USA’s United Health subsidiary Optum decides which Ealing patients referred to hospital by GPs will have their treatments funded

UNITEDHEALTH IN THE NHS  In 2014, America’s largest health insurer UnitedHealth saw their President of global expansion, Simon Stevens, installed as Chief Executive of the NHS in England.

UnitedHealth is right now embedding its subsidiary company Optum as an integral part of NHS GP care nationwide, through its financial control systems, referral management systems and IT systems (including the Scriptswitch software).  This insurance company has sold these Trojan Horse systems into the Clinical Commissioning Groups which control our GP services nowadays.

UnitedHealth has a track record of being fined for fraud against the US government, but these penalties do not ever seem to improve its conduct. UnitedHealth is currently being sued by the US Government in a case ongoing since 2017.  

Case study – NHS Ealing Clinical Commissioning Group (CCG)

UnitedHealth subsidiary Optum has been installed in NHS Ealing Clinical Commissioning Group’s clinical and financial decision making, with tasks that require Optum’s access to patients’ confidential medical records.

One of Ealing CCG’s Joint Vice-Chairs has a Register of Interests entry, which mentions that he is an Optum clinical adviser/consultant.

Optum Referral Management Service

In 2015 NHS Ealing Clinical Commissioning Group expensively outsourced its referral management service to Optum; this included a transfer of staff to the United Health subsidiary. The total cost if the contract runs for five years is £4.6m.

The Ealing Clinical Commissioning Group paper on the Procurement of the Referral Management/Facilitation Service said that the savings in returning or diverting referrals far outweigh the cost of running the service. And that the Referral Management Service is also an enabler to help with the Shaping a Healthier Future programme of cuts to North West London A&Es and other hospital services.

Update 29 March 2019 – Although the Health Secretary Matt Hancock announced in the House of Commons that

‘I am absolutely clear that the changes in A&E in west ​London as part of “Shaping a healthier future” will not happen,’

He went on to say:

However, there are elements of “Shaping a healthier future” that are about more community services and treating more people in the community. We look forward to working with the local NHS on those parts of the proposal.’

Where does that leave the Optum Referral Management Service?

Optum, as referral gateway operator for NHS Ealing Clinical Commissioning Group, now decides which patients referred by their GP (primary care) to hospital (secondary care) will be funded out of the NHS Clinical Commissioning Group’s budget.

In other words, a UnitedHealth subsidiary now determines whether an Ealing GP patient who needs NHS hospital treatment of the following types is allowed to access it. The “Referral Facilitation Service” covers all GP referrals that come under eight speciality areas:

The Referral Facilitation Service contract allows for provisional expansion in the future; e.g. extending to prior approval of all GP referrals to acute hospitals.

In 2018 this three-year contract was extended to “Year 4”, and the contract itself anticipates a potential “Year 5”.

GP medical records access for UnitedHealth

The “Referral Facilitation Service” contract gives UnitedHealth access to the medical records of all patients registered with Ealing Clinical Commissioning Group’s GPs whose referrals it handles.

But Ealing Clinical Commissioning Group’s Fair Processing Notice does not reference the data processor for referrals.

Optum has other NHS contracts like this, positioning UnitedHealth to access commercially valuable patient data that the patients thought they had shared only with their family doctor.

The Optum website says that they currently operate referral services in Lincolnshire, Hounslow, Ealing and Brighton.

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