The latest unholy mess taking place due to the undemocratic, unnecessary and complicated Health and Social Care Act, is the ‘Fair Playing Field’, review being undertaken by the new NHS regulator, Monitor.
A nine-month process has now seen all the submissions handed in and each organisation is wondering what is going to be the result of the review, come the end of March, this year.
April the 1st is the time when the Clinical Commissioning Groups (CCGs) are due to takeover, from the Primary Care Trusts, abolished thanks to the new legislation. The ‘Fair Playing Field’ findings, which will conclude in time for this date, will mark the end of the NHS as we know it and increase the fragmentation of services across the country.
Social Investigations can now reveal a private healthcare group’s submission, which brings to the attention of Monitor the barriers the private sector perceive to achieve a Fair Playing Field, which include corporation tax, VAT, pensions and the NHS brand. The only problem is, this same lobby group were heavily influential in maintaining competition in the Health bill during the sham of a 'so-called 'listening exercise'. Furthermore, this same lobby group had previously met with the head of Monitor in a 'like-minded' meeting, bringing the impartiality of the review into question.
The NHS Partner's Network (NHSPN) is made up of private providers who provide NHS services and whose membership includes companies that include Care UK and Virgin Care. The submission made by the NHSPN was handed to Monitor in the early stages of the Fair Playing Field review last year, titled: 'NHS Partners Network response to Monitor's Call for initial submissions.'
On the subject of 'economic components', it states: '...to achieve any given post-tax rate of return, on an investment a corporation tax paying entity would have to charge higher prices than an NHS body or charity...the estimated average magnitude of this is that it now adds between 2% and 3% to independent providers.'
Monitor list 'tax asymmetries' as number four under 'Key Issues' to be looked at during the 'Fair Playing Field' review. As well as corporate tax breaks, the NHSPN have also suggested the review look at the impact of VAT, stating, 'while NHS providers can claim back VAT on certain contracted-out services, independent providers cannot do so.' In addition, public sector providers are at an advantage because of the 'attractiveness' of the pension scheme ', which according to the submission, creates a barrier to workforce flexibility.'
Part 'C' of the submission, asks 'What do we already know about the elements of a fair playing field?' The response from the NHSPN points toward an 'illuminating piece of independent work' done in 2009 by the Office of Health Economics, partly paid for by the NHSPN.' The study builds on a previous work conducted by the University of York, but as the NHSPN funded study 'summarises the York study', they chose only to attach the study they helped fund. The NHSPN is however adamant that the study remains unbiased, stating: 'The report was co-funded by the NHS Confederation and the report itself makes completely clear that it was wholly independent. It went through OHE's normal peer review processes.’
In addition to providing this study, the NHSPN submission tries to weaken the element of public sector training and medical education, which is provided by the NHS. 'Most NHS education and training is 'funded centrally and separately from the main provision of care budgets and this does not therefore directly impact on the fairness of the playing field in the market'. However, as Mr Worskett admitted in a reponse to Social Investigations, when asked why this should be left out he said,
'We do in fact recognise there is a legitimate discussion about medical education and training but there is a need for a much fuller and longer analysis of the issues before any conclusions can be reached.'
This is followed by a bullet point that states: 'A significant (but not yet quantified) proportion of independent providers do now participate in NHS education and training, in some cases at no cost to the NHS, and while this is doubtless only a small proportion of the whole, it must not be overlooked.'
A further disadvantage the lobby group highlights, is in the 'NHS' itself. Under a heading 'The impact of the NHS "brand"', they state, 'studies of the deregulated utilities markets have suggested that one problem, in developing a fairer playing field, was customer familiarity with and loyalty to the ex-public sector incumbent brands. There is a possibility that similar responses might work unfairly to the disadvantage of independent providers in the NHS market...'
Monitor are meant to be impartial, but the discovery of an internal memo written by NHSPN director, David Worskett reveals both he and Monitor chief, David Bennett met during the Health bill 'pause' under the auspices of free market think tank, Reform.
The document, which was discovered by research blog, Social investigations, was an update informing the groups members on the lobbying that had taken place during the so-called 'listening exercise'. Mr Worksett informs his members how: 'I had a second lengthy meeting...under the auspices of "Reform", with only a handful of other (all like-minded) people present, including David Bennett, the chair of Monitor. He has also consistently taken the same line as us throughout.'
Furthermore, the same memo informs us how David Worksett 'coordinated' the position of the NHSPN during the pause, 'carefully with Monitor...' When asked what this position was, the NHSPN claimed it was 'to establish that Monitor, like us, had not seen the introduction of competition as an objective in its own right but, instead, as a means of improving quality of care for patients.'
David Bennett distanced himself from the comments saying: ‘The comments made are the opinion and conjecture of Mr Worskett and Monitor cannot be held responsible for these. Mr Bennett did attend the same meetings as Mr Worskett during the NHS listening exercise but at no time has he referred to himself as a ‘like minded’ person to Mr Worskett. Similarly there was no coordination of position between Monitor and the NHS Partners Network. ‘
David Bennett's bias was brought into question previously when a FOI revealed an email from an unnamed McKinsey executive from May 2010, suggesting it was exploiting its privileged access. It stated: “We have been gathering our thinking on the implications of the new Government programme for the NHS (and) have started to share this with clients. Would you like to meet to discuss it?” The recipient of the email was David Bennett.
None of this would have been necessary if it hadn’t been for the Health and Social Care Act. The manner in which the services are being sold off, serves only to fragment services and pit providers against each other. David Bennett was a former senior partner at McKinsey & Co, the architects of the £20bn savings that are being justified to sell off large chunks of the NHS. The ‘Fair Playing Field is about to launch the NHS into a brave new world, and what’s the betting the outcome will favour the private sector?
1. NHS Partners Network - Who are they? here
2. Unedited document of lobbying by NHS Partners Network here
3. Statement from NHS Partners Network on Telegraph article - here
4. The Telegraph, the Think Tank and a Very Dodgy Business - here
5. Unedited response to questions related to above article from NHS Partners Network here