Unanswered questions about the Health Bill

Tory peer, Earl Howe  has had these since October and has not yet addressed a single one .

Journalists, patients, anyone … can ask them of their MPs/adopted Lord, GP, hosptial specialist, local GP Commissioners, etc.

1. How does Earl Howe explain the comments he made at the Laing & Buisson Independent Healthcare Forum on 7 September (during the 3rd Reading) in which he informed the audience of private sector providers that there were big opportunities for them to make money by taking patients away from the NHS?

2. What safeguards are to be put in place to prevent private equity companies from taking a stake in NHS ex-employee buyout “social enterprises”, gearing them up [raising loans against them and extracting the principal, a standard asset-stripping manoeuvre], extracting the cash and dumping the remains once no more income stream can be extracted?  i.e. the Southern Cross story?

3. There are sections of the Bill which pertain to property transfers (134, 299, 300 and Schedule 23), but none of them mention the value at which land and buildings may be transferred under their provisions.  What safeguards are in place to prevent NHS land and buildings being transferred at undervalue?  Can Earl Howe guarantee that these transfers will not take place for a nominal sum?  The Bill contains no provisions for public scrutiny of such transactions involving the Secretary of State and “qualifying companies”.  How will public oversight be arranged for this?

4. Several of the US companies which are hoping to come in to the NHS as either providers or commissioners have been in trouble for defrauding the US government.  What safeguards will be put in place to stop them applying the same low business standards to their dealings with patients, GPs and the UK government?

5. One large company which has been lobbying for access to the post-reform NHS is a South African company [Netcare, parent of General Healthcare Group] which was found guilty of removing the kidneys of minors and selling them. What “fit and proper person” tests are to be applied for the new entrants to our state-funded health system? Will the general public be allowed to lodge protests against particular providers who seem to have demonstrated themselves not to be fit and proper persons to be involved in running services for the NHS?  The Mirror alleges that GHG is under consideration for contracts to run transplant services in the UK: http://www.mirror.co.uk/news/politics/2011/09/06/organ-selling-firm-in-nhs-talks-115875-23399313/

6. Once NHS hospitals are required to make their money through selling services, they will have to balance their books or go out of business.  Is it planned for those burdened by expensive PFI deals to be left to sink or swim, or is the government planning to force the taxpayer to take over all of the PFI deals so that such hospitals have a chance of survival in the new market-place?  What efforts have been made so far to repudiate these deals and stop the PFI lenders and providers from continuing to fleece the taxpayer?

7. The Care Quality Commission has been running regulation on the basis of self-certification and has a track record of believing those assessments rather than inspecting in person; the Winterbourne View case demonstrated that self-assessments by profit-making, private-equity-funded suppliers are not to be trusted.  For the last year the CQC has recruited no-one with any medical qualifications for any of its management or inspection roles.  The reason appears to be systematic under-funding and management which fails to protest about the fact that it has insufficient funding to do the job properly. The Bill puts the responsibility for technical inspection on to the underfunded and underskilled CQC and mandates no extra funding. Can Lord Howe please elaborate on how the system will be changing to safeguard patients properly? For instance, how will the figure for an adequate amount of CQC funding be arrived at?  What is the planned frequency of facility inspections by medical doctors?

8. What safeguards are to be put in place to stop GPs denying patients treatment under the NHS (and retaining the money saved, as would be permitted by the Bill) then offering to give private treatment for the same complaint (as also permitted by the Bill). None are at present included in the Bill.

9. What proportion of the referrals budget is expected to be spent on commissioning overheads and profits (of contractors to which the commissioning tasks are outsourced)?  Is it reasonable to expect this to be in the 20%-40% range as applies to similar arrangements in the USA?  What do your projections show for the amount of the budget given to GP consortia which will be consumed by the outsourcing of commissioning costs?

10. The Bill (s13) allows privatisation of secure psychiatric services; s35 allows the Secretary of State to nominate whoever he likes to approve people to section individuals thought to be a danger to themselves or to other people. The Bill states that the SoSH may or may not arrange compensation for this task.  Clearly there is potential for abuse in this combination of changes.  There has been a recent related abuse in the USA: http://www.nytimes.com/2009/02/13/us/13judge.html?pagewanted=all but in that case the scheme required bribery of judges and the sentences were for months only.  In the NHS case abuse would not require any illegality, merely the possession of the right to lock people up and to be paid for doing so (under a contract) and the ability to approve people to section others (who as well as approval need the minimum qualifications specified under the Mental Health Act 1986); and the deprivation of liberty involved could be long-term or permanent. This seems to be a duty which should not be taken out of state supervision. What safeguards are to be put in place to protect the general public from being involuntarily admitted to profit-making secure mental hospitals which are paid by the number of inmates held?

11. What safeguards are in place to prevent inmates of secure psychiatric facilities privatised under s13 from being pacified with drugs which have serious permanent side-effects, or with ECT, in order to enable lower levels of staffing to be maintained and more profits made?

By Dr Lucy Reynolds.

