Showing posts with label 'NHS Partners Network'. Show all posts
Showing posts with label 'NHS Partners Network'. Show all posts

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.

Wednesday, 16 January 2013

Revealed: Head of Monitor Has Ties with Private Healthcare Lobby Group Who See Tax, Pensions and NHS Brand as Barrier in 'Fair Playing Field' Review.


The latest unholy mess taking place due to the undemocratic, unnecessary and complicated Health and Social Care Act, is the ‘Fair Playing Field’, review being undertaken by the new NHS regulator, Monitor.

A nine-month process has now seen all the submissions handed in and each organisation is wondering what is going to be the result of the review, come the end of March, this year.

April the 1st is the time when the Clinical Commissioning Groups (CCGs) are due to takeover, from the Primary Care Trusts, abolished thanks to the new legislation. The ‘Fair Playing Field’ findings, which will conclude in time for this date, will mark the end of the NHS as we know it and increase the fragmentation of services across the country.

Social Investigations can now reveal a private healthcare group’s submission, which brings to the attention of Monitor the barriers the private sector perceive to achieve a Fair Playing Field, which include corporation tax, VAT, pensions and the NHS brand. The only problem is, this same lobby group were heavily influential in maintaining competition in the Health bill during the sham of a 'so-called 'listening exercise'. Furthermore, this same lobby group had previously met with the head of Monitor in a 'like-minded' meeting, bringing the impartiality of the review into question.

Tuesday, 15 January 2013

NHS Partners Network Response Regarding Fair Playing Field

Social Investigations - contacted the NHS Partners Network over their submission to Monitor, regarding the 'Fair Playing Field' review currently taking place.

In order to maintain openess - I have listed the entire response without editing here so readers can make their own mind up.

View the NHS Partners Network submission here.

Starts-----------

Let me make it absolutely clear that contrary to some reports at no point have we asked for relief from corporation tax. We have simply pointed out that in undertaking an analysis of the different economic factors that affect public and private sector providers of care, corporation tax is one of those factors that impacts on the private sector, but not on the public sector. We have also made clear that we recognise there are factors that work the other way and we now wait to see how Monitor's wholly independent and impartial analysis concludes the various factors "net out" and whether anything can or should be done about that overall, in the interests of patients not of providers", that being Monitor's remit.

Saturday, 24 November 2012

David Cameron is accused of a 'sham listening exercise' on NHS reform after links to lobbyist are revealed

This article appears in the Observer. See Archive in July and August for more details on this research.

The coalition has been accused of presiding over a sham "listening exercise" on NHS reform last year, as a leaked document reveals how the private health lobby worked with Downing Street behind the scenes to ensure that the new legislation went ahead.

David Worskett, the industry's chief lobbyist, cleared his group's public statements with officials and was personally thanked by No 10 for arranging the publication of a letter from clinicians in support of the reforms during the key "pause" period last year, called to reflect on the proposed reforms.

A series of phone calls between the lobbyist and Downing Street's health adviser was followed by a welcome "addition" to a major speech by the prime minister, according to a five-page document written for members of the private healthcare lobby group. The government claimed at the time that it would call a temporary halt to its efforts to introduce more competition within the NHS through its controversial health and social care bill. The prime minister told doctors and nurses: "We are taking this time to pause, to listen, to reflect and to improve our NHS modernisation plans. Let me be clear: this is a genuine chance to make a difference."

Thursday, 13 September 2012

Choice and Competition Chair briefed by Lansley and SPAD before appearance on Health and Social Care Bill Committee


Just when you though the so-called ‘listening exercise could not be more of a sham, a new quote from Sir Stephen Bubb has come to light that reveals he was briefed by Lansley and his Special Advisor, Bill Morgan, before an appearance before the Public Bill Committee meeting on the Health and Social care bill.

Friday, 31 August 2012

Attacks on the NHS article roundup

This is the second time I have compiled a list of some of the articles I have put on here. The last time was June so I thought it was time for the next one.

For the June list please see here.

These last two months have seen a slight change in direction from specific MPs to the process of manipulation during the Health bill ‘pause’. In addition the research into the parliamentarian links was wrapped up revealing 60 MPs with financial links to companies involved in private healthcare, bringing the total of all parliamentarians with these links to 200.

