James Corbett walked 400 miles to oppose NHS privatisation and reinstate our #NHS4All

Last summer James Corbett walked 400 miles to gather support for his petition.

On the first 200 miles of his walk, James particularly spoke out against NHS privatisation. But the media didn’t seem to get it. The Lancashire Evening Post reporter simply recycled Department of Health and Social Care figures about the purchase of non-NHS healthcare, which claim that only 7.3% of the annual NHS running costs budget is spent on privatised healthcare.

That’s the only aspect of NHS privatisation the Department of Health and Social Care seems to want to talk about. But this is only one of at least 7 types of privatisation (and that’s without including privatisation of commissioning):

Directly outsourcing services to private and voluntary sectors;Personal budgets, which require service users to select a service provider, usually outside of the public sector;
•Choice frameworks in which service users are given choice of service provider – eg private health care companies, or self-pay services in NHS hospitals, as alternatives to direct public provision.
•Public Private Partnerships and joint ventures (may include voluntary sector as subcontractor);
•Transfer of services and functions to arms length companies, trusts and social enterprises – this is a form of privatisation, despite protestations to the contrary;
•Social investment projects funded via Social Impact Bonds;
•Community rights to own, challenge, contest, manage, bid, build, buy and transfer and limit council tax increases through the Localism Act 2011;

You can download this NHS Privatisation factsheet here:

What NHS Privatisation is and why it’s a Bad Thing

It seems that the Department of Health and Social Care is not telling the whole truth about the extent of NHS Privatisation

NHS privatisation is NOT ONLY about contracting out NHS clinical services to private companies – which has been increasing ever since 2000, when the New Labour government published its Concordat with the private health sector.

NHS privatisation is far wider and more varied than this. As indicated above, there are at least six more types of NHS privatisation. As far as we know, no reliable figures exist for their monetary value.

But even if you limit NHS privatisation to contracting out NHS clinical services to private companies, it seems clear that the Department of Health and Social Care has undercounted the true extent of this. It claims only 7.3% of annual NHS healthcare spending goes on healthcare services provided by private companies.

Dept of Health and Social Care figures for purchase of NHS healthcare from private sector

Let’s unpick the Department of Health and Social Care claim.

Table 37 (below) in the 2018-2019 Dept of Health and Social Care Annual report and accounts shows that the Department spent 7.3% of its annual running costs budget on NHS healthcare provided by the private sector. (Total RDEL stands for the Resource Departmental Expenditure Limit – it basically means the annual running costs of Department of Health and Social Care and it covers all kinds of stuff in addition to spending on healthcare services.)

Why we disagree with the Department of Health and Social Care’s figures

First, the 7.3% doesn’t include the £1,619m spent on the voluntary/not for profit sector as privatisation. We do. It may be “soft privatisation” but it’s still privatisation. Apart from anything else, the definition of this sector includes some of the major private providers such as BUPA and Nuffield Health, which are not-for-profit companies. In the care home sector, the so-called not-for-profit companies often turn a relatively healthy profit. Similarly, a large number of all private hospitals are also registered as charities.

Second, there’s the £2,899m healthcare purchased from local authorities. This is for social care, community mental health services and Continuing Healthcare. Most local authorities have privatised social care and community health services, so by rights this £2,899m should be counted as privatisation spending. As should Continuing Healthcare, since this is about Personal Health Budgets that patients with long term health problems, who need healthcare at home, are awarded to buy in their own care. This is usually spent on private providers.

On top of that, Table 4.1 on p171 has NHS grants to local authorities of £3,070,284,000 x2. I think these are for NHS-purchased social care, and this should be counted as spending on privatised services since most social care services are now provided by private companies, not local authorities who are now largely social care commissioners not providers.

The Department of Health and Social Care also omits two other categories of NHS spending on healthcare from non-NHS providers:

  • Expenditure by NHS Trusts on services from the independent sector, local authorities and the voluntary sector.
  • All expenditure on primary care services which are delivered by non-NHS providers – including high street pharmacy services provided by Boots or Lloyds Pharmacy, optical services provided by Specsavers or Vision Express, as well as dentists – and GP practices on Alternative Provider of Medical Services contracts.

