Friday, February 4, 2011

Tory "Donorgate" - NHS Reforms - KMPG - Conflict of Interests

Hands Off Our NHS!
If allowed to proceed, Conservative Secretary of State for Health, Andrew Lansley,  will undermine the structure and principles of the NHS in the largest overhaul of the service since its foundation in a move of radical reforms, reforms so radical they are unprecedented in any other country in the world. There is simply nothing to gauge these kind of reforms by.  Up until recently here has been little public discussion of the proposals and hardly any consultation, the scale and speed of the proposals is a major concern for virtually everyone connected with providing NHS healthcare, "free at the point of need".

NHS London has awarded a contract to the KPMG Partnership for Commissioning to support the development of pathfinders across the capital.
NHS London is the strategic health authority (SHA) for London. All 10 SHAs are soon to be abolished by the Government/Department of Health.

The KPMG partnership for commissioning has "apparently" only recently been formed!

The NHS budget for 2010-2011 is £110bn and there are around 40,000 GPs working in England and Wales. At present, the budget is divided among the ten strategic health authorities, which devolve it down to primary care trusts (PCTs). The strategic authorities set strategy and hold local delivery agents to account. The PCTs commission services from hospitals, GPs, opticians and primary services. Trusts have increasingly been forging strong links with local authorities to provide social care to the elderly and people with disabilities or other needs. Cuts to these services in particular is being reported along with massive cuts to local authority budgets. This is one of the main worries with consortia, who will fund these patients health care? GPs will be working to a finite budget, so taking on to already heavy lists, patients who have increased and expensive healthcare needs is going to be a massive problem and will probably prove to much for most consortia.

In what I believe was one of the first steps to "decommissioning the NHS" (amongst other services like education) the British Conservative led government recently and controversially closed down the Audit Commission, (a public quango). The closure of the Audit Commission directly benefits a number of companies that have donated large sums of cash (and "free" services) to the British Conservative party, namely one such company it benefits is a company  called KPMG an accounting giant.

KPMG has donated at least £500.000 directly into the coffers of the Conservative party.

Recently the KPMG Partnership for Commissioning has won one of the first contracts to support the development of the early waves of pathfinders across NHS London and help them to become commissioners of services in the future.
The partnership, claimed to be the first of its kind, sees KPMG teaming up with UnitedHealth UK, the National Association of Primary Care (NAPC), Healthskills, NHS Primary Care Commissioning and legal firm Morgan Cole.

The NAPC maintains it is not political, but it is  political it is almost sycophantic in its adoration of the Tories, read it for yourself, it "warmly" backs the Conservatives.  NAPC stands to gain from winning contracts from the Tories radical reforms, how can it be non political and non biased when it has placed itself in a compromising position? One of its *PRIVATE* GPs Dr Johnny Marshall has publicly backed David Cameron, fair enough, but then we should also know that Dr Johnny Marshall of NAPC has also helped UnitedHealthcare a controversial *PRIVATE* US company, win NHS contracts !

Question 1: - Why specifically, was the contracted awarded to  KPMG?

Question 2: -  Did NHS London run an open tender for this contract *BEFORE* awarding it to KMPG? (This is required by competition law) If they didn't, then this contract is most likely illegal.

Question 3: - Was the problem of conflict of interests with the Conservatives and KMPG taken into account when the contract was awarded? There is an obviously conflict of interests here and if awarding these contracts stands any chance at all of working then the procedure *MUST* be above reproach.

Derby City Primary Care Trust has already been put out to tender and has had three expressions of interest;

 1. BUPA; 2. Boots and 3. AN-other.  (The deadline for tenders apparently passed a few weeks ago.)

Andrew Lansley has said that GP Commissioners will have to honour present contracts. However, I am informed that there appears to be a lot of contracts being signed in a "hurry" but with absolutely no clear evidence of tendering. Who is overseeing what is going on now?

