

It is also interesting to see what they consider to be "efficiency improvements" Once again there is no evidence at all to support their interpretation and this is in line with many such reports. For example, they say that the length of stay in hospital is coming down and that this is an example of better productivity. They do not show why that is a good thing, that is taken as read. But in order to demonstrate that you would have to show that readmission rates have not risen; that the care the people discharged receive is safe and appropriate; and probably a lot of other things which would come to me if I was writing the report and spent some time thinking about it. They say nothing on those issues, so far as I can see. " Productivity" is not a simple thing: if you wish to improve the care of patients it is not at all obvious that cutting the number of nurses will achieve that, and there is reason to suppose it will not. But a productivity measure will show an improvement if one nurse is looking after 20 patients where there used to be two. I am not persuaded that one can do as good a job as two, if you happen to be interested in actual nursing (including the intangible things such as time to talk to patients): but you can't measure those things very easily and if you are a McKinsey you will not even see why you should, I suspect.

The report points to some innovations which have already proved effective and which they claim give high patient satisfaction. Except that is not really true either, at least not in all cases. One instance is the "telemedicine" approach to long term conditions such as diabetes: said to reduce the need for in patient treatment; to reduce the length of hospital stay when that is required; and to have had very positive feedback from patients. All of that might be true and wholly positive: but it is based on pilot studies and
. It is a little premature to imply this is established: pilots, in my experience, tend to be better resourced than nationwide versions of the same service, and it remains to be seen what happens when the change is made on the bigger scale. I do not wish to be seen as dismissing the benefits of innovation: some of these things will be better. But it seems to me that the development and evaluation of such things should be independent of cost: that is a consideration which should be addressed after the pilot has demonstrated its worth in other terms.

Yet they conclude that since funding is not going to increase
They use this conclusion to justify dismantling the NHS on explicit grounds of TINA.


(my bolding). And this is in context of a report which says that

There follows some recommendations, which again sound positive if you don't think about them too hard.

1. They advocate better management of long term conditions. Who could disagree? Only it rests on the idea of improved community care, which is neither evidenced nor implemented, as already discussed: and it says it rests on increases support for "self care" (ie. no care at all) and carers (who are having the support they receive cut as we speak)

2. Decommissioning of ineffective or non essential treatments: fine so long as that is determined by research and by doctors and their patients. I am not aware of the expertise which allows management consultants to say that "potentially cosmetic" ear/nose/ throat surgery is "actually" cosmetic and I do not think that surgery to correct truly disfiguring conditions is demonstrably ineffective or non-essential.

3. Prevention: it is absolutely true that promoting healthy lifestyles would save money in the long term: which has nothing whatsoever to do with cutting spending and does not belong in this report: but it is always handy to demonise the victim wherever opportunity arise

4. Managing referrals/reducing variations in assessment.


Well "we" cannot be surprised if management consultants want more management. But that will not necessarily be cheaper, though that is the implication. It is just as likely that those doctors who make more referrals have better outcome in terms of health than those who make fewer.


5. Optimising urgent care. Fine: but once again the instance they mention depends on spending elsewhere, eg in "fall prevention support of elderly people". If that can be done well and good: we should do it if it does not entail restrictions on the quality of life of those people etc. But it is nothing to do with cutting the costs of health care directly. Less use of A&E is also in this section through, for example, better use of minor injuries units: do they exist? I am not aware of them. If someone is injured, and going to the GP is not enough or is not possible, they do not go to A&E because they insist on that: what they do is go to the hospital and the only place you can be seen without an appointment is A&E. It is for the triage nurse to decide priorities and presumably to decide which department as well. I infer that these minor injuries units are not available routinely and that is something that could change if it is cheaper and equally effective to put them in place.

