NHS for Sale: Myths, Lies & Deception (20 page)

However this is surprisingly difficult. Politicians constantly call for vigilance and transparency in public services but have double standards when it comes to the private sector. Private companies providing NHS care are not expected to meet the same standards of transparency as the publicly delivered NHS; for instance they are not subject to Freedom of Information requests, and as a result much about them is shrouded in secrecy. Their costs, profits and most importantly their outcomes are largely unknown, withheld from those who are paying for and using the self-same services. ‘Commercial confidentiality’ is paramount and overrules patients’ and taxpayers’ interests. Margaret Hodge, chair of the Public
Accounts committee, once famously complained that even her committee could not get behind the wall of secrecy erected by the commercial sector. It is therefore easy for the peddlers of the market to continue to claim its benefits while having conveniently few facts to back up their claims.
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In the absence of evidence we are left with anecdote and there is no shortage of that. And while Woolhandler’s and Himmelstein’s warnings to the UK about the dangers of a marketised health system were not comprehensive they serve as a good place to start.

The 2007 paper reported higher death rates in the US in privately-run hospitals and renal dialysis centres than in not-for-profit ones. Concerns about outcomes for NHS patients treated in the private sector have been around for years but, in the absence of any government data, have been difficult to prove. What we do know comes largely from anecdotal evidence and from research conducted by clinicians and campaigners.

In 2009 hard evidence appeared when the
Journal of Bone and Joint Surgery
published a paper
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which reported a much higher than expected rate of problems following hip replacements carried out on NHS patients in a privately run Independent Sector Treatment Centre (ISTC). The authors blamed poor technique, but this was not their only worry. The problems were only detected because of concerns raised by the local NHS about the surgical results at the ISTC, and the patients had then to be sorted out by the NHS. The authors drew attention not only to the poor outcomes for patients but also warned that detecting the problems and dealing with
them had impacted significantly on the work of their NHS unit.

The paper concluded by asking that in future

Contracts should not be renewed (for ISTCs) and new contracts should not be signed until a proper independent evaluation has been published assessing referrals, actual treatments carried out and payments made for work done along with value for money analysis. Full contract details and costs must be placed in the public domain for this assessment to take place.

Needless to say the paper received little national coverage and their recommendations fell on deaf ears. Commercial confidentiality continues to trump every other interest including that of the patients. An article in
Hospital Doctor
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summarised the known problems with ISTCs and concluded ‘if ISTCs are providing treatment at higher costs than the mainstream NHS, with poorer outcomes, why are we sending our patients to them?’ Why indeed.

In September 2013 the BBC reported that a privately-run ISTC had been taken back under NHS control after the unexpected deaths of three patients after routine surgery for joint conditions.
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The Surgicentre (run by Clinicenta, a subsidiary of the giant construction and facilities company Carrillion) provided routine operations for NHS patient from the nearby Lister hospital. In 2012 the Care Quality Commission (CQC) failed it in four out of five areas and local GPs had ‘decided to adopt a policy of dissuading their patients from being treated by the private care provider’.

The deaths were described as ‘unfortunate’ by the Clinicenta clinical director and as ‘serious incidents’ by the
local NHS, and they contributed to the ‘21 serious incidents of both a clinical and patient information governance nature’ since the clinic had opened in 2011.
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They also followed an investigation at the centre earlier in the same year after six patients suffered ‘irreversible sight loss’, due to ‘a lack of follow up care after treatment’.
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GPs were warned that they should not ‘refer patients to a service for which they have … genuine concerns that the quality is substandard’.
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A local Tory MP, Stephen McPartland, was appropriately outraged, calling for the private clinic to be closed. Christine McAnea of Unison commented that the government’s drive to privatisation was putting patients at clinical risk in a fragmented health service and that while politicians talked about patient choice, patients could not have known about the risks when they chose the privately-run Surgicentre for their NHS operation. ‘These companies see the HSCA as a big opportunity to increase their business, but safeguarding patients has to be the number one priority.’
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In June 2014 the Bureau of Investigative Journalism broke a story about a private company, Healthcare at Home (or not, as the case may be), who were contracted to deliver medicines to seriously ill patients in their own homes.
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The Bureau revealed that due to failures in the service patients had been left waiting for vital prescriptions, some of which had not arrived in time. Affected patients had had to fight to get through on the company’s busy phone lines and patients were left ‘confused and uncertain about when and whether their medication would arrive’.

Problems had arisen because distribution had been subcontracted out, and because extra patients had been taken on when another company, Medco Health Solutions, withdrew from the market only three years after entering it.
Patient groups described the failures as ‘unacceptable and unsafe’ and ‘appalling’ and had spent ‘hours every week’ sorting out problems. Several hospitals stopped using the service or fined them for failed deliveries. In March 2014 the company said it was no longer accepting new ‘high risk’ patients.

Perhaps the most alarming part of the story is reserved for the end. The Bureau reported that despite what had happened the Department of Health had asked the company to re-tender to be part of a panel of firms providing drug delivery services to the NHS. The Haemophilia Society, some of whose patients had been affected by the firm’s failures, was involved in the decision making process. Their Chief executive, Liz Carroll, complained that they were not allowed to take account of Healthcare at Home’s past performance when deciding on whether they should be on the new panel.

We have been advised that when making a decision on which firms should be included in the panel we can only consider the content of the bids. We are not allowed to take the company’s past performance into consideration. We have asked for that to be changed. As a patient organisation we cannot just forget the experience of our members.

