Wiltshire CCG seeking legal advice over ‘Care UK’ contract for Wiltshire’s new NHS 111 phone service

I have just read another interesting article from Toby Millet at ‘Marlborough News Online’ (read it here). (See also a BBC report here).

It seems that the out sourcing of the NHS 111 phone service in Wiltshire is not going too well. The launch is being delayed and the new Wiltshire Clinical Commissioning Group (CCG) is taking legal advice on the contract.

It appears that during tests on ‘out of hours calls’ during evenings and at weekends far too many calls were not answered within the required time limit and ambulances were called out for people who definitely did not need them – apparently in one case to someone with a sore throat.

The article gives full details of the problems but I would like to take a closer look at private health care provider, ‘Care UK’, who bought out the original winner of the 111 phone contract (another health care company called Harmoni).

‘Care UK’ is a British private health care provider well placed to take advantage of the outsourcing of the NHS under the new Health Care Bill. Its chairman, John Nash[6], made a donation[1][2] of £21,000 to the private office of Andrew Lansley when he was opposition spokes person for Health and who later became Secretary of State for Health. According to a Guardian report ‘Care UK’ has a reduced tax bill[3] by taking out loans through the Channel Islands and coming to special agreements with HMRC.

If the NHS were being outsourced, for the benefit of patients, to small or medium sized organisations or enterprises, embedded in the local community and with a stake in maintaining the principles of the NHS this might not be so worrying, but Care UK is one of a number of companies (Spire Healthcare, Care UK, Circle Health, Ramsay Health Care, General Healthcare, Virgin Care) that clearly see the NHS as a cash cow. These companies along with the likes of KPMG, McKinsey, Price Waterhouse[4] are positioned to drive through changes to our health care that will suit them and their share holders with little protection for the interests of the users. The “legalised corruption”[5] that is the “revolving door” where advisors and decision makers can move from these private companies into government and then back again with resulting huge conflicts of interest will mean that there will be little to prevent our health service becoming yet another conduit for transferring tax payers cash to multimillionaires and share holders.

[1]  “Andrew Lansley embroiled in ‘cash for influence’ row after accepting £21,000 donation from Care UK chairman John Nash”Mail Online. 15 January 2010. Retrieved 6 April 2011.

[2] “Andrew Lansley bankrolled by private healthcare provider”The Daily Telegraph. 14 January 2010. Retrieved 6 April 2011.

[3] “Firms poised to take advantage of NHS shake-up ‘avoid tax on their profits'”The Guardian. 17 March 2012. Retrieved 21 January 2013.

[4] NHS has been handed over to McKinsey, KPMG, Price Waterhouse.  Reason and Reality, 15th Jan 2013

[5] The NHS is threatened by legalised corruption  Reason and Reality, 4th march 2012

[6] The price tag for becoming an unelected government minister – seems like £300,000. “In 2013 it was announced that John Nash would become a schools minister.  He became a life peer as Baron Nash, of Ewelme in the County of Oxfordshire on 21 January 2013.  He and his wife have donated almost £300,000 to the Conservative party and according to the Telegraph, the appointment raises concern about a potential conflict of interest and appointment of donors though the Department for Education said he would not make business decisions whilst in office”. Source: http://en.wikipedia.org/wiki/John_Nash,_Baron_Nash  Wikipedia

UPDATENHS 111 implodes as GPC withdraws support for urgent care hotline  By Jaimie Kaffash, PULSE, 22 March 2013

Wiltshire’s new NHS111 telephone service delayed for a month  Tony Millett Marlborough News Online, 22 March 2013.

Patients are being put at risk due to catastrophic failings of the new NHS 111 non-emergency phone line, doctors have warned. Daily Telegraph, 28 Mar 2013.

More UPDATE: Delays, abandoned calls and an 11-hour wait for a call-back: Leaked document reveals the extent of NHS 111 performance issues  Pulse 12th April 2013

Salisbury NHS Watch – Update

Not much to report, but the following updates may be of interest:

Virgin Care to take over children’s health services in Devon: As reported here previously, we already have fifteen GP surgeries in Wiltshire  partnered to Richard Branson’s “Virgin Care” and a GP from one of those surgeries appointed as Chairman of the new Wiltshire Clinical Commissioning Group.  So it may be of interest that Virgin Care have been named preferred bidder in a £130m deal that will see the privatisation of children’s health services in Devon.  See here for details.  It seems like Serco and Virgin have privatisation of the NHS in the South pretty well sown up.

It is important to point out that concern about companies like Serco, A4E, G4S, and Virgin Care taking over the running of our public services is not part of some left wing ideological agenda.  If the NHS were out sourcing parts of its work to small or medium sized, home grown businesses or organisations that are part of our community and have a track record of providing a quality service for a responsible and reasonable rate of remuneration then there would be no need for concern. But, in reality our services are being taken over by large national and international corporations that do not have a promising track record – they are essentially in the business of making large profits by employing members of our own community (Cameron’s hard working families) on lower pay with poorer employment conditions while providing the minimum service they can get away with.  Remember that these organisations will be signed up on confidential contracts, protected by commercial confidentiality and will not be open to Freedom of Information requests – they will be pretty much unaccountable and if things go wrong it will be the remnants of the NHS plus tax payers money that will be left with the problem. (Breast implant scandal: 3,500 private clinic patients referred to NHS)

Senior staff could be moved out of the ‘Agenda for Change’ pay framework under proposals devised by NHS Employers. Unfortunately this article is behind a pay wall but I suspect that the article will confirm what we already know – that regional pay for NHS staff (i.e. lower pay for everyone except for those who work in wealthy high pay areas) will not apply to the senior managers.  Sounds like a good way to encourage loyalty and enthusiasm from the staff or is it just a way to smooth the transition to the lower pay of Serco and Virgin Care?