Is anyone looking into the many breaches of competition law that could possibly be occurring?  Who is responsible for looking into such matters? This is but one clear example of what breaking up and fragmenting the NHS will cause, no one will know who is responsible for what, who and when! This may possibly leave GPs in a very vulnerable position of possible litigation and accusations of bias, cronyism, insider dealing etc etc etc.

Any future contracts will be awarded under Lansley's preferred "Any Willing Provider" scheme. The Department of Health under the previous Labour government were going to use the "preferred provider" system, meaning  that the NHS would win the bulk of the contracts.

In what amounted to a non-legal "class action", the then Labour government's competition commission agreed to look at a complaint brought by hundreds of charities and private sector companies angered by a decision, made by the then health secretary Andy Burnham, that the NHS would be the "preferred provider" of NHS care.
This means failing or under performing NHS trusts would be allowed to keep an NHS contract to allow them to improve, rather than allowing charities and private companies a chance to take over provision of that service.

So who are these "hundreds of  charities and private sector companies"? Well some may turn out to be not for profit organisations like NAPC and private companies that operate like Care UK, Healthcare UK, UnitedHealth UK.  Not hard to see why they have a vested interest in this government NOT having the preferred provider system is it? With the any willing provider system now employed by the Tory government akin with the radical reforms and GP commissioning and the abolition of SHAs and PCTs, the NHS is for certain going to be squeezed out of providing our health care and privatisation will not be arriving by the back door, but will be galloping down every single street and road and charging through the front door of our hospitals and surgeries and completely taking over our NHS. At this rate we will see full-scale privatisation of the NHS by 2013. This government hope to stay in power until 2015, clearly they hope the fury aimed at what they are doing will have been forgotten by the next general election. (Again we see manipulation of the electorate by this Tory led government.)

However, by using the "any willing provider" system means the NHS will have to compete for every single contract and they will be competing against private companies who could very well offer a "Loss leader" of such tremendous value, that the NHS will be priced out of the market. In my opinion this is another step towards complete privatisation and we could be witnessing the "Tesco-isation" of our NHS! Already some GPs are setting up surgeries in supermarkets, where they have been given  highly valuable commercial floor space "free" of charge! Why? What is in it for the supermarkets? Footfall? If rolled out across the country it is not hard to see that supermarkets will benefit greatly from vastly increased sales in over the counter medications and this year, we see the return of pharmacies to some Tesco supermarkets, who had previously been taken out, it all slowly begins to snap into place!

KMPG are now the ones providing commissioning support for the pathfinder consortia which Cameron has now said totals 140 covering half of the country, the next step will be for them to provide the commissioning support for all *actual consortia* after 2013, when it is expected that the main bulk of the reforms will have taken place. 
The Department of Health/Government is very keen on getting rid of any health services they possibly can and off of central government's hands and of course these services will ultimately land up in the laps of private corporations. One of the first steps is to allow social enterprises, or Arms Length Trading Organisations (ALTOs) to take over various services. Social enterprises are not for profit organisations and although some are well intended, the fear is that the ALTOs will be run by big companies, such as  *BOOTS* SERCO and a plethora of American healthcare giants.
Serco operates a number of public sector contracts on behalf of the government and local authorities.
These include running four prisons including Doncaster, the maintenance of a number of RAF bases including Brize Norton, and the operation of London's Docklands Light Railway, recently Serco tried to pass on the impact of government spending cuts to suppliers. Serco, had asked its largest suppliers to pay a 2.5% rebate. However, when it thought it may lose its lucrative contracts from the Conservative government, it decided not to go ahead. But there is nothing to stop serco doing this in the future when their contracts are in place. In fact Andre Lansley has taken out the very regulation that prevented companies like this adopting such practices.