Not only were no lessons learned, they were apparently
wilfully ignored.
The implication is that when the private sector is involved it is acceptable to overlook the track record and concentrate on the promises, the marketing strategy of snake oil salesmen through the ages.

In August 2014 the Centre for Health and the Public Interest (CHPI), a progressive think tank, published a report
about patient safety in private hospitals. It noted that over 800 patients had died unexpectedly in private hospitals in England during the previous four years. It surmised that this might in part be due to lack of appropriate staff, equipment and facilities. Three of their main findings are of major concern and are worth quoting in full:

• The majority of private hospitals have no intensive care beds, some have no dedicated resuscitation teams, and surgeons and anaesthetists usually work in isolation – without assistant surgeons and anaesthetists in training present.
  
• Although the private hospital sector now gets over a quarter of its income from treating NHS-funded patients, there is significantly less information available to patients about the performance of private hospitals than about the NHS.
  
• It is not possible to establish whether all private hospitals providing NHS care are fulfilling their legal obligation to publish Quality Accounts letting the public know how they are performing ….
  

The report also confirmed another problem which has long been known about but never officially recognised: that the private sector uses the NHS as a safety net or – rather more unceremoniously – a dumping ground when it runs into trouble. The report highlighted that:

• thousands of people are regularly transferred to NHS hospitals following treatment in private hospitals, with over 2,600 emergency NHS admissions from the private sector in 2012-13.
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In summary, while private hospitals are increasingly turning to the NHS for their income (see
Chapter 9
) they may not always be equipped to deal with the problems that arise, which they may then transfer back to the NHS. Information which would allow patients to exercise ‘choice’, in particular about private hospital performance, is in short supply. We don’t have the government to thank for this important information, crucial to the interests of taxpayers, patients and voters, but a progressive think tank (CHPI) which went to the trouble to do the unfunded and uninvited research.

It is worth noting in passing that the average private hospital has fifty beds. As they don’t deal with emergencies they tend to bring surgical staff in on a sessional basis and they don’t have junior staff resident as they don’t train doctors. This may be fine for routine work but not when emergencies arise, hence their use of the NHS as a backstop.

There is still an alarming lack of clarity about who is liable when things go wrong for NHS patients being treated in private facilities. In August 2014 the
BMJ
reported that Musgrove Park, an NHS hospital, had terminated a contract with a private provider, Vanguard, after only four days when half of the sixty patients who had undergone cataract operations were found to have experienced complications.
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One patient lost his sight and was told he would need a corneal transplant. There was immediate confusion about where liability lay and the patients’ solicitor Laurence Vick referred to the ‘uneasy relationship’ between the NHS and the private sector. ‘Private providers must agree to an immediate joint investigation with the NHS of problems on contracts, in place of the current fragmented approach.’ It was also not clear whether the NHS
hospital could recoup its losses after ending the contract. It was left to Vick to comment that ‘from the taxpayer’s point of view it would be totally unreasonable for Vanguard to walk away from this scandal with only their reputation, and not their investment, damaged’.
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In September 2014
The Guardian
reported that Musgrove Park had carried out its own investigation (more NHS money spent on sorting out problems with the private sector) but was reluctantly refusing to publish it after lawyers had advised that ‘individuals and parties might sue for defamation’.
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It looked very much as though the NHS was afraid of publishing the truth about what had happened: an unacceptable outcome for the patients concerned. Vick commented:

We have been waiting for this investigation for five months, and it is imperative that it is released to the public. The fear is that, when the private sector is involved, there can be absence of transparency that has become a reassuring feature of the NHS. There is concern as to whether the NHS should outsource to a private health sector that is still inadequately regulated. Private companies have a duty to shareholders as well as patients.

Shortly thereafter the report was leaked and confirmed many of the problems dogging outsourced contracts. Vanguard had undertaken to perform twenty operations a day, six more than the hospital’s own doctors would do in a day. The firm had subcontracted the supply of surgeons and equipment to another company which had further subcontracted the supply of some equipment. This combination had not been tried before and training was still going on when the first patients arrived at the mobile operating theatre.
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The refusal
to publish the report even after it was leaked made a mockery of the government’s promise of transparency after the Mid Staffs scandal.

It is not possible in a book of this scope to give a comprehensive list of all the evidence that has emerged about poor outcomes for NHS patients at the hands of the private sector and the reader is referred to the reading list at the end of the book for a guide to further sources. It is important to note that the failures have often had to be uncovered by investigative journalists, patient groups, NHS campaigners and progressive think tanks, and not by the government or the Department of Health. It suggests that the government is either having difficulty in monitoring the increasingly privatised and fragmented NHS, or that, for ideological reasons, it has double standards when it comes to the private sector, or more likely both.

The private sector must be treated in the same way as the NHS in all regards, including publishing its outcomes and being held to public account for its failures, but that is still not the case. Until that happens we are left guessing as to whether the horror stories that surface give us the whole picture or are just the tip of an iceberg that the government, despite their calls for openness and transparency, would rather keep submerged.

A 2014
BMJ
editorial estimated that ‘between 10% and 25% of global spend on public procurement of health is lost through corruption’ and identified it as ‘one of the biggest open sores in medicine’.
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The US was singled out as having lost between $82 and $272bn to medical embezzlement in just one year (2011), and as an 2014
Economist
article (The $272 billon
swindle) amply demonstrated, healthcare fraud in the US is big business.
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