Thursday 23 August 2012

Reform - Setting the Agenda with Unknown Others

Reform is a right-wing think tank that claims to be ‘independent’. Like many think tanks they have charity status, although when you look at their work, it is hard to see where the charitable part exists. They are setting the agenda for our public services in meetings that only they know who was in attendance.

Reform has and continues to be influential in the attacks on the NHS. A document written by the health lobby group the NHS Partners Network revealed Reform’s involvement in setting up meetings with key players of the NHS Future Forum and Monitor during the ‘health bill ‘pause’.

Reform were part of an ‘orchestrating of the Telegraph’s editorial during the Health bill ‘pause’, working together with the director of the NHS Partners Network, David Worskett.

Collaboration between the two makes sense when you look at their ties to the private healthcare industry. The NHS Partners Network has several members who have MPS and Lords on their payroll. These include Circle, who pay Mark Simmonds £50,000 a year for 10 hours a month as a strategic advisor. Another company are Care UK, whose owner, John Nash, donated money to run Lansley’s office when he was shadow health secretary.  Furthermore Care UK were purchased by Bridgepoint who have BBC Chief, Lord Patten of Barnes as an advisor.

Corporate partners
Reform, who remember are a ‘charity’, have multiple healthcare companies as their corporate partners. Current members are:  ABI, Aviva, Balfour Beatty, Benenden Healthcare Society, Bevan Brittan, BG Group, BVCA, Cable & Wireless, Capita, CH2M Hill, Clifford Chance, Citigroup, The City of London, Ernst & Young, GlaxoSmithKline, G4S, GE, General Healthcare Group, HP, ICAEW, KPMG, Maximus, McKesson, MSD, Optical Confederation, PA Consulting Group, Serco, Sodexo and Telereal Trillium.

General Healthcare Group own BMI Healthcare who are the UK’s largest hospital group. When Circle produced a press release showing how they have managed to ‘turnaround’ Hitchingbrooke hospital, Reform were very quickly onto the case promoting the need for more hospital outsourcing. This is also because their Head of Communications, Nick Seddon used to do PR for Circle. He has since been replaced by Andrew Lansely’s former aide Christina Lineen.

One can’t help wonder what is charitable about this.

Further connections are available to Reform through Lord Carter who acts as Chair for McKesson Information Solutions Ltd, which delivers IT to “virtually every NHS organisation”. Lord Carter is The head of the increasingly influential Competition and Cooperation Panel. McKesson released a statement on this potential conflict of interest to the Guardian, stating: "Lord Carter steps down from any investigation where there is potential conflict of interest.”
Reform are also invited to meetings where minutes are not taken with Parliamentarians present. In April this year, as the government were in their so-called ‘listening period’, Reform hosted an event with Lord Warner as chair.

Lord Warner is a former adviser to Apax Partners, one of the leading global investors in the healthcare sector. Current director of Sage Advice Ltd. He works as an adviser to Xansa, a technology firm, and Byotrol, an antimicrobial company, which both sell services or products to the NHS” and was “paid by DLA Piper, which advised ministers on the £12 billion IT project for the NHS” projects that he was responsible for when he was a government minister.

The meeting was held under Chatham House Rules, which are a near century old rule that are used to supposedly allow participants to speak freely with fear of their words being highlighted in the media. What it means is that the public have no idea what was said as no minutes are taken and none of the participants can announce to the public who was there. Therefore information that comes out from these meetings is controlled.

Even so, despite this, thanks to a post-meeting feedback by Comunications head Nick Seddon, we know that competition was on the agenda, and that there will be a need for ‘constant political pressure if either competition or integration is to be achieved.’ Not only that, but true to their partners needs, hospitals were discussed and it was considered that: ‘Dealing with failing hospitals will either be through outsourcing, radical reconfiguration, or closure.’

Reform like using Chatham House Rules, which says much about their attitude towards transparency. In February 2012, they held another meeting without minutes, which spoke of the need to reform ‘fast and at scale.’ Thanks to the introduction, we know that Julian Le Grand was in attendance. In the same month, In a letter to the Guardian, in February this year, Mr Le Grand, stated: ‘With respect to the NHS bill, it is important that even those who generally prefer to rely upon their instuitions should avoid muddying the waters by accusing the bill of doing things that it does not, like privatising the NHS.’

