Optum increases dominance of NHS thanks to former employee Simon Stevens – now NHS commissioning quango boss

Optum – a subsidiary of USA global healthcare company United Health – continues to extend its tentacles into the NHS in England.

South East London Sustainability and Transformation Partnership and the four West Midland Sustainability and Transformation Partnerships have fallen into the USA company’s clutches.

And a Dorset GP practice is receiving free, loss-leader “support” from Optum.

Optum’s growing influence over the NHS is thanks to its former employee Simon Stevens – now Chief Exec of the NHS England quango.

Before David Cameron appointed him to run the quango that was set up to covertly dismantle the NHS as a comprehensive universal health service, Stevens was Chair of Optum Institute of Sustainable Health, while also working as a Chief Exec for United Health.

NHS England hires Optum Alliance to speed up formation of Integrated Care Systems

Last year, NHS England hired the Optum Alliance (Optum Healthcare Solutions together with Pricewaterhouse Cooper) to develop the Integrated Care System in South East London.

NHS England also hired PwC and Optum to work with four sustainability and transformation partnerships in the West Midlands to “help progression towards integrated care systems”. These four Sustainability and Transformation Partnerships make up the West Midlands NHS region:

  • The Black Country and West Birmingham
  • Birmingham and Solihull
  • Coventry and Warwickshire
  • Herefordshire and Worcestershire

In Dorset, Optum are “improving” at least 3 GP practices

At Wyke Regis and Lanehouse Medical practice, Optum are doing free “loss leader” work on patient analytics. Optum are also working on “improving” Preston Road Surgery and Royal Manor Surgery to their desired taste – as NHS England’s ‘Preferred Development Partner’ of course.

The Wyke Regis and Lanehouse Medical Practice website says:

“Optum
We are working with Optum International (UK) to conduct a one-off piece of analytics work to support the care and treatment of the population registered with GPs in Dorset.
 A small number of analytics specialists from Optum in the UK team, all of whom are based in the UK, will have access to pseudonymised data. This means that Optum will not be able to identify any individual and the data they receive will ensure anonymity. Optum has a long track record of working with and within the NHS are fully compliant with all necessary data protection laws.
Once the work with Optum is complete, they will delete the data from their systems. Patients who have chosen not to share their data will be excluded from the extract at source and their data will not be extracted from the GP system.
In addition Weymouth & Portland GPs are working with Optum, who will spend time observing and evaluating how the practice functions to quantify potential areas of improvement for both clinical and back office service delivery.  Optum are the preferred development partner with NHS England and, as with all our team, have suitable governance in accordance with all applicable laws, privacy notices and in accordance with all contracts.”

A Dorset GP says he thinks 

” They [Optum] are the thin end of the United Health wedge.”

And he adds that Optum are doing this work for free not out of the goodness of their hearts, but because they will then be in a good position to clean up in what will be a very profitable market in data analytics. Once all the Sustainability and Transformation Partnerships have become Integrated Care Systems, they will be operating on the basis of population health outcomes contracts that rely on such data analytics.

Insurance-based Accountable Care Organisations (rebranded in England as Integrated Care Providers) rely on systems of control that are based around analytics. The extent to which Optum’s software and training is already embedding in the infrastructure of the new NHS is hugely underestimated. They have been moving in under the radar for some time.

The doctor is bang on. But what is at stake is wider than United Health wanting to clean up on the analytics side. What Simon Stevens is installing today in England is United Health’s own preferred model of healthcare – with United Health’s feet already under the table.

It is plausible to suggest that Simon Stevens wants the removal of the competition regulations because they would make Optum’s increasing dominance in the NHS illegal under competition law.

In Dorset, Optum’s infiltration so far extends to referrals, patient data and the development of a single point of access for health & wellbeing services

Optum have been controlling Dorset referrals into London hospitals since at least 2014 – as well as all other Thames Valley and Wessex Clinical Commissioning Groups’ referrals into London hospitals, by the look of it (use ‘find’ function, here.)

These referrals include deciding on Individual Funding Requests. (See paras 2.25 – 2.28 in that downloadable pdf.)

Optum also process data from at least three primary care localities as part of the ‘digitally transformed Dorset’ element of Dorset’s developing Integrated Care System .

As we previously reported here, Optum won a county-wide three year contract from Public Health Dorset in April 2015 for their patients’ behaviour change service “Livewell Dorset”. It provides a single point of access for Health & Wellbeing services and cost around £920,000 per annum.

The contract expired in March 2018 and the Council decided to take the service in house – together with Optum staff to work in the Council team. Optum created the new digital platform for the service.

5 comments

  1. Why are all these STPs ‘falling’ into Optum’s hands? Where are our scrutiny boards? Why don’t they see the downgrading and destruction that will follow a For-Profit US style health business? No councillor voting for such schemes deserves a seat in the Council Chamber.

    Liked by 1 person

  2. Weapons of Math Destruction: How Big Data Increases Inequality and Threatens Democracy

    “We live in the age of the algorithm. Increasingly, the decisions that affect our lives—where we go to school, whether we get a car loan, how much we pay for health insurance—are being made not by humans, but by mathematical models. In theory, this should lead to greater fairness: Everyone is judged according to the same rules, and bias is eliminated…………

    But as Cathy O’Neil reveals in this urgent and necessary book, the opposite is true. The models being used today are opaque, unregulated, and uncontestable, even when they’re wrong. Most troubling, they reinforce discrimination: ”

    “For many of the businesses running these rogue algorithms, the
    money pouring in seems to prove that their models are working. Look at it through
    their eyes and it makes sense. When they’re building statistical systems to find
    customers or manipulate desperate borrowers, growing revenue appears to show
    that they’re on the right track. The software is doing its job. The trouble is that
    profits end up serving as a stand-in, or proxy, for truth. We’ll see this dangerous
    confusion crop up again and again.”

    CCGs want to wash their hands of responsibility for denying patients the ‘care’ they need so are encouraged to use the ‘points’ system, (simplifying the language greatly for algorithms,) to pretend it is not them doing it. North Kirklees CCG have studied the Long Term Plan and decided that they are going in the ‘right direction’! They admit that each of their networks of GPs will have a ‘Director’ (so how can it be a network, exactly) but they did not answer my question, ‘how much power will the ‘Director’ have, and who gives them that power’? I am reminded of the former Medical Director Linda Peeno in the US, as reported in the film Sicko.

    Like

  3. How long before the UK becomes just another Americans state?
    This insidious underhanded dismantling of our NHS must be resisted at all costs.
    Many people will not be able to afford the money for private health insurance.

    Liked by 1 person

  4. And all of this facilitated by the suggestion the country is short of money, an obvious nonsense when what we use for money is IOUs issued under license from the same government who keep telling us there is none.

    Liked by 1 person

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