In the final feature of this series of three, we examine what the coalition’s plans - embodied in Equality and Excellence: Liberating the NHS - mean for the health service and who are the people and companies behind them.
Who’s taking over the NHS?
The earlier attempt to encourage GPs to take on commissioning roles through ‘practice-based commissioning’ has been widely acknowledged to be a failure, mainly because most doctors prefer to focus on patients. This allows the 14 major US and UK health corporations, consultancy firms and insurers that currently make up the ‘Framework for Procuring External Support for Commissioning’ (FESC) to step in and play an increasingly central role in allocating the bulk of NHS finances.
The FESC functions include population risk assessment, procurement and performance management, and data harvesting - but it is in service redesign that their impact will be most felt.
So who are these companies?
Aetna (US), Axa PPP (UK), BUPA (UK), CHKS (UK), Dr Foster (UK), Health DialogServices Corporation (US), Humana (US), KPMG LLP (US), McKesson (US), McKinsey (US), Navigant Consulting (US), Tribal (UK), UnitedHealth Europe (US), and WG Consulting (UK).
How these companies profit from the ‘revolving door’ in senior health personnel
At KPMG, the former Department of Health head of commissioning Mark Britnell now leads the company’s European Health Division. Britnell also has close ties with Dr Foster, having previously been one of its non-executive directors.
UnitedHealth now employs Blair’s former top health adviser Simon Stevens. It also has the former head of the Department of Health’s commercial directorate, Channing Wheeler, who, alongside Britnell, set up the FESC before being recalled to the US to face the securities and exchange commission on charges of illegally backdating share options at the time of 9/11.
BUPA has the services of former health secretary Patricia Hewitt in her role as advisor to the private equity company Cinven, which recently bought out BUPA’s entire hospital portfolio.
Tribal’s director of its healthcare division, Matthew Swindells, was chief information officer of the Department of Health and a special adviser to Patricia Hewitt. The company can also call upon Phyllis Shelton, who jumped ship from the Department of Health, where she worked as the lead for measurement on the integrated care organisation programme. Prior to this, she was the founder and managing director of the UK arm of HealthDialogue.
McKesson’s UK chairman is Lord Carter. As chairman of the NHS’s competition panel, he is well situated to ensure that decisions on mergers and procurement - including those on commissioning - will follow the privatisation route.
McKinsey has the Department of Health’s former head of strategy, Penny Dash. Some idea of Dash’s influence on the commissioning front can be seen in the fact that, in her guise as vice-chair of the King’s Fund, she led a recent briefing for PCTs to cut back on commissioning of what she considered to be ‘low-value’ medical procedures. Sure enough, in June this year, NHS North London proposed cutting back on ‘low priority treatments’.
What will happen to the NHS?
It’s simple - hospitals that ‘fail’ will be left to go bankrupt and close, or be handed over to be run by private companies.
GP consortia will run the service, in theory. But doctors don’t have the time or skills to do the large amount of administration required and these are the contracts the private health companies are after.
There will be £20 billion of cuts. On top of that, the more complex the market system gets, the more money will be spent on administration instead of medical care.
The consortia will end up trying to reduce costs by denying certain treatments. And if they are to make money, they will do it by employing fewer, cheaper staff.
In place of a public service we will have a profit-driven healthcare market.
Read the first and second articles in this three-part series that examines the aims behind current NHS reform.
This article first appeared in Red Pepper.
Tags: Health policy, Privatisation