I hope you find the list interesting and useful.

Friday, 3 August 2012

NHS Partners Network response to Telegraph article

 
The NHS Partners Network have responded to the article linking them to Reform, and the Daily Telegraph. The statement is written in full below along with the quote, which I used from the document written by the director of the NHS Partners Network. I will be contacting them back in due course in which I will be expecting honest answers.

Thursday, 2 August 2012

The Telegraph, the Think Tank and a Very Dodgy Business


"And the whole sequence of Telegraph articles and editorials on the importance of the Government not going soft on public service reform, including some strong pieces on health, is something I have been orchestrating and working with Reform to bring about.’ - David Worskett – Director of NHS Partners Network – Communication document written on 20th May 2011

This extraordinary sentence is written by the director of private health lobby group David Worskett, as part of an overall feedback for the NHS Partners Network’s members towards the end of so-called ‘listening period’ in the Health bills passage.

Thursday, 26 July 2012

NHS Partners Network – who are they?


The start
The NHS Partners Network formed in 2005 to provide a voice for private health companies, and was initially made up of organisations involved in the government’s Independent Sector Treatment Sector programme (ISTC). The ISTC initiative was to open up non-emergency treatments to the private sector that would operate (no joke intended) from treatment centres based within NHS hospitals.    

When a leaked document from the Health care Commission raised questions over the quality standards within the ISTCs, the NHS Partners Network used its influence to make sure a report on ISTC’s was less critical than otherwise would be.

In 2007, they were voted on to the NHS confederation, the main representative organisation for organisations offering NHS services.  Since the initial ISTC days, the Network has expanded to include companies and organisations providing services to the NHS.

Social Investigations conducted Lords research
Why do they have influence?
The NHS Partners Network is largely made up of private healthcare companies, with a couple of non-profit organisations thrown in. Their current members list contains 7 companies with financial connections to MPs, Lords or former MPs.


A few examples of this are:
Alliance Medical Limited: 
www.alliancemedical.eu.com – Alan Milburn Alliance Medical runs diagnostic services for the NHS, including in Birmingham and Falkirk. UNISON reported that services were giving patients sub-optimal care, losing the NHS money because of below-capacity uptake, and pressurising hospitals into using private sector treatments.
Care UK: 
www.careuk.com – Andrew Lansley John Nash the Chairman of Care UK gave donations of £21,000 to run Lansley’s office when he was shadow health minister. Bridgepoint who have Lord Patten of Barnes on their books purchased Care UK.
Circle: 
www.circlehealth.co.uk – Mark Simmonds MP is a strategic advisor - the self-styled “social enterprise” that became the first private company to take over the management of an NHS hospital, is owned by companies and investment funds registered in the British Virgin Islands, Jersey and the Cayman Islands. See Corporatewatch ‘An unhealthy business’
The full list of members is below.
How have they used their influence?
When you have connections like they have it certainly provides a platform to being able to obtain high-level meetings.

According to their 2007/08 annual report, they held ‘Major high-level’ meetings with
  • Andy Burnham the Minister of State for Health. 
  • Mark Britnell, who was then the Director-General of Commissioning and System Management for the Department of Health. Mr Britnell has since moved to the private sector as Global Head of Health for business service giant KPMG, He famously said in 2010, while discussing reforms to a private healthcare conference: “In future, The NHS will be a state insurance provider not a state deliverer”, and that “The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years'.
  • Mark Simmonds as Conservative junior minister for Health Spokesman

The latter raises some serious questions as to what part of the draft bill was influenced by the network. In addition to this according to their 2007/08 Annual Report, in October 2007, they held 'informal conversations with Andrew Lansley' and the Conservative party conference, and perhaps more importantly, held a 'meeting with Lansley on the Conservative party's draft bill.'

The latter suggests that they had advanced warning of the bill and parts of its content which they may have influenced. When we consider who their members are (listed below) this might be considered to be giving them an unfair advantage and certainly more notice that the public were given.What was said? Did they put in anything to do with competition? Lansley had competition in mind when writing the White Paper, he just didn't bother telling the public who he is meant to represent.