6. Social Care improvements. Already addressed in this thread and elsewhere. This is just a wish list, with the additional recommendation of more "co-payments"

7. Shifting to lower cost settings: this means apparently that folk should go to the GP rather than outpatients because the GP can treat them if he has sufficient specialist support in many cases. I expect GP's are just sitting about waiting for work. That is an assumption that management consultants often make about people who are not management consultants

8a. Reducing average length of stay in hospitals: already addressed
8b. Increasing staff productivity:


This is just drivel in a context of reducing staff numbers and reducing the numbers of managers and administrators. But it is just what one would expect from management consultants

9. Optimising the use and procurement of drugs. Fair enough

10. Optimising the use and procurement of other supplies. Fair enough

11. Making better use of our estates


Don't know about Northern Ireland nor about the general situation over the country: I do know that my mother's friend was in hospital for a few days last week and that people were kept waiting for a bed to become vacant because the place could not meet the need. I would need detail of this unnecessary space: to me this just looks like closing hospitals which are fully utilised: might be wrong

12. Seems to be specific to NI but is better procurement again

13. Renegotiate or reprocure private services for less money. Great idea, given that care homes cannot make a profit at current rates, according to what they are saying. GP's and pharmacists and opthalmologists will obviously welcome a cut in their wages as well. That is all this is: wage cuts for other people (and profit erosion for those private care providers who are there because they are so efficient and cheap)

14. Optimising management and admin costs. Already been done, they say, so I don't know why it is there. Probably because McKinsey always put it in when they produce these lucrative off the shelf reports

There is a curious sentence further down in the report


That is not because they are pish, of course: it is due to


I am sure you can translate that in terms which fit your background views: I know I can.

The most important part of this report is section 4, where they go on to look at more radical solutions should the wish list not be enough. This is the meat of the proposals and it seems to me it is the heart of the privatisation agenda.

They want fewer acute hospitals because of reduction in hospital stays, yet an increase in local hospitals. That looks odd until you notice that "local hospitals" is in quotes. It remains to be seen what they actually mean for they say those local hospitals will provide complex and urgent care and medicine; intensive care units and "paediatric ambulatory treatment services" It looks like an A&E unit with some outpatient service for kids, and a small amount of inpatient facility, for example for those who have broken a hip and can't go home immediately; and an intensive care unit. It is once again short on rationale and short on detail so it is not easy to grasp the "vision" they say they have. Anyway that is to be combined with putting all the GP's in one place and the development of "integrated care centres" which will also provide urgent care: not clear if they are the same as the "local hospitals" or something different.

As the report says, none of this is new or original. Make me wonder why we pay these people, but I often wonder that. And in case you missed the TINA, the reiterate


If you are talking rubbish it never hurts to repeat it.

Then the detail: 350 fewer hospital beds then "we" have at present. 30% fewer outpatient hospital appointments. Balanced by 20% more GP consultations (because they are just sitting about) and 15% more community contacts (because health visitors and social workers and district nurses have nothing to do). In case you doubt that, it is specifically stated that


though in fact I see no such plan at all: I see an assumption with no underpinning outline of how this is to be achieved. Hey, they are "big picture" people! If you doubt that they say so:


Despite the fact there is no plan they say 1000 fewer staff will be needed: as against the extra 10,000 needed by next year if "we" do nothing. Does that look plausible to you? But never mind: we need 1000 fewer staff but we need a lot more "enablers" who will "champion" the "reforms" You may not be aware but this word "champions" is now quite widespread. I first came across it when working in child care some years ago. It was a source of great derision and considerable embarrassment for those required to adopt the title: just as the content was because the people who got the role did not actually believe in it quite often. This is just more "off the shelf stuff" But the "enablers" are really another tier of management: what is not to like? Especially since they will need to be trained in "leadership": I wonder who will do that?

Oh and "we" need "incentives" for the staff to improve their "productivity". So it seems that they are not expected to agree this is improvement. We need to influence
Since doctors and nurses and physiotherapists and pharmacists are already graduates or at least have tertiary professional education, I think we can be sure that this is more bean counters. Either that or we are going to have graduate hospital porters.

