“The NHS will be shown no mercy" says Cameron health adviser

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Tamasin Cave

9 May 2011

'GPs won't have to turn to the private sector' to help with commissioning health services, said Andrew Lansley today in the Commons, trying to fend off accusations that the Tories are privatising the NHS with their reforms.

?The House knows my commitment to the NHS," he continued. ?I haven?t spent seven and a half years as shadow secretary and secretary of state to see the NHS undermined, or fragmented or privatised... That was never my intention. It is not my intention.?

Privatisation was ?never his intention?? Someone should tell that to Mark Britnell, a former high-flyer in the Department of Health, now global head of health at KPMG, and recent appointee to David Cameron?s ?kitchen cabinet? of health experts to advise on health service reform.

Just six months ago, Britnell told a conference of private healthcare executives1: ?In future, the NHS will be a state insurance provider not a state deliverer.?

In case there was any ambiguity in that, Britnell explained to conference delegates (in a session called 'Reform Revolution'):

?The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years."

How could Britnell, who made it into the top ten of the ?100 most influential people in health ? last year - as well as into No.10 - have got Lansley so wrong?

(Ref 1: Mark Britnell was speaking at a conference in October 2010 organised by private equity firm, Apax Partners. Read the conference brochure, and his quote, here.

www.spinwatch.org/blogs-mainmenu-29/310-tamasin-cave/5435-the-nhs-will-be-shown-no-mercyq-says-cameron-health-adviser

I also read that in the Observer, blows apart any Tory bullshit about "The NHS is safe in our hands" far from it, it seems.

Scary, I'm not against reform of the NHS if it is done in a sensible and considered manner, for example looking at the systems which work most efficiently/deliver the best results in other countries.

But no, just ill thought out profiteering, what else can we expect, as someone more witty than me said "Socialism for the rich, Capitalism for the poor".

I am actually really worried about the future, I do not see any rays of light on the horizon, I can't see how anything is going to get better for a fairly long time.

The only way things are going to get better, Viennetta, is if people turn out into the streets in the hundreds of thousands or millions, and demand that things change.

Iraq war?, didn't a million turn out then?

I don't think peaceful protest works in this country. It could work, in inventive ways, but too many people are brainwashed/narrow minded, they believe the whole Labour/Tory bullshit, immigration, dole scroungers shite.

Vienetta-

Peaceful protest doesn't work in this country - at least not marching from A to B. Yes, the Iraq war taught us that much.

What we need are mass strikes and direct action. Unfortunately our democracy has failed. The only thing which works are methods which put throw a spanner in the system.

Oh, that will be the KPMG private sector firm who already have a contract for GP commissioning in London?

Under this Mark Britnell?

Terrifying.

I think the histrionics here are misplaced. There is already heavy involvement of privated companies in the NHS and the new bill continues that involvement, making it possible for organisations to tender for certain contracts. I recently underwent tests at a private clinic, organised & paid for via my NHS GP practice - an excellent service costing me nothing as an NHS patient. In that instance the NHS was the insurer and the private clinic was the service provider. It is not new.

The contracting out of small parcels of work to individual private clinics can be reversed at the stroke of a pen. Literally.

Restructuring the NHS so that the administrative, financial and planning organisations (Health Authorities) no longer exist is fundamental and extremely difficult to reverse.

It's important to get it right so that it doesn't have to be reversed. It's important to anticipate weak points like 'cherry picking' and frame the rules accordingly. And it's very important not to be sentimental just because it's healthcare. Which is why I'm quite pleased if there are people experienced in the business of health insurance included in the conversation. There was talk at one stage of the former Tesco boss Sir Terry Leahy taking on the NHS because he's got a good track record of running an organisation that relies heavily on procurement and distribution... two things at the heart of the NHS.

But why on earth would you want to?

Other than to "create opportunities for private enterprise"? That's the motivation here, not a better NHS for the people.

By the way, I'm in no sense saying the NHS should be a static organisation. It hasn't been since its inception; it shouldn't be now. A state of continuous improvement, of adaptation to new challenges and new capabilities, is essential.