Update 2 Oct 2019

Centre for Health and Public Interest claims 18%-26% of annual NHS clinical services spending goes to private companies

The Department of Health and Social Care’s 7.3% figure is way less than the 18% – 26% of annual NHS clinical services spending that’s contracted out to “the independent sector”, as reported by the Centre for Health and Public Interest:

“in 2018/19 £29 billion was spent by NHS England on the independent sector, which is around 26% of total expenditure… If General Practitioners are excluded from this calculation, the figure is £21 billion or around 18% of total expenditure on the independent sector.”

This refers solely to NHS spending on the purchase of non-NHS healthcare, which includes personal budgets, and possibly choice frameworks.

It doesn’t consider any of the four other types of privatisation- Public Private Partnerships and joint ventures, transfer of services and functions to arms length companies, trusts and social enterprises, social investment projects funded via Social Impact Bonds, and Community rights to buy etc, under the Localism Act 2011.

Why we do not view GP Practices which hold General Medical Services or Person Medical Services contracts, as non-NHS providers.

In functional terms, these GPs operate as NHS providers. The contracts are owned by GPs who work in the practice. The salaries for the GPs contract owners are fixed by national or local arrangements depending on the services provided by the GPs and others working in the practice. The NHS payments to the practice are intended so that no profits are made by the GPs, and GPs cannot hand on the contracts if they retire or otherwise leave the Practice – meaning they cannot extract profit from it when they leave.

If you add up all these categories of NHS spending on purchase of non-NHS healthcare (omitting spending on GP practices for the reasons just given), in 2018-19 the true figure for NHS spending on healthcare provided by non-NHS bodies was around 18%, according to calculations by the Centre for Health and the Public Interest.

This is the figure we accept.

(End of update)

Update 23.10.2022 – Commercialisation of GP Practices through Alternative Provider of Medical Services contract

We do view GP practices holding Alternative Provider of Medical Services contracts as private providers of NHS health care.

Opening NHS GP Practices to commercial companies was the reason for the contract’s introduction in 2004 by the New Labour government.

Alternative Provider Medical Services (APMS) contracts are the only general practice contracts that can be entirely owned by those who are not NHS GPs, such as private commercial organisations. They seem to be the main mechanism for corporate takeover of GP practices. They allow for profits to be taken out of the practices.

And perhaps more significantly – given limited opportunities for extracting profit from GP practices – they allow corporations to take controlling positions in the new Integrated Care Systems and to access the goldmine of NHS patient data.

You can find more info about this here.

Contracting out NHS clinical services to non-NHS providers is far from the whole story of NHS Privatisation – here’s some of the rest of it

The Department of Health and Social Care doesn’t admit that NHS privatisation TAKES MANY OTHER FORMS THAN contracting out NHS clinical services to non-NHS providers. Here are some of them.

Hospital Domestic, Catering and Laundry Services

Hospital cleaning services were the first bit of the NHS to be privatised, under the Thatcher government in the early eighties. Standards of cleanliness fell and suddenly the MRSA and C difficile bugs were making hospital patients sick.

Not to mention catering, portering, laundry and other non-clinical but vital services.

This privatisation damaged staff as well as patients. Trade Unions were unable to protect staff terms and conditions and a two tier workforce was created, cutting the wages and working conditions of non-clinical but vital staff.

Who knows what the value of all these privatised services is? Except it’s BIG.

Some information about the costs of maintaining and equipping hospitals and the provision of services such as cleaning, laundry and food (mostly privatised) and the costs and consumption of utilities is available in the 2020/21 Estates Returns Information Collection. It shows that:

  • The total cost for cleaning services was £1.1 billion – an increase of 5.0 per cent since 2019/20.
  • The total cost of providing inpatient food was £0.6 billion. This figure cannot be compared with earlier figures due to a change in definition

In London, five of the city’s fifteen non-specialist hospital trusts have recently ended their private company contracts for cleaning, catering and portering and brought these staff back as hospital employees. Epsom and St. Helier University Hospitals said it was doing this in order to improve workforce equality and support staff from minority ethnic communities.