Health and Social Care bill
In 2008 they had a Meeting with then shadow health secretary, Andrew Lansley, on matters to do with the Conservative party’s draft bill.
In October 2010, Simon Burns (the Minister for Health), Earl Howe, and Andrew Lansley’s Special Advisor, Bill Morgan, attended two meetings with David Worskett, the director of the NHS Partners Network. In the meetings, the ministers reassured the lobby director that opposition to parts of the bill increasing competition would soon ‘dissipate’.

A further meeting head with Earl Howe and Simon Burns on the 19th May, 2011, went well. Earl Howe offered a ‘depiction’ of the ‘Government position’, that meant ‘“choice” was a non-negotiable.’ This view led Mr Worskett to say: ‘He could have been delivering a précis of our briefing notes (which of course he had already seen)’. No wonder then that later in the day at a National Stakeholder Forum, Earl Howe ‘endorsed [Mr Worskett’s] arguments twice during the session on competition and regulation’.

Competition in the bill
A newly discovered document has revealed the lobby group held a ‘lengthy’ discussion with the chair of choice and competition of the NHS Future Forum Sir Stephen Bubb, during the Health bill ‘pause’.

In the meeting according to the document which was intended for the eyes of the Network’s members only, Mr Worskett had ‘agreed on the approach he (Mr Bubb) would take, what the key issues are, and how to handle the politics.’ He has, he concluded, ‘not deviated from this for a moment throughout the period.’ Perhaps it is this influence that they are referring to in the annual summary 2010/11 report where they say, one of their ‘main activities’ involved ‘influencing the development of the NHS reforms’.

The NHS Partners Network are not finished lobbying yet, having recently responded to the first stage of the health regulator’s (Monitor’s) review into the fair playing field for NHS providers. They held a meeting under the auspices of the right-wing think tank "Reform" with David Bennett, the head of Monitor who are running the review. The room was full of ‘like-minded’ people. The NHSPN’s press release announcing their submission to the review states: ‘We look forward to working with Monitor throughout the consultation process.’


NHS Partner Network members and connections
3Well Medical: 
alma.3well.info/home
Alliance Medical Limited: 
www.alliancemedical.eu.com – Alan Milburn Alliance Medical runs diagnostic services for the NHS, including in Birmingham[15] and Falkirk.[16] UNISON reported that services were giving patients sub-optimal care, losing the NHS money because of below-capacity uptake, and pressurising hospitals into using private sector treatments 
Alliance Surgical Plc
: www.allsurgical.co.uk/
Assura Medical Limited
: www.assuramedical.co.uk - Baroness Morgan of Huyton Ex-director of failed care home, Southern Cross, is a member of the advisory committee board of Virgin Group Holdings Ltd. Virgin Healthcare Holdings is a subsidiary of them, who took over Assura Medical Limited and renamed them Virgin Care. Vivienne Mcvey is a board member/Director of Virgin Healthcare holdings and has represented NHS Partners Network when giving evidence on behalf of the Care Quality Commission (CQC). Ms McVey is a member of the CQC Providers Advisory Group and was a part of the NHS future forum and is also a member of an 'Independent' Panel set up by Lansley in March  to look at the impact of the NHS Constitution.

Barchester Healthcare: 
www.barchester.com – Baroness Ford – Chairman - Chairman of Grove Ltd, a holding company for for Barchester Health.  Mike Parsons the Chief Executive was voted 2nd most influential person in healthcare by the HealthInvestor members.
Baxter Healthcare: www.baxterhealthcare.co.uk/
Bupa Home Healthcare: 
www.bupa.co.uk/home-healthcare – Baroness Bottomley is a director, Lord Edmiston has shares, Lord Leitch is a non-executive director, Baroness Liddell is an Associate member
Care UK: 
www.careuk.com – John (now Lord) Nash the then Chairman of Care UK gave donations of £21,000 to run Lansley’s office when he was shadow health minister. Bridgepoint who have Lord Patten of Barnes on their books purchased Care UK.
Circle
: www.circlehealth.co.uk – Mark Simmonds MP is a strategic advisor -
Connect Physical Health: 
www.connectphysiotherapy.co.uk
General Health Group
: www.generalhealthcare.co.uk
Harmoni CPO Limited: 
www.harmoni.co.uk
Healthcare at Home: 
www.healthcare-at-home.co.uk
InterHealth Canada: 
www.interhealthcanada.co.uk
Medical Services: 
www.medicalservicesuk.com
Nuffield Health
: www.nuffieldhealth.com


