Accountability in the NHS


Talk at the Northern Labour Party Regional Conference Socialist Health Association Fringe Meeting 24/3/14

Thank you all for coming today. It’s a sign of how much we value the NHS that you have taken time to come along today. We are here today because of the concern that we share over the current state and the direction of the NHS.

Illness is neither an indulgence nor an offence Nye Bevan
Illness is neither an indulgence nor an offence Nye Bevan

I believe that the NHS is becoming a less democratic organisation and is becoming less and less accountable to the wants and needs of the public.

In recent years the number of public services being outsourced has accelerated. One in three pounds spent by the current Government now goes into the hands of private providers. Owing to the Government’s policy of opening up public services to the private and voluntary sectors, billions of pounds of NHS contracts are now being made available to the private sector.

Since the implementation of the Health and Social Care Act 2012, 7 in 10 NHS contracts have been awarded to private healthcare companies. More and more NHS contracts are being handed over to private healthcare companies, many with pasts checkered with fraud, failure and criminality. Unfortunately, while more and more taxpayer money is being handed to the private sector, the public have their hands tied when trying to obtain information about those who are providing their public services. Currently it is not possible to make private providers comply with freedom of information requests.

Private health care companies should not be permitted to hide behind a cloak of commercial confidentiality. Billions of pounds of taxpayers’ money is being awarded to private sector companies under barely transparent contracts. Meanwhile, private companies are free to benefit by gaining detailed knowledge of public sector bodies through their use and submission of FOI requests. The same information is then used by the private sector to undercut or outbid the very same public sector bodies when contracts are tendered or put up for renewal.

This is something I have been campaigning against in parliament. I believe that, as the NHS constitution says, the NHS belongs to the people, not to predatory private healthcare providers and that it should remain in public hands and should stay accountable to the public. This is why I have been campaigning on the back of my 10 Minute Rule Bill – Freedom of Information (Private Healthcare Companies) The Bill would extend the provisions of the 2000 Act to all bodies bidding for NHS contracts and ensure that freedom of information legislation is applied equally in the implementation of any public contract.

Labour has pledged to extend the current FOI legislation to all private provides provide public services, but I don’t believe the NHS can afford to wait even another year. The cloak of commercial confidentiality that private providers are afforded in our NHS is damaging the organization.

The danger for our NHS is that we are inviting convicted fraudsters into our health system.

HCA, which is the world’s biggest private health care company, won the contract to provide cancer treatment for NHS brain tumour patients, stopping patients receiving world-class treatment at London’s University College hospital. The Competition Commission has already caught HCA overcharging private patients in the United Kingdom. In the United States, HCA has had to pay fines and costs in excess of $2 billion for systematically defrauding federal health care programmes. The public are right to be concerned about these providers coming into the NHS. If that is to happen, it is essential that their operations and their contracts with the NHS should be open, transparent and subject to public scrutiny.

Last week during PMQ’s I asked David Cameron about East Coast Ambulance Service, a private ambulance operator that won a £600,000 NHS contract despite one of its managers previously running companies owing the service thousands of pounds. Their Operations Director had previously been involved with three private ambulance firms, all of which went bust leaving millions of pounds of debts. Despite the director’s track record of failure he was awarded another large NHS contract. East Coast Ambulance Service folded in 2011, owing thousands in unpaid wages to staff. The North East Ambulance Trust said they would not have awarded the contract had they known the history.

There is a democratic deficit surrounding how the public pound is being spent and the public are prevented from obtaining important information. We are being denied information that we ought to have access too, and it is damaging our NHS.

On Tuesday this week the Care Bill passed through parliament. I was involved in the pre-legislative scrutiny of the Bill as well as the Bill’s committee stage and have been intimately involved with the Bill’s journey through parliament.

By and large, many of the reforms contained within the Care Bill were sensible. They sought to bring together and reform the disparate pieces of legislation that regulate social care in England. However, a piece of legislation concerning health and social care under this Tory Government would be incomplete without a few appendages that sought to make our NHS less transparent and less accountable to the British public.

Clause 119, or, as it’s aptly referred to in some circles, the “hospital closure clause”, is a terrible affront to democracy and accountability in our NHS. Far from delivering a de-centralised service that puts power in the hands of clinicians, which was the promise of this Government’s NHS reforms. Jeremy Hunt has wrestled power away from GPs and local communities to further re-configure the NHS for purely financial reasons. The Trust Special Administrator regime has been distorted. It was never intended as a backdoor way to make unpopular re-configurations, but that is what it has become. Clause 119 was designed to allow the Secretary of State to do what he failed to do in Lewisham—to close down thriving and financially sustainable hospitals on a whim, without full and proper consultation.

Sometimes there is a strong argument to close and reconfigure services in a local health economy. In such cases there needs to be a sustained effort to persuade people about the benefits of a reconfiguration, and the arguments need to be clinically led. It should not be done at the whim of a Secretary of State on the basis of a financial driver. Genuine public engagement is required, not unaccountable decisions decreed from Richmond House by Whitehall bureaucrats. The Secretary of State’s increased power and Monitor’s expanding role directly contradict earlier Government promises that local commissioners would no longer be subject to central diktat, and represent a reversal of the vision of a decentralised health service that was presented during the passage of the Health and Social Care Act 2012.

We warned that rhetoric about putting GPs in charge was a smokescreen and the Act was a Trojan horse for competition and privatisation. Can anyone now seriously dispute that?

Last year, for the first time ever, the Competition Commission intervened in the NHS to block collaboration between two hospitals looking to improve services. Competition lawyers, not GPs are becoming the decision makers in our NHS. The outgoing NHS Chief Executive, Sir David Nicholson, has complained that the NHS is now “bogged down in a morass of competition law”. Since April, CCGs have spent £5 million on external advice as services are forced out to tender. This competition regime is a barrier to the service changes that the NHS needs survive in the 21st century. It is sheer madness to say to hospitals that they can’t collaborate or work with GPs and social care to improve care for older people because it’s “anti-competitive”. If we are to relieve the intense pressure on A&E, and rise to the financial challenge, it is precisely this kind of collaboration that the NHS needs.

The NHS is becoming less transparent and less accountable to the public. The service is being stolen from us and sold without our permission, and this in turn is preventing the changes that need to be made for the NHS to rise to the challenges that funding cuts and changing demographics bring.

It is a crucial moment for the NHS. Letting it go down the road of marketisation and privatisation and removing transparency and democracy from the service is not sustainable.

We can see the direction the NHS taking under this Government and the public have a choice. A public, integrated NHS, transparent and accountable to the public under Labour or a health market accountable to nobody and cloaked in commercial confidentiality under David Cameron. For the future of the NHS it is crucial that we win.