Thursday, 21 March 2013

Unhealthy influence: The rise of the NHS Partners Network


The transformation of a small private healthcare trade association into a powerful and influential lobby group provides a clear indication of the direction the NHS has taken.  Today the NHS Partners Network has some of the most powerful private healthcare companies as members and is a trustee on the NHS Confederation board. Social Investigations journalist Andrew Robertson examines the development of one of the best-connected and most persuasive privatisation cheerleaders.

The early days
The NHS Partners Network (NHSPN) came into existence in 2005 to provide a voice for private health companies involved in Labour’s Independent Sector Treatment programme (ISTC) which opened up non-emergency treatments to the private sector.

This programme provided a foothold for private companies in the NHS and the NHSPN quickly started playing a protective role for its membership. Its 2007 annual report boasted of using its influence to downplay the significance of a leaked document from the Health Care Commission that raised questions over quality standards within the ISTCs.

’Blending’ with the NHS

In the same year it was voted on to the NHS Confederation, the main representative for organisations offering NHS services, a move that gave it increased legitimacy. Now, as part of the agreement for all networks in the confederation, the NHSPN is represented at trustee level, currently through the Chief Executive of Care UK, Mike Parish.  In addition to this, David Worskett the director of the NHSPN, is also a director within the Confederation. 
The influence of the network has now increased well beyond its original remit.. As part of its membership package, the NHSPN promises ”regular dialogue with ministers and senior level decision makers within the main political parties”, and ”good contacts with the media to promote the role of the independent sector within the NHS”.

You can judge a club by its members…
In 2008, the network’s membership stood at just ten companies, which included Care UK, Circle and Ramsay Healthcare UK. Yet, it now held considerable influence. The 2007/8 annual report informed members how in October 2007, the network had held a meeting with Andrew Lansley “on the Conservative Party’s draft bill”.  This ”bill” went on to become the infamous ‘Equity and excellence: Liberating the NHS’ white paper and in turn the even more infamous Health and Social Care Act of 2012. The report also described “briefings aimed at furthering the interests of members with shadow health secretary Andy Burnham, Conservative MP and advisor to Circle Health Mark Simmonds, and multiple other key personnel and advisors at the Department of Health.

To become a member of the NHSPN, an annual payment of £35,000 is required, which includes a membership fee to the NHS Confederation, which is a registered charity. The sum of money is clearly seen as money well spent and by 2009 the network’s membership had grown substantially to 17 companies, which led to a total income of £347,500 from subscriptions for the year. Two new entrants to the NHSPN stable for this period were UnitedHealth UK and the new GP out of hour’s services provider Harmoni, since bought by Care UK.


The latest annual report lists 26 members, with additions including Bupa and General Healthcare Group. Membership income now stands at £434,000. 
Oliver Letwin led negotiations
Dates for the diary
By 2009, NHSPN staff were moving among the highest political circles.  In the 2009 annual report shows how they had held a NHS board meeting with Andrew Lansley, hosted breakfast meetings at all the party conferences, had a meeting with new industry regulator, Monitor and met with the free market think tank Reform. In control of the network’s marketing and promotional activities at this time was David Worskett, who would soon go on to take over the reigns as director.

The NHS Partners Network was indeed going places, made possible by the Labour party and encouraged still further by a Conservative party intent on shaking the very foundations of the NHS. In May 2010, it was back in power, albeit in coalition with Liberal Democrats. Less than two months after the coalition had formed, Andrew Lansley, now new health secretary, introduced the ‘Liberating the NHS’ white paper.

The remarkable speed with which this hitherto unknown policy appeared was of course no coincidence. The plan had been hatched many years before. However, having failed to win by a clear majority, the Conservatives had to negotiate more than they would have liked. ‘Never Again?’, a book  by Nicholas Timmins from the Institute for Government, describes the deal made behind closed doors by Oliver Letwin and Danny Alexander, who had agreed to support the government’s changes to NHS in exchange for Lords reform. This reckless and deeply undemocratic move allowed the wheels of Conservative policy to begin rolling.