"We" also need to sell the case for all of this: and "we" must get our skates on.
It is true that policy made in haste tends to be rubbish: but this is an emergency!! Again you will be able to translate that in line with your wider views: I read it as, if we don't get this through before 2015 the government might change and it won't happen at all. Where will our pals get their profit from then????

There is also discussion about extending co-payment beyond bringing that into line with what is in place in england; reducing the service and restricting the availability of treatment: eg. refusing hip replacement operations to those who need them if they do not meet other criteria: like you have to be over 80 to get one; introducing means testing for all; etc. They acknowledge those types of changes are probably illegal: but that can be dealt with, presumably. It also acknowledges that they might indirectly increase costs in the long term: but can we rely on government to take that into account?

This post is too long: but I think it is important and I should say that it was marked as not intended for release to the public. That tells you something, I think

Edited by FionaK - 15/1/2013, 15:54

Why the determination to privatise our health service? I have already mentioned some of the murkier financial ties between our politicians and the companies which seek to make profit: but someone has done a lot more work on that aspect. In the past people in the UK were quite smug about our system, in part because they believed it was not corrupt. That may have been true in the past (though I am not convinced): it is certainly not true now

http://socialinvestigations.blogspot.de/20...-companies.html

The link provides an extensive list of those politicians (and lords) who have fingers in the private health care pie. There are a lot of them.

Mr Nash and Mr Lansley have been mentioned above: but there is a great deal more to learn. This author has found 66 MP's and 142 Lords who either have gained or stand to gain from private sector involvement in health care. That is quite a lobby group.

The first one mentioned is David Cameron. It is not suggested he has direct income from private health businesses but it does note that the Tory party got £209,000 from one Dolar Popat, and Mr Cameron made him a Lord just after Mr Cameron became Prime Minister. He also speaks for the government on business matters and is now a whip in the house of lords. Best government money can buy, you might say.

Mr Popat and his company are interesting. The company is called TLC group and you can tell they are good guys because the TLC stands for Truth, Love and Compassion. Their website is here:

www.tlc-group.net/#

They run care homes: six of them, I gather (not certain because the information I could find at companies house is at odds with the company's website in this respect). Oh, and a hotel, but that need not concern us. They were set up in 2007 and they are very sweet: as the website says, their culture reflects a state of mind embodied in their name ( I will be passing out sick bags, so don't fret) and it says that Truth, Love and Compassion


According the latest accounts ( to 30/4/11) the company is very healthy indeed. It had a gross profit of £5,105,790 that year and an operating profit of £1,476,203. Unfortunately that does not seem to be the whole story because its pre-tax loss was £289, 737 and tax is shown as -£740,560: that means, I think, that this is loss that can be set against any future tax liability, though I might be wrong about that.

It has 483 employees and it paid wages of £ 7,970,499: the average is about £16,000 a year which is hardly a princely sum

They are, of course, subject to regulation by the Care Quality Commission. That body is not the sharpest, but even they seem to have noticed something wrong with this outfit

According to Private Eye, Inspectors from the commission visited one of TLC's care homes, Carlton Court in Barnet, at 7am one day in June of last year. They found the residents in bed with their clothes on. Wondering why that might be they asked the staff. They were told that residents often went to bed with their clothes on because there are not enough workers to help them into pyjamas.

Some of the men had been unshaven for days; there was food residue on their clothes and faces; staff were not properly trained in the management of conditions like bed sores. The Inspectors concluded that "privacy, dignity and independence" were not being respected.

They issued an enforcement notice and it seems the care home improved. Orly? Perhaps it did.

Inspection of a different care home,Cooperscroft, which is also part of the group (remember it has six homes in total) found there were too few staff to give residents their medication on time. The inspectors also had to point out "a trail of faeces along the corridor" which appears to have gone unnoticed, or at least not been dealt with by the staff.

The commission issued an enforcement notice, and the home will be re-inspected quite soon.

So you can see how they live up to that name and that management speak they are so proud of.