This is clear evidence that the effect of privatising these services has been to depress wages and divide the NHS workforce.

Public Private Partnerships and joint ventures – Privatisation of the NHS Estate

Over the last five years, public/private reconfigration of the NHS estate has been taking place through implementation of the Naylor Review, which proposed £10bn of investment: one-third from land sales, one-third from the private sector, and one-third from the government.

The aim is to reshape the NHS estate to fit the new type of healthcare provided by Integrated Care Systems and run by new business alliances aimed at ‘capturing value from the human body as data platform’.

The NHS Five Year Forward View 2014-2019 and the Long Term Plan (2019- 2024) are shaped and driven by the commercial agendas of Big Pharma and digital technology companies. Both 5 year plans embed diverse types of privatisation into the NHS – as advocated by the global capitalist World Economic Forum and enabled by the Coalition government’s UK life sciences strategy , and subsequent developments of it.

This new kind of healthcare – also known as Big Pharma 3.0 – sees medical innovation in the NHS as a bonanza for the private sector, with often deleterious consequences. Commercial interests may be put above medical knowledge, evidence and guidance. And the public/private model provides a fertile breeding ground for corruption and conflicts of interest.

A key aim of public/private investment in the NHS Estate, according to the government’s response to the Naylor Review, is to change the NHS estate so that it accommodates this new type of commercially-driven healthcare, to be delivered by new models of care set out in the Five Year Forward View and developed by Sustainability and Transformation Partnerships and Accountable Care Systems – now renamed Integrated Care Systems.

In particular this means accommodating the planned shifts of hospital services out into integrated primary/community health/mental health and social care hubs. This is apparently to be achieved through the Cavell Centre Programme, with 6 pilots currently in preparation.

The public/private Local Improvement Finance Trust Council is currently making a pointed pitch for private sector partners in the 49 Local Improvement Finance Trust Companies to have a major role in funding and developing the Cavell Centre pilots.

In its response to the Naylor Review, the government said it would hold Sustainability and Transformation Partnerships to account for the successful delivery of approved capital developments (such as the reconfiguration of Calderdale and Huddersfield hospitals ).

To achieve this, the government told Sustainability and Transformation Partnerships (as were – now Integrated Care Systems) to regularly update their estates strategies for acute, primary, community and mental health care, so that the NHS Estate in their area

“accommodates the requirements of changing clinical service strategies and supports STPs’ visions for local clinical excellence and financial sustainability”.

This government-mandated update of NHS estates on the basis of the Naylor Review is being carried out by a variety of public/private companies and Boards that include:

  • The NHS Property Board, (that includes the Director of a new national Strategic Estates Planning service that is to push STPs/ICSs into the provision of strategic estates in their area; as well PropCo and Community Health Partnerships Ltd – both Wholly Owned Subsidiaries of the Department of Health and Social Care)
  • NHS Cavell Centre pilots
  • The Local Improvement Finance Trust (LIFT) Council
  • The 49 Local Improvement Finance Trust Companies and their commercial partners
  • The Community Health Partnership’s 21 private shareholders, 14 service providers and 81 soft facilities management providers.
  • Numerous PFI equity holders and Special Purpose Vehicle companies in NHS assets owned and managed by PropCo
  • Real Estate Investment Trusts that are exempt from corporation tax and redistribute profits to shareholders.

More info here.

Community right to buy

Under the Localism Act 2011, local authorities must keep and publish a list of their “assets of community value”. Community interest groups may bid to buy these assets. For example, the Friends of Edward Hain Hospital in St Ives, Cornwall, have agreed to pay more than £1m to take on ownership of the hospital site, which they plan to run as a health and wellbeing centre. The hospital was closed in 2020 after the local clinical commissioning group, NHS Kernow, said it was no longer fit for purpose.

Privatisation of NHS patients!!!

FGS – first they privatised NHS services – now they’re privatising NHS PATIENTS – A foundation trust is outsourcing more than 100 patients to a private facility for chemotherapy. Northumbria Healthcare Foundation Trust has signed a contract to transfer between 120 and 150 patients to Rutherford Cancer Centre’s facility in the North East.