Thanks to their feedback, we know that they spoke about whether there ‘should any areas of public service delivery be off-limits?’ The answer to this being, ‘in principle…“no”’. A further idea was the need to ‘go back to the idea behind Compulsory Competitive Tendering’. This former Conservative policy was introduced in the UK throughout the 1980s, but was dropped following resistance from local authorities and health trusts. The policy focused on price at the expense of quality and employment conditions, leading to a demoralised staff, that this should be being discussed a possibility is very worrying indeed.

So we know that Reform were holding meetings without minutes with key figures, though who many of them were remains unknown. They were part of the ‘orchestration’ of the Telegraph’s editorial, and were heavily promoting the benefits of outsourcing hospitals of which one of the corporate partners would be a beneficiary. They continue to push for the further role of private companies in the NHS many of whom are the partners and are linked to our so-called public servants. They call themselves a charity, which is patently absurd, and if we are to call ourselves a democracy, the use of organisations like this must not use the Chatham House Rules, which are used widely across political organisations.

Keep an eye out they are influencing the future of our public services.


  1. From this Monitor document:

    produced by Frontier Economics and the Boston Consulting Group for Monitor: "A study investigating the extent to which there are economies of scale and scope in healthcare markets and how these can be measured by Monitor" - Final report August 2012

    on page 20:
    "considering whether A&E facilities really require support services that only a full-scale hospital can provide, given emerging models of stand-alone A&E facilities.. “

    (What use is a 'stand-alone A+E' with no consultants and services to call on if needed)

    On page 86 are the caveats for ideas about how to save money in the new A&E "market":

    "Equipment: prices of equipment have been obtained using web searches and have normally been converted from prices in US$. If anything, we expect that these are prices are lower than prices obtained by a standard NHS trust and so would lead us to underestimate the degree of economies of scale…
    "Drugs and medicines and medical supplies: it has not been possible to specifically check the cost of drugs, medicines and medical supplies used by an A&E department. However, based on discussions with experts we believe they are in the right ballpark.
    "Nurse practitioners: our model is based on current best practice use of junior doctors. We understand that there is a move towards using more nurse practitioners instead of junior doctors. This is unlikely to significantly affect results as rates of pay are similar.
    "Highly qualified nurses: our model is based on current best practice use of middle grade doctors. We understand that there is a move towards using more highly qualified nurses. This is unlikely to significantly affect results as rates of pay are similar."

    - nurses are to be used instead of junior and mid-range doctors, although this won’t save money because nurses are paid the same as doctors;
    - savings on NHS equipment, based on US prices quoted on the internet that they “expect” are lower than what the NHS pays although they don’t actually know what the NHS spends on equipment;
    - savings on drugs and medical supplies, although they don’t actually know what the NHS spends, but they “believe they are in the right ball-park”
    - for savings in pathology, prices are “assumed” based on advice from un-named experts
    - they “believe” their advice is right because they talked to experts although they do not know the actual cost of drugs and medicines and equipment used in A&E.
    - A&E needs to be guided by US practices to save money – but in the US, healthcare is twice as expensive as the NHS.
    - A&E doesn’t need to be centralised in hospitals but could be done from “stand-alone” providers

    But will nurses work out as more expensive because they spend longer seeing patients than doctors do and their full working week is shorter than doctors'?
    Nurses are not trained in diagnosis as doctors are so if they see unselected patients on their own without close supervision - is this acceptable to the general public? What if their are mistakes? Massive hike in Personal Injury claims against private providers, paid for no doubt out of NHS coffrs but not by private providers who will make sure that they are not liable in their contracts.

    What use is a 'stand-alone A+E'? No other consultants and services to call on as required?

    Suggestion on p 62 that the US is the example to follow in price (twice that of any other country) or quality - with the worst mortality in the western world and 50 million with no health cover, relying on charity and 60 per cent of bankrupcies due to healthcare bills?


  2. They won't stop unless they are stopped - thank you for posting this.


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