‘The whole point of our NHS reforms,’ David Cameron said, is ‘to put the power in the hands of local doctors, so that they make decisions based on what is good for their local area.’
That is tosh. Yes, most of the NHS budget was handed to GPs, who are now – phase 2 – handing it over to private corporations.
It is private firms who will determine how and where the NHS budget will be spent (through a process known in NHS speak as commissioning).
Everything from deciding which hospitals stay open, which services are still available on the NHS, and who provides these services, the NHS or the private sector.
As the Observer reveals this morning, the list of approved suppliers bidding for this work – the planning and buying of care – has just quietly been released.
The list is dominated by management consultancies, outsourcing giant, Capita, and US health insurer, UnitedHealth, the previous employer of NHS CEO, Simon Stevens.
(The graphic above is this list broken down into main suppliers. A high res version is here).
Last year, Spinwatch uncovered how UnitedHealth’s lobbyist, Chris Exeter, chaired a discreet forum, the Commissioning Support Industry Group, giving these firms regular privileged access to senior NHS officials overseeing the creation of this new market in ‘commissioning services’.
Capita was another member of the group, as were KPMG, PwC, EY (formerly Ernst & Young) and McKinsey.
There are nine consortia set up to ‘supply’ local health purchasing decisions. UnitedHealth, Capita, KPMG and PwC are now approved suppliers to two thirds of them. McKinsey and EY are suppliers to half of them.
These companies (and others) will supply GP commissioners with key services that have until now been done by the NHS for the NHS: planning services; managing relationships and contracts with healthcare providers, like hospitals; and crucially deciding what the NHS will look like in the future – what NHS England calls ‘transformation and service redesign’.
GP groups will be forced to re-procure a lot of these services by April 2016 (apparently in order to comply with EU procurement law). It is thought that, consequently, between £3-5billion of services will be bought through these consortia.
The privatisation of commissioning hands the private sector more power, more influence and potentially a lot more of the NHS budget.
It also presents potentially huge conflicts of interest, with private companies like United Health bidding to take charge of local health budgets at the same time as it is increasingly looking to provide the healthcare those budgets pay for.
UnitedHealth, for example, is bidding for the biggest privatisation in NHS history, Staffordshire’s £1.2bn contract to run cancer and end-of-life care. Are rules in place to prevent any conflicts of interest?
The approved list of suppliers also includes a number of commercial lobbying firms working for private healthcare clients seeking to make money out of the NHS.
Take commercial lobbying agency Hanover, which is part of a consortia led by UnitedHealth. Hanover’s head of health is lobbyist Andrew Harrison, a former aide to Labour’s privatising health secretary, Alan Milburn and an ex-colleague of the man currently holding the NHS purse-strings, Simon Stevens.
Hanover has been UnitedHealth’s lobbying agency for years. Another recent client is HCA, the huge private hospital operator that had to pay $1.7bn in US fraud settlements in 2003. HCA has a few ‘joint ventures’ with the NHS, but wants more. Hanover also bends ministerial ears on behalf of the US pharmaceutical lobby group, the American Pharmaceutical Group. Another long-standing client is Alliance Medical, which paid ‘cash-for-access’ Tory MP Malcolm Rifkind to sit on its board and recently won an £80 million contract to run cancer scans across England (despite a rival NHS group claiming their bid was £7 million cheaper).
Hanover, which as an approved supplier is now in line to provide “communications services” to local health bosses, already serves a number of NHS bodies. It provides the NHS Cancer Screening Programmes with ‘reputation management’, and advises on ‘managing relationships with key stakeholders’, for example.
Hanover aren’t the only commercial lobbyists on the list faced with potential conflicts of interests.
Engine is in another of the private sector consortia, MBED. Engine is actually a group of communications companies, which includes lobbying agency MHP. The firm has long been a favorite of healthcare companies. Until recently, their star turn was Bill Morgan, who was Andrew Lansley’s right-hand man.
MHP’s roster of clients contains all the big names in pharmaceuticals, and some drug-funded health charities. Since 1999, Engine has also worked for Bupa, including providing the private health company with ‘business consultancy’ and support for its e-Health programmes (using computers to both collect health data and provide healthcare and monitoring).
Global business consultants FTI Consulting are a part of half of the consortia that GP local health bosses will now be encouraged to use.
FTI claims to have years of experience creating campaigns to ‘protect clients’ political and policy interests’. Who they lobby for in the UK isn’t known, but in the US clients include the lobby group for the private health insurance industry, America’s Health Insurance Plans; the Biotechnology Industry Organisation; and the health insurer AXA. In Brussels, FTI stands up for private health insurer, Prudential; lots of pharmaceutical companies, plus the European Association for Biotech industries.