As we can already see in the case of Derby City  and London Primary Healthcare Trusts, this change is already starting to happen.
Further, I  am told that now it is very likely that consortia will  have to tender for their commissioning support, so  former PCT staff will find themselves in a position where they will have to form organisations and bid competitively for contracts. Of course huge organisations like KMPG are way ahead of any competition and have clearly been preparing for this for a few years. In the interests of fairness, questions need to be asked as to how these giant companies suddenly find themselves already prepared for something they "presumably" did not know was happening prior to this government's publication of its white paper on the "Liberation of the NHS"?  After all according to Cameron and the Tories, they were not going for any "top down reorganisation of the NHS"! (Then we learn directly from Cameron that the Tories and Lansley have been working on this for years - more lies from Cameron and Lansley) Were these companies like KMPG given information prior to this government coming to office while the Conservative party were still in opposition?  I find it incredulous that a huge company like KMPG has been awarded a contract of this magnitude when they have given such financial backing to the Conservative party, and then the company seems to be ahead of everyone else in the field? Or are we supposed to believe that KMPG just cobbled together their partnership commissioning company since last July 2010?

Putting aside that any group or organisation formed now to challenge for NHS contracts will certainly be at a colossal disadvantage, and even if ordinary people, like former PCT workers were able to form organisations and groups to try and compete for NHS contracts, how likely is it that they would be able to compete with huge organisations like KMPG? How likely is it that they will be able to realistically compete with these multi-national private companies, who are so far ahead and in terms of purchase power, could just offer quality loss leaders and blow them completely out of the water? This is just flim-flam and window dressing from David Cameron and Andrew Lansley, a concealed plutocracy which is disguised by being wrapped up in pink fluffy stuff designed to make their plans look acceptable when they are anything but!  This duplicitous Tory government know, and we know, and these huge organisations know, and any likely co-operative of PCT workers know, that this is a completely unfair and uneven market and the odds are stacked dramatically against any small PCT co-operative. How will they be able to compete with these huge companies like the KMPG partnership for commissioning, who appear to have been formed specifically to offer this kind of care in the UK?
Ultimately what will happen (it has already started) is that services will be syphoned off to these huge private companies, health workers, former PCT workers etc will be binned off and made to reapply for their positions at LESS favourable rates and terms of employment, it will be that or face redundancy. Of course many former PCT workers will be made redundant in any case as it is huge doubtful that private companies will want to hire all previous PCT staff, these companies generally try to get the work of three people done by one, this is the era we are now moving into.

As I have already shown above the big companies will offer huge economies, even loss leaders,  (they have the purchasing power to do so) and profit will be the beginning, middle and end in the NHS, profit will dominate and it will drive services and quality down, cheapest is very rarely the best and cheapest often turns out to be a false economy anyway. The NHS is headed for complete chaos, confusion and mayhem, post code lotteries for treatment, appointments and drugs will be back in ever increasing numbers and many patients will be forced to travel  many miles out of their locality for treatment. The government's mantra is that GPs and patients know best and patients want choice, sounds good, but what patients and most GPs want is good quality local care they can depend on whenever they need it, choice is fine, but it comes way down the list. Ask a patient to choose out of a list of 6 consultants specialising in the same field, how are they going to know who is best? Short answer is in the majority of cases they won't and will have to take advice and then that procedure becomes opened up to corruption!

The following are the kind of companies that the UK Conservative led government is now enlisting to run our NHS and care for our health needs.
KMPG - Have helped wealthy clients dodge millions in taxes.
Following accounting scandals KMPG changed the name of its business consulting arm to BearingPoint. BearingPoint has been granted a $76 million USAID contacts in Iraq.
KPMG, PWC, E&Y and Deloitte behind almost half of all known tax avoidance.

The Department of Health’s (DH) director of commissioning Gary Belfield  has taken up a new position with KMPG. Gary Belfield has held roles in the NHS and DH for over 25 years, and his name is closely associated with the World Class Commissioning drive, along with his predecessor Mark Britnell who left to join KPMG in 2009. Surely this is a conflict of interests?