But fundamental restructuring is traumatic, experimental and expensive, and should only happen if there's a) a jolly good reason for it and b) a very very high chance it will successfully serve the prime objectives of the organisation.

Reorganising in order to create opportunities for private enterprise hits none of those buttons.

Agreed TIANC. I just love how they're scrapping the regional cancer networks and replacing them with nothing at all. Doesn't sound particularly well thought out to me.

They have no mandate to experiment with people's lives in this way.

I think creating opportunities for private enterprise is a sound way to ensure future investment. Something the NHS (in common with most nationalised organisations) doesn't really have access to within the budget constraints. There seems to be the idea that all private companies do is take profits and hand them straight over to shareholders. Maybe some do but it's a very short-term strategy and safeguards could be written into contracts to discourage them. Successful forward-thinking private companies borrow money and reinvest profits in long-term research and new product development, meaning that they grow their business and the health services they supply benefit from the latest drugs and equipment. One private enterprise I know developed anti-bacterial dressings that need changing less often than conventional dressings, saving costs, man hours and reduce patient discomfort at the same time. The NHS is not in a position to do this kind of research.

Do you work in healthcare provision Cogito? 'Cos it seems that those who have spent their lives saving ours fundamentally disagree with you.

I don't understand your point about research. Research is already outside of the NHS and operates just fine, other than charging the taxpayer an arm and a leg for every new drug.

I was thinking the other day about 'privatised' industries and it got me wondering. The NHS received a 71% approval rating from it's users. I doubt any of the previously nationalised industries would rate anywhere near that highly.

The other thing that you constantly fail to mention Cogito is the cost of privatisation.

We all know the american system is shit but costs a fortune.

The French system is apparently the best in the world, but costs considerably more than ours.

As far as I know, Lansley and co have mentioned nothing about us spending more on healthcare in these reforms, perhaps I'm wrong?

Can anyone give an example, anywhere in the world, where they have a better healthcare system, accessible to all regardless of wealth, that costs less than the NHS?

I don't think what we're talking to amounts to privatisation, however much the Labour Party keep repeating it in the hope that we buy the lie. Privatisation US-style would be a system where we're required to pay for an insurance policy and we get treatment based on how much or how little that insurance policy covers with some minor emergency provision for the uninsured. That's not what's on the table.

So if the problem isn't really the involvement of private companies, because it happens already. And if we accept that the principle of 'free healthcare at the point of need' remains central then your real objection seems to be 'cost'. If regional cancer networks are being scrapped then your beef is not with the reforms which haven't happened yet, or even with the basic funding which has stayed steady, but probably with the PCTs responsible for apportioning the funds available with different priorities. Yes, it would have been better if the previous government had reformed the NHS when times were good and money was plentiful and yes, if money is tight it makes organisational change more challenging... but I don't think waiting for the economy to pick up is a reason to do nothing.

As for the healthcare professionals that don't like the plans, I am sure they have legitimate concerns but hope their objections are constructive rather than political or selfish.

No, it is directly due to the reforms that the regional cancer networks are being scrapped. Lansley is stopping funding next year, even though, under his proposals, the new consortia won't start until 2013. Hence my argument that, if it's taken 7 years to come up with this, he ought to be sacked for a major oversight. What else is in the detail that we've yet to pick up on?

I object to the constant assertion that those against these proposals are in favour of 'doing nothing'. Everyone who has attacked these proposals accepts we need change and efficiency, that doesn't mean that we have to welcome the tories plans with open arms. To (mis)quote Nick Clegg, no bill is better than a bad bill and this is a bad bill. Those working in the sector are almost universal in that opinion.

The NHS improved massively under Labour, in all sorts of areas. It's not perfect, but it certainly doesn't need the kind of reform Lansley is talking about.

I'm fascinated by the repeated denial that this is privatisation. If we're not talking about privatisation, can someone please explain why KPMG are absolutely creaming their knickers over these proposals? Why is it the private healthcare sector are the only people in the field who actually support the plans?