Milord Popat owns this company in toto and his son sits on the board

But apparently the cabinet office told Private Eye


and arrangements have been put in place to


I repeat, he is a government whip: and that means he tells tory peers how to vote, and sees that they support their government. What influence could he possibly have?

Edited by FionaK - 17/2/2013, 21:55

I came across something very interesting which I had missed.

On 13/4/2013 a new company comes into being called NHS Property Services Limited. The background is the abolition of the Primary Care Trusts. NHS property which is not transferred to service providers is to be transferred to the new company. It is estimated that the company will own about £5 billion worth of property comprising some 3,600 NHS facilities ranging from GP surgeries to administration buildings.

There has not been a lot of reporting of this, and it seems to me to be quite important. There is a website which is all optimistic on the surface. It explains that it has "an exciting vision to provide high quality, well maintained, modern environments"

It is not quite so upfront about other aspects. For example it is reported elsewhere that the company will charge commercial rents for the properties where that is not already the case, and that the cost gap is estimated at £500 million a year

http://www.hsj.co.uk/news/finance/nhs-prop...5053896.article

The linked article notes that to date some premises have been available for use at less than a commercial rent, and that the PCT's were prepared to cross subsidise in some cases. Since the new company is expected to own significant assets including 30% of GP surgeries this is not trivial. Once again we see the odd spectacle of one part of the NHS paying another part .....oh wait, we don't.

The company is a true private company and one cannot help but wonder why that is. At launch it is a private company limited by shares and the article of association are available here:

http://www.property.nhs.uk/wp-content/uplo...te-Articles.pdf

Only one share has been issued and it is owned by the Secretary of State for Health. One effect of this, it seems to me, is that once the property is owned by that company any action taken in relation to it is not longer subject to democratic oversight of any kind. Certainly the Secretary of State controls it: but that is not quite the same as there being parliamentary or local accountability as is usual in public service. Which is what piqued my curiosity. So I read the articles of association and a very interesting document it is.

For example, any idea that conflict of interest will be effectively addressed is dispelled. The articles state that a director of the company can benefit from any arrangement or transaction of the company in which he has an interest, subject to general company law and to disclosure to the other directors of that interest. In particular, article 19.1.2 and 19.1.3 say that a director, notwithstanding his office


Article 19.1.6 makes plain that that director can even vote on the issue he is directly concerned with, again subject to general company law and to certain provisions covered in later sections

That is quite comprehensive and it seems to say that this property owning company can, for example, sell anything it likes at any price and the buyer can be a company which employs or is owned by one or more of the directors. And he can vote on whether they should do that

I might be wrong: but that interpretation seems to be reinforced by Article 20, which says




The Articles also state that anybody who is willing can be a director if he is permitted by law to do so: so I volunteer! Except that in practice the only people who can make me a director are the directors: and I am not one of their pals

It is a pity, cos this is a great job: you set your own wages, if you are a director.It says so at Article 32


Also that remuneration can take any form and they can claim expenses too: though the latter is limited to what is "reasonable", so that is something of a constraint: however small

Does that look like the sort of company we should be handing our public assets to? It doesn't to me. Especially since it is also in the Articles that the Company can issue new shares of any type whenever it likes: so they can effectively sell the whole shebang if and when they want to

It is entirely possible that this is the standard for articles of association for this kind of company: I wouldn't know. If it is it is quite shocking anyway. But this is not an ordinary company: it owns a great part of our NHS. And it seems to me to pave the way for privatisation proper. Again.

http://healthland.time.com/2013/02/20/bitt...are-killing-us/

Vninect sent me this article, which is about the costs of private medical care in the US. It is a very long article and it is frankly stomach turning. But it is well written and well researched and it puts the mechanisms in a very human context.

It is not inevitable that our NHS will follow the American model if and when it is privatised: but it is very likely given the deceit which the government has clearly displayed in the difference between the assurances it gave to get the "reforms" through with libdem support and in the lords: and the actual content of the bill and the regulations it has tabled.

