Another reason why we should all keep our eye on the ball

This article titled “The biggest privatisation in NHS history: why we had to blow the whistle” was written by Kate Godfrey, for theguardian.com on Monday 16th March 2015 12.16 UTC

I’m not a journalist, but as of this morning I know what it feels like to be part of the biggest leak in NHS history.

Published on openDemocracy, the memorandum of information for the £700m sell-off of Staffordshire cancer services is now available for the 800,000 directly affected and 3 million indirectly affected patients to read online.

That document, together with others relating to the joint £1.2bn privatisation of cancer and end-of-life services in Staffordshire, was sent to me. They are commercially confidential, secret agreements that will rebuild NHS services for hundreds of thousands of people, but are for the eyes of the bidding companies only.

Not only is this the first billion-pound NHS privatisation, it is the first time that it has been deemed acceptable to put care designed to meet the needs of our most vulnerable patients on sale.

Uniquely for a privatisation on anything of this scale, there has been no public consultation, simply a series of weak “engagement” events led by paid “patient champions”. For the past year unpaid patients have not been able to have their say. Thanks to the brave person who shared the documents, now they can.

The background is this: Staffordshire commissioners want to hand the management of all care for cancer and end-of-life patients to a private company, a “prime provider” that will take responsibility for the delivery of care, subcontracting and performance management.

There are lots of firsts here. It is the first time that cancer or end-of-life care has been contracted out. The first use of the prime provider model on anything like this scale. The first privatisation without formal consultation. The first huge international NHS contract that could fall under TTIP. Transfer these services out of the NHS now, and we may never get them back.

The leading bidders are all US private healthcare companies, some of them implicated in failures of care elsewhere. One is Optum, the US brand facing allegations over the American hospice-packing scandal. (Optum is defending itself against the allegations.) It is the first time that the commissioning responsibility held by local clinical commissioning groups (CCGs) – the right to spend a billion pounds on behalf of the NHS – will simply be gifted to a private company.

And it looks like it will be a private company. There are clauses in the published document that simply have no place in a project that will stay within the NHS. Bidders are encouraged to explore a “VAT efficient model”. Not only is this disturbing in its own right, but NHS bodies don’t pay VAT. This is a strange level of detail to find in a document that is otherwise so imprecise.

There is no plan here, no benchmarks against which a bidder could be selected; just a hope that the shape of the contract will resolve itself as bidders make their own suggestions and time goes on.

To me, it looks as though local commissioners simply got bored, and decided they didn’t want to be responsible for cancer care any more. To the health expert John Lister, it looks worse. He says the contract is “no more than a blank cheque for whichever private firm is the most ruthlessly willing to cut services to shore up their own profits”.

The winning bidder will be free to decommission or disinvest as they like – cutting contracts with local hospices, therapeutic providers or even frontline healthcare such as radiotherapy and surgery. The bidder could simply replace them, delivering services such as radiotherapy themselves, further fragmenting the services that mean most to patients. Or they could just squeeze existing contracts. No payment structure is specified. Bidding companies can decide for themselves what they are worth, as long as their fees are self-funding within the current budget. Based on similar health privatisation contracts, £100m in fees is the minimum that a private provider will accept. This money will be diverted straight from funds currently spent on frontline care.

Those hospices and providers will be told that they can still provide care – it just has to be for 20% less, with the remainder meeting the fees of the winning bidder. They might just reduce costs, or they might cut services that cancer patients depend on. It is the postcode lottery written into an NHS contract.

The question the document doesn’t even try to answer is why. Commissioners’ own figures show cancer care in Staffordshire to be above national average. Only one of the four CCGs backing the change list cancer as an area where they could make significant improvement. There is no clear case for change, but there is an opportunity.

Time and time again we have seen Staffordshire used as the proving ground for the 2012 Health and Social Care Act. Cancer and end-of-life privatisation has been introduced here because it was politically convenient. Our history is used against us; our patients pay the price again.

Not only was there no formal consultation, but local patients were meant to get no say on this contract at all. The original plan was to sign the deal in March – before people could have their say at the polls. Labour has said it will not let the project go ahead.

The campaign group I work with – Cancer Not For Profit – fought for more time. When the awarding of the contract was put back until June, we thought that we had won a small victory.

Our source heard differently. The project wasn’t delayed, they were told, but simply hushed up. The political implications of pushing through the biggest privatisation in NHS history two months before a general election were too serious. It had to move forward with speed, and if the contract lacked benchmarks or risk management, forget it. It could all be resolved later. (It is the essence of contract law that weaknesses are generally not resolved later.) The only thing being delayed until after May was the announcement, which would now be made in June. And then a gamble that a new government couldn’t go back on a contract already awarded.

“I’m going to publish,” I told the source. “Tell me if you don’t want me to publish.” I never heard from them again.

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