Your selfish remark directed at Drs and nurses did make me snigger. Like private industry is known for it's philanthropy!

No, for me the problem really is the scale of involvement of private companies.

An analogy.

We bought our house and pay private companies to occasional services (plumber, electrician, etc). This is an incredibly different experience from being a tenant paying a landlord for all aspects of housing provision.

It's different because our No 1 aim is to make the house serve us the way we want it to - everything from choosing the wallpaper to investing in energy-saving devices to lower running costs.

A landlord's No 1 aim is to make money. IME they are uninterested in lowering running costs. Everything is immensely cumbersome because it has to feed through their reluctance to pay for basic repairs, even wrt serious safety issues. Their only interest in providing a service is to keep it just not so bad that I'll undergo the cost and hassle of actually moving out.

BTW, the "cost of moving out" bit is a major part of the strategy for professional services firms like KPMG. I've mentioned Client Capture elsewhere, where the firm digs itself in so deep it becomes impossible to extirpate. An organisation which pulls the plug on the firm running most or all of its computer systems, payroll, customer records, etc, is looking at 6 months of paralysis while it commissions and ports its admin/knowledge/systems across to another firm. It's enough to kill some commercial setups (according to a friend who is an IT/professional services consultant).

The same consultant, btw, described his own industry as "like heroin dealers". The first hit's cheap/free, anything to get a foot in the door. Nothing's too much trouble. And there's always a little bit more we could do if I bring more -and more - of my colleagues in ("pull-through" as it's called).

Initial contract looks like good value, with price and services set in stone for 10 years, say. Except, as I mentioned above, organisations like the NHS need to constantly change.

A change to the contract? Certainly sir. That'll be £££££. "Most things are possible, but the answer to every question is more money," as my consultant friend put it.

Sorry wubbly, X-posted. That "No" was echoing yours, not contradicting it!

Can't agree more with you ThisIsANiceCage....
In many ways, the difficulty is that the previous changes to the NHS - creation of the 'internal market' (Thatcher and John Major) and the introduction of private providers paid for by the NHS (Blair) - almost make the next steps (as proposed by Cameron, Lansley et al) inevitable. What Lansley etc are working towards is an NHS 'kitemark' type system - with all services provided by private providers (including admin etc) and merely given the NHS stamp of approval. Where we currently have private providers performing procedures for the NHS you will find that those private providers cherry pick the easiest least complicated cases. There's no room for the voluntary sector in this brave new NHS - it will be the big global providers that carve up contracts. Costs to the public purse will escalate. Employee terms and conditions will be reduced - there will be hospitals going bust; services failing; certain local areas will lose out.
I am heartily glad to be living in Scotland where no such changes are being proposed (the Scottish Government control the NHS here)... I am just anxious for my fellow citizens 'over the border' and distressed that what was fought for by our grandparents/parents and what is proven to give exceptional value for money will be dismantled by millionaires with their eyes on pleasing corporate friends...

ThisIsANiceCage -

Using the analogy of the housing market - I would suggest that the private home owner is more akin to an 'extreme free market' ideal where an individual is made responsible for their own health care.

So a person would be their own 'fund holder' allocated their own health budget to spend as they wish. For the same reason a rational person invests in their own home: they would be incentivised to take care of themselves. Taking exercise, a good diet and choosing cheap preventive medicine to avoid expensive care later, just as a home owner invests in basic maintenance and checks roof tiles & guttering.

Sadly there are several flaws in this scenario - not least that many people aren't very rational.

So which healthcare model are we emulating here then Jack, that we can improve services, cut costs and have private industry making mega bucks all at the same time?

Sounds like a crock of shit to me.

I expect it does Wubbly.

Maybe there are some people on here interested in why politicians look to the 'free market' to improve our public services (even if they then decide the 'central planning' model is better, overall).

Both approaches have their costs and risks. But in order to criticise it helps to understand both models.