‘Health Services Support Framework’ is privatising NHS commissioning

Since the 2012 Health and Social Care Act, most NHS clinical services have been planned and bought by around 100 Clinical Commissioning Groups – each covering a different area in England.

Now the government is dismantling the NHS into 44 so-called Integrated Care Systems that function as if the NHS is a business driven by financial considerations, not patients’ clinical needs.

This requires Clinical Commissioning Groups to set up and use a commercial insurance-based model within the NHS shell of Integrated Care Systems. This calls for a different set of skills and resources than Commissioners possess, so they are required to pay private companies to do the work for them.

The NHS England quango has a list of approved companies on their so-called Health Services Support Framework.

Companies on NHS England’s Health Support Services Framework

We have no idea how much money Clinical Commissioning Groups have paid these private companies since the Health Services Support Framework was set up a few years ago. We are asking all of them this question.

Spending £348.5m on management consultancy companies to tell the Department of Health, NHS quangos, Commissioners and Hospitals what to do

This usually involves paying management consultancy companies large amounts of money to say what bits of our NHS to cut.

Here is the Department of Health and Social Care Annual Report and Accounts 2018-19 Breakdown of management consultancy spending.

Update July 23 2020 Here’s some info about how a consultancy company extracted profits from the NHS that were spun into a venture capital company and from there into the coffers of Vote Leave Ltd, Boris Johnson’s leadership campaign and a pro-TrumpUK-US trade deal “think tank”

Restricting patients’ access to many kinds of NHS treatment and then making them available on a self-pay basis or in private clinics within NHS hospitals.

The Department of Health Annual Report and Accounts 2018-19 (p 168, Material Income Items) shows this cost private patients £614.4m.

In June 2019 CK999’s Chair Jenny Shepherd reported How ‘self-pay’ is shrinking the English NHS by stealth

“One hospital trust last week announced a ‘pause’ its controversial MyChoice scheme after an outcry. But Warrington is not alone in expanding such self-pay schemes. What’s going on?”

Update July 2020: As part of the post-Covid19 “reset“, diagnostic services are being privatised.

Somerset NHS Foundation Trust has contracted Rutherford Diagnostics to provide a Community Diagnostic Centre (CDC) in Taunton. The press release from Rutherford Diagnostics partner Philips Health UK states,

“In addition to providing services to NHS patients, the centre will be available to private medical insurance and self-pay patients in the South West.”

This is the first of five new community diagnostics centres across the UK that Rutherford Diagnostics and Philips Health UK are due to set up.

Update August 23rd 2020: FOI response is almost entirely redactions because of ‘commercial sensitivity’

An FOI request re the Rutherford Health & Somerset NHS Trust contract by medical student Ron M @quackophage yielded a big fat set of redactions:

“Almost all of what I’ve asked for has been redacted or simply not supplied. Of what morsels remain, it’s just another tale to add to the pile marked #NHSPrivatisation.”

The whole (redacted) contract is here. The redactions are justified on the grounds that the data are “commercially sensitive”:

Private equity – turning NHS services into “very high returns” for private equity companies and and their management teams

We have no idea of the profits private equity companies are leeching from privatised NHS services.  But here is one example. We have quite a few others.

How can it be right that private equity company Root Capital is profiting from our children’s mental health problems?

It is though.

Root Capital has funded XenZone with private equity since 2015.  XenZone produces and runs Kooth – an online counselling and emotional well-being online platform for children and young people aged 11-25. It is free at the point of use, paid for by many clinical commissioning groups as a privatised element of Children’s and Adolescent Mental Health Services (CAMHS).

RootCapital say they only invest when they see the potential to build a much larger business and sell it on at a profit:

“We invest up to £10m from our own funds into each company in our portfolio and become an involved and active business partner with the long-term aim of very high returns for ourselves and our management teams.”