Oasis Dental Care Limited
: www.oasisdentalcare.co.uk – the recently deceased Baron Newton of Braintree
Pfizer Health Solutions UK: 
www.phsownhealth.co.uk –  Owen Smith: MP for Pontypridd. A former UK lobbyist for the American pharmaceutical giant Pfizer, where he was head of government affairs from 2005-2007. Lord Goldsmith: Partner in International law firm Debevoise & Plimpton LLP, whose clients include Pfizer.
Primecare Primary Care: 
www.primecare.uk.net
Ramsay Health Care UK
: www.ramsayhealth.co.uk
Spire Healthcare: www.spirehealthcare.com - Cinven purchased them and Cinven are connected to Patricia Hewitt
The Horder Centre
: www.horder.co.uk
UK Specialist Hospitals Limited
: www.uk-sh.co.uk
UnitedHealth UK: 
www.unitedhealthuk.com
Vanguard Healthcare Solutions Ltd: 
www.vanguardhealthcare.co.uk

Friday, 20 July 2012

Health Minister and Lansley’s Special Advisor held Meetings with Private Health Care Lobby Group to ‘reassure’ Before Parliament Aware of Bill

A newly discovered document has revealed a top-level political trio, held a secret meeting with a private healthcare lobby group to reassure them about the likely calming of opposition to the healthcare reform, two months before the bill was even introduced to parliament.


In October 2010, Simon Burns (the Minister for Health), Earl Howe, and Andrew Lansley’s Special Advisor, Bill Morgan, attended two meetings with a private healthcare lobby group, NHS Partners Network (NHSPN). These meetings have just come to light, following the discovery of another document written by the NHSPN, which revealed the discussions took place three months before the Health and Social Care bill was introduced to parliament.


The purpose of the discussion, according to the document, was to give members an opportunity to ‘express their support for the Government’s policy of Any Willing Provider (explained below) and moves towards greater patient choice.’ 


In addition, the members could express any ‘concerns about whether a level playing field would truly be created’.



So, the NHS Partners Network were able to access the very top of our political tree before our elected politicians had even been given a chance to debate the bill in the Commons. And no minutes were taken.


The meeting informed the network of a ‘command paper’ that was about to be published by the Department of Health, to set out the ‘principles of the NHS reforms more clearly’. They also ‘received assurances’ that the Government will make it clear to commissioners what the Any Willing Provider (AWP) policy means for them, and that they intend to ‘adhere’ to the reform timetable.


The update on where the government was in terms of action was backed up with further assurance that opposition to the AWP policy would not last long. The introductory paragraph of the document highlighted that both ministers and Mr Morgan expressed the view that any problems with the implementation of the AWP policy, such as opposition to commissioning of the independent sector from GP commissioners – were likely to be ‘short-term’ and ‘dissipate’ in the future.


However, several months after the meetings the situation had changed, because once the content of the white paper had been realised, a near total rejection from both the public and the medical profession resulted in the government taking a ‘pause’.


The so-called ‘listening exercise’ required a temporary group to be set up, called the NHS Future Forum which had Sir Stephen Bubb, a David Cameron appointment, in charge of competition and choice. We now know that Sir Bubb worked with the NHSPN, who together influenced the direction of discussion. The newly established forum meant a new set of lobbying was required, and the NHSPN made sure they were at the helm, as revealed in their annual 2010/11 summary report: 



‘This (pause) prompted a major new effort to communicate our views to the NHS Future Forum, and to the top-level political decision-makers to whom the forum will report.’