I am not convinced either by arguments that we can have a "european model" which combines the best of both worlds: because so far as I can see at least some of the "european models" are also under attack from the same flank: and will also end up like the American system. That is not so certain, but what is certain is that our governments (of all stripes) are in thrall to all things American and this is not likely to be any different for that reason

For me this is the shape of things to come and it is very well worth reading in its entirety. It is probably also useful for americans to read, because it is rare to see such information set out in one accessible piece

You really couldn't make this up! We are told that we can't afford the NHS, on this, its 65th birthday.

www.guardian.co.uk/society/2013/jul...2020?CMP=twt_fd

Atos, the private company which has won contracts for assessing whether people are fit for work and which is manifestly incompetent to do that has a trick which was reported at the end of last year

They won the contracts for this work for Scotland and parts of northern England. It is now reported that they are to subcontract that work in North Lanarkshire....to the NHS.

www.guardian.co.uk/business/2012/oc...cal-assessments

It is almost funny....but it isn't. And once again we find that there is a great deal of obfuscation and misreporting even within the constraints of this already absurd situation.

According to the article the work is to be subcontracted to "NHS Lanarkshire's occupational health arm, Salus". What you will not be aware of is that Salus is not a part of the NHS at all, despite having the NHS logo on its front page. Its home page says:


Whatever that might mean.

They have a mission statement too


I am not wiser: I never am when I read that kind of froth.

What seems very clear is that this is not a part of the NHS as I understand it. It is a business, and it imagines the NHS is a business too, if its "mission" to support the "corporate objectives" of NHS Lanarkshire means anything at all.

Until 2011 it was headed by Professor Ewan B MacDonald, who is an expert in occupational health: he has worked in the field for a very long time and he has several honorary and substantive positions related to this work. It is unfortunate that he is full of bullshit, as this paper shows:

http://employability.clients2.civiccomputi...licy-makers.pdf

Note in particular his acceptance of the "broad political consensus" about the failings of the benefits system and the assumption about the characteristics of those who are out of work. It is especially striking that he subscribes to the " bio-psychosocial model of health." That is woo, as it is applied in practice, whatever its philosophical status may be.

The paper is drivel from beginning to end. But it is politically popular drivel

See discussion of that model already linked in another thread here;

https://thosebigwords.forumcommunity.net/?t...145&p=364213577

So we have to pay ATOS a profit so they can sub back to a social enterprise based on nonsense and pretending to be part of the NHS; and we can't afford the NHS run properly as a public service? See also PFI arrangements discussed in other threads. They are surely quite creative in making sure this essential service is handed over to their profit making pals. And that is all this is about, IMO. The first link includes this telling statement



Edited by FionaK - 5/7/2013, 20:34

http://www.theguardian.com/society/2014/ja...y?commentpage=7

Apparently our medical information is to be gathered in to one data base and then sold to anyone who can pretend they have a good reason for wanting it. The privatisation of our health service is by now well advanced and so that is given as a reason for making no distinction when selling this stuff between profit making institutions and public service bodies. It seems that this is being touted as a benefit to the NHS in terms of improved health research, and so it is good for us all. That is quite clearly bollocks. Even if it were true that there would be better data and research (and I have no reason at all to believe that) we can't apparently afford new treatments etc cos we are broke. That is in another part of the forest, of course. So any finding of any practical use must necessarily lead to a cut in costs: if the research suggests we spend more it will be a non starter.

Nor is the data to be anonymous. Can you think of any reason why statistical trends need to be based on information which is identifiable as belonging to an individual? I can. Private health care as practised in the US denies insurance to those with pre-existing conditions: and it would be very handy to have a central data base so the companies can find that out easily and for little cost.

Later in the article there is another worrying element. It says


So the whole population will be united in their new role as lab rats. Nice.

The linked article is typical of the useless stuff which passes for journalism these days. It mentions you can opt out but it doesn't say how

This does

http://medconfidential.org/how-to-opt-out/