Salisbury NHS Watch

First Chair of new Wiltshire Clinical Commissioning Group is a senior GP from a Virgin Care ‘Partner’ Surgery

The first chair of the new Wiltshire Clinical Commissioning Group (CCG) is a medical director from the old NHS PCT and a senior GP from a Virgin Care ‘Partner’ Surgery

Trowbridge GP Stephen Rowlands has been a senior partner at the Bradford Road surgery for 27 years and served as the medical director of Wiltshire’s Primary Care Trust for the past year.  “I am very keen to support the transition from PCT to clinical commissioning as smoothly as possible,” the doctor said. (‘This is Bath’, Monday 7th May 2012)

This looks reassuring – hopefully a GP led CCG will avoid the worst excesses of the governments top down NHS “reforms” to be seen elsewhere in the country.

But just one word of caution, Dr Rowland’s Bradford Road Surgery, is  a Virgin Care ‘Partner’. When Richard Branson took over ‘Assura‘ he inevitably gained access to hundreds of GPs who were joining CCGs across the country as part of the government’s reform programme.  There are already fifteen surgeries in Wiltshire that are Virgin Care ‘Partners’ so there is a possibility that there are more Virgin Care ‘Partners’ in the Wiltshire CCG.  Is this a good thing?? What does being a Virgin Care ‘Partner’ mean?? Is there a potential for a conflict of interest?? Who knows??  However, it does look like Virgin Care have got off to a good start in Wiltshire.

‘This is Bath’, Monday 7th May 2012

‘Virgin Care’ partners in Wiltshire

Conflict of interest fears in NHS shakeup plans

Is Virgin Care set to take control of NHS services in Andy Burnham’s own constituency?

Salisbury NHS Watch: News

In case you didn’t know, Clinical Commissioning Groups (CCGs) are taking over from the old PCTs (Primary Care Trusts). Our local CCG is the “Sarum NHS Alliance”.  However it seems that the Sarum NHS Alliance is merging with other Wiltshire CCGs to form one county wide CCG.

The news report linked below indicates that the merger is due to the work loads involved and to the need to avoid a “post code lottery”.  This last point is interesting because it is exactly what the previous , chief executive of Salisbury NHS Foundation Trust, Matthew Kershaw, admitted the reforms could lead to.

In an article from last year (see link below). Kershaw discussed the risk that neighbouring CCGs could offer different levels of service, refuse to provide certain treatments or allow longer waiting lists for more expensive treatments.  Conversely he warned of the possibility of CCGs merging together to provide a more uniform service in an area but that this would undermine and prevent the competition that the Government is aiming for.  Interesting issues – see link below for more details.

The new CCG will operate in shadow form and work closely with NHS Wiltshire this year before it takes over the reins in April 2013.

So What are Clinical Commissioning Groups?

Clinical Commissioning Groups are groups of GPs that will, from April 2013, be responsible for designing local health services In England. They will do this by commissioning or buying health and care services. (There is also the NHSCB and the four SHAs but more of those in a future post).  Apparently, aboard of 5 GPs and 2 non GPs was formed last April to run a Clinical Commissioning Group based around Salisbury Hospital, called Sarum NHS Alliance. It consists of 27 practices and approximately 150,000 patients.

This all sounds great – who better to control our health service than dedicated well known and trusted local GPs.  Unfortunately it might not turn out like that in the long run – the kind of GP who is dedicate to his/her patients and the community is unlikely to enjoy the management and committee work of a CCG.  Evidence is already appearing which indicates that CCGs are likely to end up consisting disproportionately of GPs who own stakes in non-NHS providers and could use their decision-making power to simply commission their own companies to offer services.  Here is an example. I stress that I have no reason to believe that any of this is true for our local CCGs and am sure that those that have got involved have done so for the best of reasons – to ensure that they can adapt and guide  the reforms for the benefit of their local communities. However, we all need to be vigilant to ensure that we spot the conflicts of interest that could develop in the long term.

A Salisbury GP has resigned as chair of Sarum NHS Alliance commissioning group. The Doctor, who was previously heavily involved in practice-based commissioning, said ‘The CCG role was becoming too much. I had to make a choice and in the end my priority was my patients’:  http://www.pulsetoday.co.uk/newsarticle-content/-/article_display_list/13150087/gps-quit-ccg-roles-as-commissioning-enthusiasts-lose-heart

NHS reforms ‘risk’ creating a postcode lottery: http://www.onmedica.com/viewsArticle.aspx?id=ab2354d4-b1b2-4b85-8cbf-c7f3bf68ea98

Three Wiltshire CCGs (including Sarum NHS Alliance) to merge:  http://www.gazetteandherald.co.uk/news/9628367.Three_Wiltshire_CCGs_to_merge/

Half of GPs on clinical commissioning groups have financial links with private providers:   http://www.pulsetoday.co.uk/newsarticle-content/-/article_display_list/13150087/gps-quit-ccg-roles-as-commissioning-enthusiasts-lose-heart