Then there’s EY, formerly Ernst & Young, another global consultancy firm that is poised to help direct how and where the NHS spends its money. EY are – you guessed it – lobbyists for private health companies. EY has just registered Prudential as a client on the UK’s new register of lobbyists. The Pru is also a US lobbying client, as are Zurich and AIG; Pfizer; and every NHS-leader’s favorite US healthcare firm, Kaiser Permanente.
PwC, which is a supplier to most of the consortia, has registered itself on the UK’s register of lobbyists, meaning it lobbies ministers on behalf of (as yet un-named) clients. PwC is looking to increase its position in what it sees as the UK’s growing, commercial market in healthcare. ‘The health industry in the UK offers strong opportunities for growth in the wider economy and for PwC,’ said chair of PwC’s advisory board, former health secretary, Alan Milburn.
McKinsey, a supplier to five of the groups on offer to GPs, earns most of its revenue from advising corporations: health insurers, private hospital groups, pharmaceutical companies, tech interests and investors. Emails show that it was sharing its thinking on the implications of the Coalition’s NHS reforms ‘with clients’. Who they are, and what McKinsey does for them, though, is confidential. McKinsey also appears to act as a bridge between the public and private sectors. More documents show the consultants connecting London’s health officials with one of Germany’s largest private hospital chains to discuss ‘potential opportunities’ to take over public hospitals in the capital. McKinsey also advised them how to minimise public resistance to the privatisation of hospitals: start ‘from a mindset [of] one at a time’.
Then there’s KPMG, a supplier of services to six of the nine approved groups. Official spending data shows how much work has already been sent KPMG’s way by the NHS-led consortia. From September 2013 to March 2014, it picked up £3.5m from them. One group on the list, the Arden & Greater East Midlands Commissioning Support Unit (GEM) paid KPMG over a quarter of a million pounds a month in the first six months of 2014 for services, including work on a £500k ‘enhanced analytics’ project, and supporting ‘specialised commissioning’.
KPMG has itself subcontracted some of this work to UnitedHealth (via another unnamed company), according to a Freedom of Information release. There is no contract between GEM and UnitedHealth, showing just how opaque this new system is with its corporate supply chains, but NHS-front.
At the same time, KPMG is engaged with the private healthcare sector. Addressing a conference of healthcare companies and investors in New York in 2010, Mark Britnell, head of KPMG’s UK health division, spoke of the private sector opportunities presented by the UK’s health reforms: "The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years," he advised the attending companies.
Britnell was speaking a year into his job at KPMG, which he joined from the Department of Health where he was director general in charge of commissioning. Britnell was the architect of what we see today: the privatisation of commissioning.
Back in 2010, the BBC reported the Coalition’s reforms of the NHS as 'handing funding powers to GPs'.
And now they are being told to hand it to the private sector. These corporations will determine what the NHS will be like for future generations.
The foxes have control.
The parties all have different positions on lobbying transparency. Which is the best, and which the worst? (Updated)
Whoever wins the election, lobbyists will be first in line with the congratulations.
And those with the best political connections to the next party, or parties, in government will be at the front of the queue.
They'll all have questions: will the newly-elected government honour its public and private pledges; will the lobbyists get what they want from any coalition negotiations; which policies – privatisation, fracking, free schools – will be sped up, slowed down, or scrapped by the result?
Lobbyists are paid to be on top of the detail, and to be first to have a quiet word.
Whether or not we will be allowed to know anything about any of this lobbying post election will be dependent on how we vote.
The manifestos are out, and the parties all have very different positions when it comes to opening up lobbying to public scrutiny.
We’ve ranked them from good to bad.
- The Green Party comes out top. It has long supported a robust register of lobbyists, and its 2015 manifesto includes a pledge to ‘ensure that all lobbying, and in particular corporate lobbying, is registered and fully disclosed, including lobbying of elected politicians and of civil servants’. It also says they’ll get rid of the government’s Lobbying Act, which introduced a fake register of lobbyists while restricting campaigning by charities.
- Plaid Cymru is another that is pledging to repeal at least the bit of the Lobbying Act that gags charities (it also needs to get rid of the section introducing the register of lobbyists, and start again, so bad is it). It also says it will 'ensure that the lobbying system is genuinely transparent with appropriate access to all', which sounds like a dig at the current fake register introduced by the Coalition.
- Thin on detail from the SNP, but a clear statement in favour of transparency. Its manifesto says the SNP will 'support strict rules on lobbying'. Like the other opposition parties, it would also do away with the recently imposed restrictions on campaigning charities.