Part of the concerns the lobby firm had now centred on the policy of ‘Any Willing Provider’ (AWP), which had changed to ‘Any Qualified Provider (AQP). It was a semantic difference that was hailed by the Liberal Democrats as a victory. In reality the AWP commissioning procedure is set by an EU procurement directive, and the term ‘AQP’ does not exist in EU law.  


The British Medical Journal highlighted the significance of this change in an editorial aimed at the media, who at the time had failed to pick up on it: ‘If a future government wishes to bring a health or social care service back into public sector provision (say if the consequences of this reform turn out to be bad for patients) any existing or would-be provider may sue under EU law on anticompetitive practices.’


The NHSPN, however, did not want to take chances over any weakening of competition in the bill, and having ‘agreed on the approach’ to take with Mr Bubb in a previous ‘lengthy’ meeting, they turned their attention to Earl Howe, who would be leading the debate in the House of Lords.


On the 19th of May 2011, David Worskett, the director of NHSPN, set up another meeting with the Earl. A newly discovered document for the NHSPN’s members revealed that ‘Simon Burns also asked to join the meeting’. Mr Burns’ request to be included, according to Mr Worskett, indicated the recognition by the minister that NHSPN were ‘less than happy about things.’


The meeting went well for the lobbyists. The document revealed that although the ministers were ‘necessarily constrained’ by the fact that everyone was supposed to be listening, they gave ‘every signal possible that they understood and sympathised with our concerns and shared our view of the key issues and priorities.’


Indeed this understanding was absolute. Earl Howe offered a ‘depiction’ of the ‘Government position’, that meant ‘“choice” was a non-negotiable.’ This view led Mr Worskett to say: ‘He could have been delivering a précis of our briefing notes (which of course he had already seen)’. No wonder then that later in the day at a National Stakeholder Forum, Earl Howe ‘endorsed [Mr Worskett’s] arguments twice during the session on competition and regulation’.



The NHS Partners Network are not finished lobbying yet, having recently responded to the first stage of the health regulator’s (Monitor’s) review into the fair playing field for NHS providers. They held a meeting under the auspices of the right-wing think tank "Reform" with David Bennett, the head of Monitor who are running the review. A fair playing field has nothing to do with it. If that were the case, then Simon Burns et al would not have offered a reassurance on policy ahead of a debate in the Commons. The NHSPN’s press release announcing their submission to the review states: ‘We look forward to working with Monitor throughout the consultation process.’


I bet they do.


Unanswered questions

So why were the trio of Simon Burns, Earl Howe and Andrew Lansley’s special advisor, Bill Morgan, holding a meeting to reassure a trade and lobby group, before our elected MPs had even had a chance to debate the bill in the Commons?


Did Bill Morgan pass a message back to Andrew Lansley or did Andrew Lansley pass a message onto NHS Partners Network?


Further notes:

The newly appointed special advisor to Andrew Lansley, Bill Morgan. The former private healthcare lobbyist came under the spotlight in March 2011, following an investigation by transparency campaigners Spinwatch. Mr Morgan had received a list of GPs who were in favour of the reforms, who would represent a ‘public relations coup.’ The list was provided by an outsourcing firm called Tribal, who according to Spinwatch, had ‘£150 million worth of government contracts’, and were connected to some of the new GP Pathfinder Consortia.


Tuesday, 17 July 2012

Edited version of lobbying document of what really happened during the 'pause'.


This newly discovered document handed to Social Investigations reveals the true lobbying that took place during the Health and social Care bill ‘pause’. I have edited some of the juicy sentences – to view the full document details click here.


To view article: ‘Key Member of NHS Future Forum Colluded with Lobby Group over Competition’, click here.Please share this far and wide.


To receive the original document email me on: [email protected] - and if you use the contents of this document, I would appreciate it if you quote Social Investigations as the source.


The task
Therefore the tactical imperative had to be to influence the forum members directly and to concentrate other activity on those who themselves would have most influence on the forum.’

Stephen Bubb Chair of competition and Choice on NHS Future Forum
‘ I also have the impression that the arguments in favour of choice, competition, plurality and economic regulation put forward by the small handful of like-minded members ably led by Sir Stephen Bubb have often carried the day and won more support than we might have expected.’

‘I had 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.’