The first tender of its type to be awarded in the country was awarded to KPMG and comes at a crucial time where GPs face the transition to legally accountable commissioning organisations by April 2013.  The contract was won through the establishment of the KPMG Partnership for Commissioning which comprises the National Association of Primary Care (NAPC), Healthskills, Primary Care Commissioning (PCC), United Health UK and Morgan Cole.

"The KPMG Partnership will draw on the expertise of its members to provide a comprehensive and evidence-based package of business, finance, governance and personal development support. The programme will help GPs to develop key skills they will need as future commissioners, such as financial management skills, contract management and engaging with local councils and other stakeholders."

Gary Belfield, Associate Partner at KPMG said:
"I am delighted that NHS London has awarded this ground breaking contract to the KPMG Partnership for Commissioning. GP commissioning consortia are at the leading edge of the Government's health agenda as they align clinical responsibility with financial accountability. Over the next two years GP consortia will have a stretching development agenda before they formally take the commissioning responsibility for over £70bn of resources across England.”
“We look forward to working closely with the early pathfinders in London to ensure they are as prepared as possible to meet the commissioning challenges that face the NHS in the coming years.”

I do not doubt that Mr Belfield was delighted, close on the heels of Mark Britnall from the Department of Health  to KMPG, I bet KMPG were delighted too! Especially when Mr Belfield decided to leave the Department of Health in 2009, take all of his knowledge to KMPG and quite possibly help them start setting the new partnership for commissioning up - PRIOR to the Tories even winning the 2010 general election. Ah, it must be great to have psychic abilities, especially where lucrative NHS contracts are concerned! I bet some former PCT and SHA workers wish they had these abilities too!

Dr Johnny Marshall, Chairman of the National Association of Primary Care said:
"We are excited to be part of this initiative and look forward to providing support to practices as they seek to implement GP commissioning locally."

Again I bet Dr Johnny's excitement knows no bounds as he is a private GP backing David Cameron and his company, not for profit organisation NAPC, is suddenly a benefacto in the "new" KMPG partnership for commissioning! Incidentally, not for profit organisations do not stop their chairmen and executives from receiving huge salaries and every conceivable company perk imaginable!

Question 4  - While still in opposition, how much of his reforms has Andrew Lansley previous discussed with people like Gary Belfield and Mark Britnell? And companies like KMPG; NAPC; UnitedHealth UK? And drug companies like GlaxoSmithKline and AstraZeneca and private healthcare companies like Care UK and Healthcare UK?

Question 5: - Has Andrew Lansley been in discussion with companies that offer private health insurance?

Question 6: - Has Andrew Lansley and George Osborne ever had discussions about waiving all, or part of National Insurance Contributions (NICs) for people choosing to opt out of the NHS and go private?

UnitedHealth UK:  is the UK subsidiary of the large American organisation UnitedHealthcare. UnitedHealth UK is now part of the KMPG Partnership for GP Commissioning, now aiming to cash in on millions of pounds of NHS money. UnitedHealthcare  has repeatedly cheated the US health system in the past decade.
UnitedHealth UK is set to advise and run GPs' services under controversial plans announced by Health Secretary Andrew Lansley and prime minister David Cameron. UnitedHealthcare was fined tens of millions of dollars for fixing charges in 2009 alone.
In a catalogue of cheating UnitedHealthcare paid over £1million in 2000 in nine states for offences including overcharging and denying treatment.
UnitedHealthcare was featured in Michael Moore’s health docu-movie Sicko, in which he claimed 18,000 Americans die each year because they cannot afford to pay insurance.

Morgan Cole: Has links to a Conservative MEP

Ashley Fox is a British Conservative Member of the European Parliament (MEP) representing the South West of England.
He was elected to the European Parliament in June 2009.  As a British Conservative he is a member of the European Conservatives and Reformists Group (ECR). He sits on the Internal Market Committee where he takes a particular interest in the Aerospace and Pharmaceutical Industries.
Before being elected as a MEP Ashley worked for 15 years as a Solicitor in Bristol, specialising in Insurance Litigation. He was a Partner at Badhams Thompson and an Associate at Morgan Cole.