- Labour also promises to repeal the Lobbying Act, and ‘replace it with a tougher statutory register of lobbyists’. The important word here, though, is tougher. Not tough. Labour’s proposal only goes halfway to solving the problem. It is good in that it has pledged to force all paid lobbyists to register and operate in the open, rather than the small fraction covered by the Coalition’s newly launched register. It is bad, very bad, though, that Labour’s version of a register of lobbyists will not require lobbyists to divulge anything of their lobbying activity, in other words, who they are lobbying in government and what they are lobbying for. Under Labour’s proposals, we will be able to see lobbyists running around Westminster, but the sound will be turned off. (A clear ban on MPs holding paid directorships and consultancies is an additional and welcome pledge).
- The Lib Dem’s position is vague and not helped by its track record on the issue. The Lobbying Act is proudly listed in their manifesto’s ‘Record of Delivery’: a law that was memorably called a ‘dog’s breakfast’ by one senior politician; which ‘brought Parliament into disrepute’ and ‘showed contempt for the public’ as it was whisked through the House by Lib Dem minister Tom Brake; and which introduced a bogus register of lobbyists. This much, at least, is partly acknowledged in the manifesto, which commits them to ‘strengthening and expanding the lobbying register’. A further pledge to give careful consideration to a review of the rest of the Lobbying Act, with its attack on charities, suggests that it wasn’t their proudest moment. Finally, the Lib Dems have said they would ‘prohibit MPs from accepting paid lobbying work’, which strictly speaking MPs are already banned from doing under existing rules.
- The Conservatives are making no more promises to ‘sort it out’, lobbying that is, as David Cameron did in the run up to the 2010 election. As far as they are concerned, it's sorted. ‘We addressed public concern about the influence of money on politics, with a law that established a register of consultant lobbyists’. Anyone still a bit worried? Deal with it. The manifesto goes on: ‘We will continue to be the most transparent government in the world,’ which starts to make them sound deluded. Given that the Tories introduced a genuinely fake register of lobbyists, and only then after one too many lobbying scandals, it is blindingly clear now – if for a moment it wasn't 5 years ago – that the Tories are opposed to lobbying transparency. They do not want us to see who is lobbying them, or about what.
- UKIP appears to have nothing to say on lobbying transparency.
The battle is on for the future of the NHS. Apparently. Ed Miliband came out hard, declaring he will ‘put patients before profits and stop the privatisation’. David Cameron’s camp countered with a commitment to fully fund the next wave of NHS reforms.
Like pro-wrestling, it’s a good show, but a phoney fight.
How can you tell? Just look at the players sitting round this table.
When Milburn was in charge of the NHS from 1999 to 2003 he pushed through many of the ‘reforms’ that the Conservative party have merely accelerated. His team at the time consisted of policy adviser Simon Stevens; private secretary Tony Sampson; and media adviser, Andrew Harrison.
With little fanfare, Westminster’s official Register of Consultant Lobbyists has launched. It was a rather muted and low-key affair considering the high-profile stories and scandals we have witnessed in relation to lobbying over the last few weeks.
We have seen The Guardian revealing that nearly 20 per cent of staff members employed by MPs and peers also have lobbying or outside interests. The tobacco industry has been trying to influence the recent vote on plain packaging. And then of course there was the Channel 4 Dispatches 'cash-for-access' documentary featuring Jack Straw and Sir Malcolm Rifkind.
Meet the shadowy team at the heart of many of the most controversial NHS privatisations to date, including the Staffordshire deal leaked last week to openDemocracy.
'Despite our warnings about the risks... no one has been held accountable for the consequences.'
That was the fierce criticism last week from watchdog Margaret Hodge MP and her Public Accounts Committee of the failed flagship privatisation of Hinchingbrooke hospital.
No-one can hold Circle Holdings accountable. On the day inspectors gave the hospital they were running, the worst rating for ‘caring’ of any hospital in the country, the firm announced they were giving up and walking away, three years into the ten year contract.
The UK register of lobbyists has finally launched, only five years after Cameron and Clegg promised to 'regulate lobbying through introducing a statutory register of lobbyists’.
The government’s version of the register does nothing of the sort. It is a genuinely fake register. It will not ‘make clear who is lobbying the Government and for whom’, so ‘ensuring greater transparency’ in our political system, as promised. This is government ticking a box.
Even so, we were curious to find out what the register looked like 24 hours after ‘launch’. You can find it here.
So far, 11 lobbying firms have signed up; listing a total of 23 clients.
Organisers of a major pro-Israel conference taking place in London this weekend have been vetting the political views of those registered to attend - and banned me from attending, explicitly citing Spinwatch's 2013 report on BICOM (the Britain Israel Communications and Research Centre) as the reason.