Behind closed doors
Three months after the white paper had come out - and before parliament had even seen the bill - David Worskett, now director of NHSPN, met with the then minister for health, Simon Burns and Earl Howe, who was responsible for commissioning and primary care. A document written by Mr Worskett following the meeting, explained how they would make it clear to (the new) healthcare commissioners what the Any Willing Provider (AWP) policy meant for them, and reassured Mr Worskett that opposition to the GP commissioning plans was likely to be “short-term” and “dissipate” in the future.

The remarkable courtesy shown to Mr Worksett confirmed the Network’s rising status  and this was the time to truly make its presence felt.  Its 2010 annual report described discussions with David Bennett, chairman of the new industry regulator Monitor, and Steven Dorrell, the chair of the health select committee. The self-titled ‘partners’ of the NHS now had the law on their side and were acting less in partnership and more in direct confrontation. Under the title of ‘Main activities’, the Network stated how it had  “defended members threatened by anti-competitive behaviour” and, more intriguingly, influenced “the development of the NHS reforms”.


The Future Forum

This latter statement was not a boast from a lobbying group trying to impress its members but a true reflection on the way the Network was able to maintain competition in the bill despite a near total rejection from both the medical profession and the public. The rising resistance forced the government to set up the NHS Future Forum in order to ”pause, listen and reflect”.

Much to its dismay, the NHSPN found itself locked out of the forum. To allow a private healthcare representative in would have been too politically sensitive at the time. This didn’t mean the network wasn’t involved. The person that would open the door for them turned out to be Sir Stephen Bubb, the Chief Executive of the Association of Chief Executives of Voluntary Organisations, who Cameron had accepted as head of the ”Choice and Competition” part of the Forum.

A memorandum written by David Worskett to his Network members, unearthed by Social Investigations in July last year, revealed how Mr Worskett had held one lengthy, very early discussion with Sir Stephen Bubb at which “we agreed on the approach he would take, what the key issues are, and how to handle the politics. He has not deviated from this for a moment throughout the period.” The memorandum also revealed how “several members have used their own ’routes’ to gain access to key players within No.10 and have been able to report back that the stance there is supportive.
The competition part of the Forum turned out to be such a sham that Bubb announced on his website: "Just as I was signing off our panel's report on 'Delivering real choice' I get sent a copy of the PM's speech announcing he was accepting many of our key recommendations (although we haven't actually given him the report yet!)”.

Financial links to MPs and Lords
The ability of NHSPN members to access the highest levels of government was surely not hindered by the fact that many of the Network’s members employ MPs and Lords. Baroness Bottomley is a director of Bupa for example, while John Nash, now a Lord, was the Chairman of Care UK when Lansley received a donation to run his office when he was shadow health minister. Circle, the first company to win a contract to run a NHS hospital, have Conservative MP Mark Simmonds as an advisor and Baroness Ford is the Chairman of Grove Ltd, a holding company for care home company Barchester Health.
Still so much to do…
The Health and Social Care Act is now passed but the NHSPN’s efforts on behalf of its members is far from finished. Monitor recently opened up a consultation on creating what they call a ‘Fair Playing Field review’, to make sure that when service providers fight it out against each other for contracts the ‘field’ is as even as possible. The NHSPN made a submission highlighting tax, pensions and the NHS Brand as a barrier to equal competition. The irony that the Network itself is allowed to use the NHS as a prefix to its name is apparently lost on its members.

A recent report by healthcare market analysts Laing & Buisson, revealed how services obtained from private providers has increased by 10% in the last year. In less than two weeks the NHS budget will be placed into the hands of the Clinical Commissioning Groups, which will accelerate the outsourcing of services still further. The private healthcare industry is on the rise and so too the NHS Partners Network. 


This article appeared in Corporate Watch

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