‘A number of members secured individual meetings with him, thus reinforcing and validating the messages. ‘

‘I had a second lengthy meeting with Stephen to discuss the position with him last week, under the auspices of "Reform", with only a handful of other (all like-minded) people present, including David Bennett, the chair of Monitor. He has also consistently taken the same line as us throughout.’

No10
‘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’

‘I did brief the new No.10 health policy adviser very fully, and indeed "cleared" our materials with him. I have has several other "stock-take" phone conversations with him. We are certainly on No.10's radar.’

‘We need to keep as close as possible to No.10 over the next few weeks. So much depends, first, on what the Forum Report actually says.’

‘I received an invitation to the PM's big speech last Monday and went. (Incidentally, for those who had the pre-event text, he specifically added a sentence about the importance of patients being able to attend private hospitals if they wanted to.’

The Lib Dems
‘There have been a number of contacts with the Lib Dems. I had an early meeting with Norman Lamb who continues to advise Nick Clegg very closely, and a further very long phone call with him on Tuesday this week.’

‘Meanwhile Nick Clegg is, frankly making noise in order to persuade parts of his party that he is really driving the changes needed to "save the NHS".’

Health minister Simon Burns
‘Jill Watts and I went to the DH yesterday to see Earl Howe. Unplanned, Simon Burns also asked to join the meeting.’

Lords
‘Earl Howe's depiction of the Government position was, to paraphrase, that "choice" was a non-negotiable; real choice requires a range of provider types; that means competition; and competition has to be expertly regulated. He could have been delivering a précis of our briefing notes (which of course he had already seen).’

‘Later in the day, at the National Stakeholder Forum, Earl Howe endorsed my arguments twice during the session on competition and regulation .’

‘But as we move into the next phase we will need to shift our efforts onto the politicians - those the Government listen to, and those who will play key roles in the House of Lords when the Bill gets there.’

BMJ
‘My analysis is that the aim is to use the authority of the Forum's report and the listening exercise to improve and make more acceptable the policy; circumvent the traditional "health politics" of the BMA etc; and provide the coalition with a robust basis for getting a revised Bill through the Lords and past the remaining dissenting Lib Dems.’

Monitor
‘I currently think the need for an economic regulator in the form of Monitor will be endorsed by the Forum and retained in the Bill. The language may change: "sector regulator" perhaps.’

‘What will undoubtedly change are the top-level duties of the regulator. The hugely contentious duty to promote competition will be dropped and instead we will see duties to promote any or all of: "choice"; "integration of care""; "provider sustainability"; "continuity of services". That will be claimed by others as a huge victory.‘

‘If this view is right, Monitor will be free to do its job, and while progress will not be fast, the framework and principles will be alright for us.’

Media
‘We have also had good coverage on the BBC website.’

‘And the whole sequence of Telegraph articles and editorials on the importance of the Government not going soft on public service reform, including some strong pieces on health, is something I have been orchestrating.’

Unedited document from NHS private healthcare lobby Group Reveals Actions Taken to Ensure Competition Remained in Health bill


This document, which was handed to Social Investigations, reveals the lobbying process that took place from the NHS Partner Network – in its attempts to ensure competition remained a big part of the Health and Social Bill following the listening exercise.

No words have changed as the details speak for themselves. To receive full original document contact me - [email protected] and if you write an article on the issues with this document, I ask you to please quote Social Investigations as your source.

NHS Partners' Network: Director's update on the NHS Reforms - 20 May 2011
The task

At our AGM on 19 April we agreed on how best to handle the considerable threats posed for the sector by the "pause" in the legislative process because of the opposition to the NHS reforms and the return to levels of hostility towards the independent sector not seen or heard for some years. The essence of the strategy was to recognise that if the report by the NHS Future Forum to the Prime Minister went the wrong way for us, retrieving the position would be almost impossible. Therefore the tactical imperative had to be to influence the forum members directly and to concentrate other activity on those who themselves would have most influence on the forum.

Where has the process got to?
To all intents and purposes, the "pause for listening" is now over and the decision taking phase is starting. The Prime Minister meets the Forum today for a final "round-up" and the report will be drafted and agreed very early next week. the Forum has talked to over 5000 people, with an overwhelming emphasis on the mainstream NHS and especially clinicians.