Update 20.1.2022 A metastudy of mental health apps finds that data on their effecicacy is sparse

Transfer of services and functions to arms length companies, trusts and social enterprises

There are many examples of this – from the creation of Wholly Owned Subsidiaries, to the 2015 transfer of GPs’ Primary Care Support Services to Capita. In June 2022, NHS England gave Capita a £94m 3 year contract extension, despite Capita’s appalling performance. This has included patient-facing failures such as the loss of 400,000 clinical letters to GPs, missing delivery of hundreds of medical records, and mishandling the cervical screening programme by failing to send out letters to thousands of women.

Update 4.11.2022 And now the finance and procurement services of five hospitals trusts in Norfolk and Waveney Integrated Care System are to be combined and provided by an external joint venture company for 10 years.

The external joint venture company is NHS Shared Business Services, owned by the Department of Health and Social Care and French firm Sopra Steria. Sopra Steria is a Paris-based consulting and digital services company with fingers in many UK government and public service pies. As well as its joint venture with NHS Shared Business Services, Sopra Steria has a joint venture with the UK Cabinet Office: Shared Services Connected Ltd.

Sopra Steria also has a new joint venture, CeleScan, with the Institute of Cancer Research, London and The Royal Marsden NHS Foundation Trust. CeleScan aims to “revolutionise the MRI scanning process and help to accelerate disease diagnosis, including cancer.” The CeleScan Ltd Linked In page describes the Hemel Hempstead- based joint venture as a Medical Equipment Manufacturing company that

“has developed an ethical, AI-powered, deep learning technique for accelerating diffusion weighted MRI images… CeleScan represents a true cross functional collaboration of medical and technical expertise.”

Social impact bonds – a kind of Private Finance Initiative scheme for health and social services in deprived areas

The government is pushing a kind of PFI scheme for health and social services in deprived areas, despite the fact that so-called Social Outcomes Contracts are more expensive than publicly funded services and there is no evidence of better outcomes for service users over three years of the evaluation.

Having built a Social Impact Bond market in the UK, the government seems keen to export the model to so-called developing countries, as part of its post-Brexit trade strategy.

How it works is that a public sector organisation such as a cash-strapped local authority, invites bids for a so-called Social Outcomes Contract to provide health and social services in deprived areas AND to come up withthe money to pay for them.

These contracts are typically awarded to a third sector company that provides the health or social service, in “partnership” with a Fund Management Company that pays for it upfront via a Social Impact Bond.

This means the commissioning organisation doesn’t have to pay for the services. In addition, the Social Outcomes Contract payment depends on the service improving specific health and/or social outcomes, such as keeping children out of care. This saves the Council money and it passes on part of the savings to the Social Impact Bond investors.

But in reality, a Social Impact Bond is not in fact a bond, because if the service it pays for does not achieve the specified social outcomes, investors don’t get their money back.

It is just a financial instrument designed to generate money to invest in 3rd sector-run public services in deprived areas, to return profit to investors.

And if the service paid for by a Social Impact Bond doesn’t achieve the required social outcomes, the public sector organisation doesn’t get its share of any “savings” from achieving them.

Social Impact Bond contracts are more expensive than standard publicly funded contracts that pay on the basis of the service that is actually provided. A 2017 Guardian article reported that Social Impact Bond contracts could possibly be as much as 25% higher.

NHS capital investment can go straight to private companies

For example the £12m capital funding for Leeds Teaching Hospitals pathology Laboratory Information Management System will go straight to a digital technology company on NHS England’s Framework.

For example handing over diabetes patients’ education, support, access to life-giving kit and data to private companies. These companies’ new and poorly trained staff treat the delivery of a life-giving device the same as when private companies deliver a TV or a toaster.

Why privatisation is A Bad Thing

The profit motive gets in the way of the duty of care, reduces the cost of labour and the power of trade unions

Private companies cut corners for the sake of profit and give staff poor terms and conditions. This means staff can’t provide the quality of care they want to. Whether clinical staff or non-clinical staff like cleaners, caterers etc.

You have only to look at the hospital patients killed recently by listeria in sandwiches provided by a private company. This is being investigated by the Food Standards Agency.

