ME and the new corporate controlled NHS: Greg Crowhurst

ME and the new corporate controlled NHS

by Greg Crowhurst

02 September 2008

Be aware that corporate-controlled service delivery and commissioning governed by the principles of the health insurance industry is being rolled out across the UK at something approaching lightening speed. For Myalgic Encephalomyelitis (ME) patients it does not get worse than this.

Take APMS Contracting for example.

Alternative Provider Medical Services (APMS) is a contractual arrangement which allows for Primary Care Trusts (PCTs) to commission GP services from a range of providers, including the private sector. This means that neighbourhood GP surgeries are now forced to compete for business up against the multinationals.

GP’s simply cannot compete, not even it seems for the smallest practices. In January this year , the GP contract in Camden and Tower Hamlets were awarded to the huge US company United Health and the multinational software firm Atos Origin, after local GPs were outbid, despite scoring higher on their service quality proposals.

Pulse magazine, the doctor’s journal has highlighted a dramatic rise in the number of PCTs in 2008 inviting bids for APMS contracts. Up and down the country GP practices are passing into the hands of companies like Virgin, Boots, United Health, with fewer controls over the quality and amount of care that is provided. Monitoring is “light touch” and clinical information is likely to be “commercially confidential”. Privately run Health Centres are set to open up in every town in the country, vaguely financed by a combination of Private Finance Initiatives (PFI) and a kind of PFI called NHS LIFT.

PFIs have attracted much criticism for their drain upon the public purse as Allyson Pollack (Guardian June 11 2008) reveals : “…until recently the true scale of the profits has been hidden from view with “commercial confidentiality” exemptions being invoked in response to freedom of information requests. The recent release of the Royal Infirmary Edinburgh and Hairmyres hospital contracts in Scotland and their analysis by Jim and Margaret Cuthbert show shareholders will reap dividends of £168m on an equity stake of £500,000 for the infirmary, and £89m on an equity stake of £100 for Hairmyres hospital – rich rewards for so little risk.”

Of major concern to ME sufferers in the UK is the fact that a private LIFT company could well be responsible for their clinical services; the outlook is grim:

GPs, employed on short-tern contracts by a large corporation are unlikely to have the same commitment or knowledge of their patients that a traditional GP working in a local practice presently does.

Private companies are concerned with making a profit; people with a long term chronic disease like ME, those who are housebound, may find that they receive no service, as Alysson Pollack explains : “The commercialisation of services leads to the blurring of boundaries about the funding and responsibilities of care; once NHS services have moved into the commercial sector there will be no limits on what the private sector can charge for: boutique care for those who can pay, and small-print restrictions for those who cannot. ”

Dr Kalish Chand (The Guardian Aug 28 2008) warns : “A practice with the shareholders’ interests at the fore may be tempted to cream off the fit and well from their patient list, leaving the vulnerable and chronically ill with their loyal, less well-resourced practice. As that practice is squeezed by falling resources and rising care demands, they may ultimately have to rely on health professionals recruited from abroad on short-term contracts. So continuity of care, which patients value most, will be lost.”

Private companies are already cutting back on GP input, by employing nurses, healthcare assistants and even receptionists to do some of their work.

These developments are taking place within the context of a stripping away of mechanisms for public accountability as Pollack explains “…public and staff protests have gone unheeded, and judicial reviews have merely delayed the market process…Voters face a dilemma: the temptation is to punish Labour at the ballot box, yet the Conservatives’ health proposals, published last October, advocate the abolition of the secretary of state’s unqualified duty to provide a universal health service.”

Meanwhile under the Framework for Procuring External Support for Commissioners (FESC); PCT’s are being “encouraged” to buy advice from 14 selected private companies : these are : Aetna; Axa PPP; BUPA; CHKS; Dr Foster; Health Dialog Services Corporation; Humana; KPMG LLP; McKesson; McKinsey; Navigant Consulting; Tribal; UnitedHealth Europe; and WG Consulting; these FESC commissioners look set to award lucrative contracts to each other, a process known in industry circles as “co-opetition”, states Stewart Player (Access to NHS Primary Care – for Patients or Business?

It adds up to patchwork privatisation of the NHS on an unprecedented scale. This “is deeply worrying because privatised healthcare tends to cost more; accountability suffers; the fog of ‘commercial confidentiality’ makes scrutinising public spending impossible; the profit motive encourages ‘cherry-picking’ of the lucrative work, ultimately leading to NHS services being cut.” (“The Patchwork privatisation of our health service : a users’s guide” Keep our NHS Public)

Allyson Pollack adds: “We are never told about the impact of the market or how the huge injection of cash into the NHS is being diverted into marketing, billing, invoicing, chief executive-level salaries, profits, shareholders’ returns and bank dividends. Nor is the public told how budgetary controls that made the NHS the most cost-efficient health system in the world are being dismantled in the rush to market.”

Having suffered so much at the hands of the medical insurance industry already, the ME community perhaps know better than most what to expect from uninhibited corporate interest, where would we be today if we had not fought back so hard all these years?

It is time to ratchet up the pressure.

These developments are by no means inevitable – yet. Lobby PCTs not to go down this route, organise petitions, use the local press, above all, as Keep Our NHS Public urge: “Demand the government rewrite the legislation and laws which allow companies to come in and take over our NHS for the first time in 60 years.”

Helen Keller once bravely said : “I will not refuse to do the something I can do”.


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