From the various sessions I have attended I would say that the quality of the discussion has been higher and more balanced than I had feared would be the case. I also have the impression that the arguments in favour of choice, competition, plurality and economic regulation put forward by the small handful of like-minded members ably led by Sir Stephen Bubb have often carried the day and won more support than we might have expected. Support, that is, for the intent and the substance, rather than for the presentation and mode of delivery, where criticism has been sharp.

What have we managed to do?
Our main thrust was originally to try to use individual relationships with forum members to get messages across, using "common hymn sheets" on our key issues. However, on investigation it became clear that the number of personal contacts were too few for this to be enough. We therefore sent more polished versions of our key briefs to all forum members. I received about a dozen acknowledgements, including several that specifically commended the clarity and helpfulness of the briefs. That I hadn't expected but suggests the materials "worked" in communications terms.
In terms of direct discussions:
• I had 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.
• A number of members secured individual meetings with him, thus reinforcing and validating the messages.
• I had a second lengthy meeting with Stephen to discuss the position with him last week, under the auspices of "Reform", with only a handful of other (all like-minded) people present, including David Bennett, the chair of Monitor. He has also consistently taken the same line as us throughout.
• I have heard from most of the members who said they could make direct contact with Forum members confirming they have done so. Thank you.
• Personally I have been able to speak to Steve Field himself , Jimmy Steele , Niti Pall, Julie Moore, and Paul Farmer.
• I also participated actively in two of the Forum's major "listening" events: one run by the Confederation and one by/for the Secretary of State's National Stakeholder Forum. Both were well attended by forum members. At the latter, every Minister was present and I was able to make key points in a workshop session attended by the Secretary of State and Earl Howe and chaired by Steve Field.

Sir Stephen had hoped to find a couple of hours for a meeting with the NHSPN Board, but the schedule of country-wide meetings arranged for the Forum by the DH in the end made that impossible. He is now hoping to be able to confirm a meeting on1 June when he will discuss with us what his report says and what he thinks it mean for all independent providers. I will confirm this to members as soon as I can.
In terms of "supporting" discussions:
• I have coordinated our position carefully with Monitor, the CBI and the FTN and have devoted considerable time to securing a reasonably helpful response from the NHS Confederation. That has, however, only gone off today, illustrating the problems of trying to react speedily when representing disparate interests.
• 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, though there is low awareness of exactly what the independent sector does or could do . I did brief the new No.10 health policy adviser very fully, and indeed "cleared" our materials with him. I have has several other "stock-take" phone conversations with him. We are certainly on No.10's radar - I received an invitation to the PM's big speech last Monday and went. (Incidentally, for those who had the pre-event text, he specifically added a sentence about the importance of patients being able to attend private hospitals if they wanted to, provided NHS standards and prices were being met.)
• There have been a number of contacts with the Lib Dems. I had an early meeting with Norman Lamb who continues to advise Nick Clegg very closely, and a further very long phone call with him on Tuesday this week. I will come to the politics shortly.

• We organised a letter from our Clinical Forum, on behalf of the 45,000 clinicians who do NHS work from the independent sector, to Steve Field. This was powerful. Steve himself told me how useful and well-argued it was and No.10 also thanked me for it.

The DH

• Jill Watts and I went to the DH yesterday to see Earl Howe. Unplanned, Simon Burns also asked to join the meeting, which certainly indicates that they recognise that we are less than happy about things. the two Ministers (supported by Bob Ricketts) were necessarily constrained by the fact that everyone is supposed to be "listening", but gave every signal possible that they understood and sympathised with our concerns and shared our view of the key issues and priorities. Earl Howe's depiction of the Government position was, to paraphrase, that "choice" was a non-negotiable; real choice requires a range of provider types; that means competition; and competition has to be expertly regulated. He could have been delivering a précis of our briefing notes (which of course he had already seen). Simon Burns seemed more engaged than before, defended the reforms firmly and took notice of our arguments on the issue of health sector training arrangements. In short, I do not think, under the circumstances, we could have hoped for more from the two ministers at this delicate moment in the process.
• Later in the day, at the National Stakeholder Forum, Earl Howe endorsed my arguments twice during the session on competition and regulation .