If private companies and 3rd sector organisations can’t make money, they hand back the contract or go broke

Either way this means dumping patients and the NHS in it. Examples include Circle, which in 2012 won a high-profile contract to run the NHS Hinchingbrooke hospital in Cambridgeshire, but walked away three years later.

And Serco announced in 2014 that it would cease providing clinical services after problems with its deal to run Braintree hospital in Essex and its community care service in Suffolk led the company to hand back both contracts early.

One to One Midwives, a private, for profit company, contracted by the NHS in Liverpool, recently ran out of money and shut up shop, leaving pregnant women in the lurch.

Other examples of failed private sector contracts include non-emergency ambulance transport in Sussex, Hertfordshire and Bedfordshire, while companies running networks of GP surgeries in Doncaster and Bedford went bust, and others have handed back their contracts for GP surgeries and out-of-hours services.

In July this year a children’s hospice in Bury run by the charity Forget Me Not, had to close because it’s broke. This is the trouble with leaving vital services to be run by charities and voluntary section organisations – which NHS England intends will happen more and more, in a move back to the Victorian era.

The move of NHS and social care services to charities and the voluntary sector a big part of the NHS Long Term Plan for dismantling our NHS into 44 local Integrated Care Systems.

Update 30.4.2022 A Tussell Trust Report commissioned by the government has found that NHS Contracts with voluntary and community enterprises more than doubled from 2016-2020, increasing in value over the four years from £0.6bn to £2bn. You can download more information about this here:

The wasteful transaction costs of procuring and managing contracts

No one seems to know the true costs and if they do, they aren’t telling. But this is estimated at between 4-10% of the annual NHSE budget.

Loss of transparency and accountability

This is another bad effect of NHS privatisation,  due to the claims of commercial confidentiality.

Privatisation has also opened up the NHS to litigation by private companies that contest the award of contracts to NHS organisations – and have won huge damages.

Privatisation fragments the NHS and undermines its ability to pool risk effectively

Private companies mostly contract for the cheap services it’s possible to make profits from, leaving the NHS with the costly acute and emergency services bits.

This undoes the NHS as a comprehensive universal service and speeds the creation of a two tier system where those with money pay to go private, faced with increasing restrictions on patients’ access to treatments.

Privatisation enables corruption

The revolving door spins between NHS quangos and private companies. For example: former hospital boss and NHS England director Samantha Jones has been appointed the chief executive of the UK arm of international insurance firm Centene. This is only one of many such moves.

The most invidious is the career of Simon Stevens – boss of NHS England. He started out as an NHS advisor to Blair, then jumped ship to United Health in the USA before Cameron headhunted him to head up NHS England.

As NHS England boss, he has proceeded to install his former employer’s subsidiary Optum at the centre of privatised commissioning through Health Services Support and is imposing United Health/Optum’s model of Accountable/Managed care on the NHS.Former Health Secretary.

Alan Milburn is another egregious case.

The sale of NHS estate is part of a massive privatisation of public land

For example, Epsom and St Helier Trust have sold hospital land to Legal And General for development of retirement flats which apparently will include social care support for those who need it.

But this means the social care support will be limited to those who can afford to buy a “McCarthy and Stone type” retirement flat. What the f**k is that about? To those that have shall be given. What about all the people who can’t afford to buy a McCarthy and Stone type retirement flat?

The NHS Estate is for the benefit of everyone equally, on the basis of clinical need.

Now suddenly it’s for the benefit of those who have the money to buy a retirement flat.

Channelling public money into Public Private Partnerships for NHS capital funding comes at a big cost

It means the state doesn’t have to finance and pay capital costs upfront – but we know from the disastrous Private Finance Initiative history that these projects end up costing much much more than publicly financed projects, because of ruinous interest and facilities management costs.

We also know that they compromise safety and usability standards during the construction stage, because profit is put ahead of everything else.

What you can do to stop and reverse NHS Privatisation

Walk with James! Help carry his backpack! Sign his petition and tell your local media to come and report his walk and why it matters to local NHS campaign groups.

Say NO! to NHS privatisation – to your MP, your local Authority that is busily privatising social care and public health services, your local NHS organisations, your local media.

Demand Parliament enacts the NHS Reinstatement Bill

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