As a researcher examining the pro-Israel lobby in the UK, I signed up to attend, making no attempt to conceal my identity.
But those behind the 22 March 'We Believe in Israel' conference, staged by a body of the same name which declares itself the 'grassroots' arm of BICOM - the UK’s major pro-Israel lobby group - wrote to me to say my “application” to attend had not been accepted.
Conversely, organisations with links to the transnational Islamophobia industry appear to have been welcomed with open arms.
According to its self-description, the event (expected to attract up to 1,500 people) will be 'broad-based and inclusive' and 'open to anyone, Jewish and non-Jewish, and from across the political spectrum, who supports the right of the State of Israel to live in peace and security'.
But I appear to have been designated persona non grata because I believe that peace and security need to be sought by investing in justice, not hasbara (propaganda), and will only be achieved when the Israeli state ceases to trample over Palestinians’ human, political and civil rights.
The refusal letter I received cited Spinwatch's report 'against' BICOM, a reference to "The Britain Israel Communications and Research Centre: Giving Peace a Chance?”, published in 2013.
That study was indeed highly critical of BICOM. It concluded that its activities serve only to 'encourage a skewed perception of the conflict amongst elites' by maintaining the façade that Israel is struggling to make peace while simultaneously “insulating them from pressure to support Palestinian rights” (in line with the desires of its main funder, billionaire Poju Zabludowicz).
In the run up to a parliamentary vote that saw overwhelming support for introducing standardised (plain) packaging for cigarettes, tobacco companies and their supporters made frantic attempts to influence public and political opinion against the policy. Since the very first calls for plain packaging, the tobacco industry has waged what is arguably its most virulent battle in recent years against the regulation of its business. It has employed a multi-faceted campaign to influence both public and political opinion, recognising that the former influences the latter.
Malcolm Rifkind and Jack Straw were unlucky enough, or silly enough, to get caught. But just because hundreds of MPs and Lords have paid jobs advising companies, doesn't excuse them. It makes it worse.
When the MPs expenses scandal broke in 2009 the immediate defence of many MPs was that what they were doing was all 'within the rules of Parliament'. But that didn't make it right. Nor did it alter public opinion. It took a while for the penny to drop, but finally, MPs realised that their behaviour - moat cleaning, duck housing, wisteria trimming, second homing all on the public purse – was unacceptable to the wider public. Finally, the bubble burst.
Today, we have arrived back at the issue of MPs and their second (third, fourth) jobs. The two MPs at the centre of the sting, Malcolm Rifkind and Jack Straw, both lawyers, conducted their own defence this morning. Both appear to be using the same playbook. It goes something like this:
- 'Anything I said I would do has been taken out of context and anyway, it's all perfectly innocent.'
From the few clips released by the programme makers ahead of tonight's Dispatches, I suspect this defence will fairly rapidly fall apart as the undercover films are aired. Some of it is truly shocking, whether Jack Straw's 'charm and menace' tactics, or Rifkind who is clearly under the impression that he doesn't have a job or a salary as an MP.
The Telegraph is committing 'a form of fraud on its readers'. That is the damning verdict of journalist Peter Oborne, who until yesterday was the Telegraph's chief political commentator. Why? Because, according to Oborne: 'It has been placing what it perceives to be the interests of a major international bank above its duty to bring the news to Telegraph readers.'
Oborne accuses the paper of deliberately suppressing stories about HSBC's involvement in tax dodging in order to keep the bank's 'extremely valuable' advertising account.
‘It has long been axiomatic in quality British journalism that the advertising department and editorial should be kept rigorously apart. There is a great deal of evidence that, at the Telegraph, this distinction has collapsed,’ he wrote in an article explaining why he quit on the OpenDemocracy website.
Oborne said the paper had discouraged stories critical of HSBC since the start of 2013, when the bank suspended its advertising with the paper following a Telegraph investigation into accounts held with HSBC in Jersey. He said one former Telegraph executive told him HSBC was ‘the advertiser you literally cannot afford to offend’.
Interference by management in stories about the bank was happening ‘on an industrial scale’ according to Oborne. Last week amid front page splashes and an international outcry over HSBC’s latest Swiss tax transgressions, ‘you needed a microscope to find the Telegraph coverage’ he said. Another article written last year by the paper’s former banking editor about a £70bn capital ‘black hole’ in HSBC Hong Kong’s accounts, had mysteriously disappeared from the website. And an attempt by Oborne to publish a story on HSBC’s sudden closure last summer of bank accounts belonging to well-known British Muslims came to naught – with an executive eventually admitting to him that ‘there was a bit of an issue’ with HSBC.