The Politics

What both Ministers were at pains to point out is the need to try to distinguish between three things: the policy debate; the health politics (BMA etc); and the high level "noise" around the coalition politics. We said we completely grasped this, but had to be hugely vigilant over the risk of the "noise" turning into "real risk". They did not deny this.
However, without wasting members' time on extensive political speculation, my analysis is that the aim is to use the authority of the Forum's report and the listening exercise to improve and make more acceptable the policy; circumvent the traditional "health politics" of the BMA etc; and provide the coalition with a robust basis for getting a revised Bill through the Lords and past the remaining dissenting Lib Dems. Meanwhile Nick Clegg is, frankly making noise in order to persuade parts of his party that he is really driving the changes needed to "save the NHS". There will be more of that as we enter the next phase, but we need to see it in context and not over-react.

The Forum's Report

Again, beware speculation, and we should know for sure in about a week, either officially or otherwise, but I currently expect:
• Major changes on "commissioning", which will become "clinically led commissioning" rather than "GP commissioning. There will be more flexibility on timetable and there will be a number ( 50 or so) of ongoing commissioning bodies at the level of the current "clusters". These will do the heavy lifting until "consortia" are up to the job; will provide the location for commissioning which requires scale; will also provide the place where clinical input from people other than GPs can be increased; and where other vital skills can be accessed.

If that or something like it emerges it should be better for us - terms of stability and "expert planning and buying", than the original proposals.
• Major changes on accountability, to reflect Lib Dem concerns to advance local democracy and everyone's concerns about accountability for £60m+ of public funds. On to watch for is Sir Stephen's idea of picking the concept of local "right to challenge" which feature in the Localism Bill.

Of less direct relevance to us, so impact relative to the original reform proposals is probably neutral .

• The Education and Training proposals will be endorsed in principle but slowed down: there is no need for a crash programme of change so why try to do it at the same time as everything else.

Impact is helpful as it slowing down avoids the distraction and gives time for fuller discussion of exactly how the independent sector participates.
• Economic Regulation and competition - the big one for us. I currently think the need for an economic regulator in the form of Monitor will be endorsed by the Forum and retained in the Bill. The language may change: "sector regulator" perhaps.
• What will undoubtedly change are the top-level duties of the regulator. The hugely contentious duty to promote competition will be dropped and instead we will see duties to promote any or all of: "choice"; "integration of care""; "provider sustainability"; "continuity of services". That will be claimed by others as a huge victory.
• However, in reality, those objectives are more akin to the ones required of other regulators. Competition is indeed a means to an end, not an end in itself, and can be used effectively to help achieve all of those objectives. And despite Mr. Clegg's unusual "take" on European law, national government's cannot change or undo EU law on "undertakings" or procurement!

Of course, this is the area in which the forces of coalition politics are most in play and there are other options which have been or are being talked about, including retaining the CCP, and/or dropping Part 3 of the Bill. At this moment I do not think these will emerge as the way forward but the next few days will determine all.
If this view is right, Monitor will be free to do its job, and while progress will not be fast, the framework and principles will be alright for us.

The Media
Finally, the media. We agreed we would "up" the profile on key issues, without inflaming the debate. Members will have seen some very good reporting in the specialist press of my public defence of the role of competition at a conference earlier this week. We have also had good coverage on the BBC website. Our Clinician's letter was mentioned in the Telegraph. And the whole sequence of Telegraph articles and editorials on the importance of the Government not going soft on public
service reform, including some strong pieces on health, is something I have been orchestrating and working with Reform to bring about.

Next
We need to keep as close as possible to No.10 over the next few weeks. So much depends, first, on what the Forum Report actually says. But as we move into the next phase we will need to shift our efforts onto the politicians - those the Government listen to, and those who will play key roles in the House of Lords when the Bill gets there. The report, which I am sure will be almost entirely accepted by the Government, will then guide the redrafting of parts of the Bill so that (Ministers hope) the legislative process can get under way again in early July.
David
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