Within these large political donations to the Conservative party, there is the strong proclivity for conflict of interests to develop. We have already read about Stuart Wheeler who has donated millions to the Tory party virtually admitting that large donations influence policy etc. How can we allow a situation where those that are giving advice, in terms of commissioning advice, are also potential providers and benefactors of large NHS contracts? (This also applies to education) Without a shadow of a doubt there is a massive conflict of interests that is developing with the Conservative party/government, whereby all these accountancy companies, and health care providers, and services that have already been, and will be awarded contracts within the NHS, some have already been found to have given large donations of cash and "free" services to the Conservative party prior to this White paper!

If the dubious practices I have outlined above are not worrying enough, we are now being governed by a dangerous government of plutocratic morons. They seem to have no idea what they are doing, when asked to explain, both the Prime Minister David Cameron, and the Health Secretary Andrew Lansley, are risible and lacking in any form of coherent replies, if we are seeking reassurance about the future of this country's NHS, we are not going to get it from the Tory led government of plutocratic buffoons and nincompoops, who plainly see nothing wrong with having these ties to companies that want to take the most lucrative parts of the NHS over - for good!


Robert said...

It's sad to see the NHS like this but Blair wanted to change it, in my area we went from 23 dental groups all doing NHS to none at all, I've not seen a dentist for 12 years, Being disabled I've seen the changes most of my treatment under the NHS has been carried out by BUPA. I had a scan not to long ago and had to wait six months to get a reply from Spain, when it did not arrive we were told in was lost, I paid £500 to have the scan down and read in the UK, I was rushed into hospital to have an emergency operation, my life was at risk, and I had to wait six months to get that reply.

I just feel both government have been trying to sell off the NHS only labour did it in dribs and drabs.

Gracie Samuels said...

When Labour took over the NHS, they had no option but to change it, the service was in a parlous state. People were waiting months for out patient appointments, months even years for operations and you would have been lucky to have got a scan inside months. In fact most hospitals did not even have the technology, let alone the number of staff required to run the department. I think it is really unfair to blame Labour, if it were not for them we would have lost the NHS 13 years ago. The service needed thousands of nurses and doctors, it was short of consultants because the required number of doctors had not been trained, so the knock-on effect was a shortage of consultants and GPs. It needed billions spending on it, which they did, their use of the private sector was unavoidable, it was that or we did not get the new hospitals, the new departments or accident services we desperately needed. Labour's use of the private sector was nothing like what is happening to it now, it cannot even be compared. As for the dentist, before Labour came to power there was no chance of getting an NHS dentist, now I do not have that trouble I have NHS dentist, in fact I left one and went to another more convenient without any trouble, although I appreciate this has been difficult, but it is easier now.
I don't quite understand why you would have a scan at Bupa and then wait six months for a reply from Spain? Why? The use of hospitals like Bupa and others has been done solely to get waiting times down, Labour were in a catch 22, they introduced targets, not ideal, but making people accountable has actually resulted in reduced waiting times. My daughter needed an op, she was seen at the hospital and a date and time was made for it then and there at her appointment, that was a couple of years ago she now needs another op and now because the targets have been taken out, weeks have past and she is still waiting for a date and time and this is happening all over the country.
People waiting for urgent appointments for cancer or cardiac are now waiting longer, people waiting for operations the lists are now growing again.
This is the cold reality of a Tory government, personally I'm sorry you are disabled, but I know the NHS is much better under the Labour government. This lot have only been in 8 months and already they have been the cause of increased waiting times in accident service, appointments and list for surgery are growing too. Sorry Robert, but there is no comparison. The Tories inherited an NHS that have never had such high satisfaction rates, I appreciated there are isolated areas that need attention , but what Labour did achieve in the NHS is nothing short of remarkable. There is absolutely no need for this government to be doing what they are doing, in fact, they have no idea why they are doing it.