Other articles by Dr Lucy Reynolds:

Provisions for competition in the Health Bill. Martin McKee’s blog 07.11.2011

Liberating the NHS: Source and direction of the Lansley reform 29.08.2011

Two issues with competition in healthcare BMJ 25.07.2011

For-profit companies will strip NHS assets BMJ 15.06.2011

Issues MPs and the media have missed in Lansley’s bill BMJ 24.05.2011


3 responses to “Unanswered questions about the Health Bill

  1. Another thing I would like to know is whether the Clinical Negligence Scheme for Trusts (CNST) is going to cover all providers giving NHS care.
    I understand that ISTCs are covered by this but do not have to pay a large premium like Trusts do (the size of this depending on the results of CNST inspections, which make a lot of difference). The premium is evidently paid for them by the local PCT, so really they have nothing to lose by poor treatment if this is so. My information on this came from book ‘Confuse and Conceal’ so I assume it is correct unless I have misunderstood something.

    This is an important point and we need to know the answer.

  2. The impact of implants.

    News and Comment from Roy Lilley

    The unfortunate women who have PIP made breast implants are the victims of a crime.

    Unwittingly and through no more their fault of their own than a woman in a short skirt is the author of her rape, women in pursuit of self esteem, happiness or other reasons that are none of our business, have spent fortunes on enhancements that have turned out to be counterfeit and possibly, in the long run, injurious to their health.

    Like any victims of crime they will be shocked, apprehensive and depressed about their future. The NHS does not turn its back on drunk drivers or drug addicts and must not turn its back on these women. The NHS would not turn away a patient convulsing from consuming counterfeit vodka. Neither should it turn these women away.

    There are, probably, 50,000 such women in England. LaLa has made it clear the NHS will provide replacement surgery for NHS patients, as have Ramsey, Spire and the Nuffield, for theirs. However, the majority of the rest of the companies are dissembling and shilly-shallying. The cosmetic surgery business looks greedy and shabby.

    They have carried out, perhaps, over 40,000 implants at an average cost of £3,000 creating a £120m business. Most of the companies are small, limited liability organisations that provide back-office and tax vehicles for NHS surgeons, working evenings and weekends, to take the profits in dividends and fees. This is an industry with few retained assets or reserves. It will be easier for them to liquidate than face a restitution bill of, perhaps, £60m.

    They have made it clear, through the voice of Sally Taber, the unfortunate spokesperson for the Independent Healthcare Advisory Service speaking on the BBC’s World Tonight Programme, they will argue they have no liability and the MHRA, or the manufacturing company, or the Department of Health or Old King Cole is responsible, before them. They might be protecting their profits but they are destroying their principles.

    This is a mess. This is, to the cosmetic surgery business, what the Southern Cross debacle was to the care home industry. And, a mess made even more significant by the plans LaLa has for the future of the NHS.

    The intention is clear; a mixed economy of suppliers to the NHS and a lot more use of the private sector. Effectively the NHS becomes a franchise. We are left with the question; what happens when a company, contracting for services for the NHS, goes broke, closes down, or simply is no longer viable?

    Assura are part of the popular Virgin Group, taking on NHS community and primary services. What happened to Virgin Brides, vodka, cola, cars, underwear, casino, games, records? What happened to Virgin GP surgeries? It’s OK to be entrepreneurial; if a bride doesn’t get a wedding dress it’s not fatal. A vulnerable woman not getting a wound dressed could be. And, the damage to the Virgin brand would be terminal.

    For the LaLa plan to work assurances have to be added to the Health and Social Care Bill; currently undergoing trench warfare in the House of Lords. There has to be a failure regime, an exit route for a company that stops trading and leaves the NHS struggling to catch-up and cope.

    What can we do? A surcharge to create a reserve in the event of failure? No, it will be added to the cost of the procedure or service and the NHS will pay. A tithe on profits? No, wily companies can make sure they make no ‘profits’. A tax on turnover? No, if paid in advance it will be underestimated and if it is paid later it might be too late if the company failed.

    The answer is for every company contracting for clinical or care services to provide an upfront performance bond, the amount set by Monitor, the NHS’s ‘Off-Sick’ regulator. This would give companies an opportunity to deposit the cash or insure.

    LaLa has seen with Southern Cross and now the PIP disaster that the private sector, however smart, will fail. Fail for reasons of poor management, changing trading conditions, or just bad luck. LaLa cannot leave the safety and security of the nation’s health and well being to chance.

    He must amend his Health Bill. The impact of implants will haunt him.


    We love to hear from you; have a rant want to comment, contact Roy?

    Please, use this e-mail address


    Know something we don’t – email me in confidence.


  3. • There is much talk of promoting patient choice – what will it mean?• Does anyone know how long bill’s tortured passage through the House of Lords and the Commons will take?• What lies behind the rhetoric about “integrated” care – does that really mean consolidating existing public services?• Won’t doctors spend all their time consulting – with clinical senates, clinical networks, health and well-being boards and citizens’ panels – to get on with commissioning?

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