Private sector alternatives to NHS-run hospitals developing
You do not necessarily expect to hear an ex-Goldman Sachs banker waxing lyrical on how to run a hospital, but Ali Parsa is almost evangelical when it comes to healthcare provision. In 2005, the former director of Goldman’s European technology banking team founded Circle, an employee-owned health care partnership that is now the largest in Europe.
Dubbed the John Lewis of health, the 2,600 strong-partnership is one of several companies seeking to play their role in re-shaping healthcare in the wake of the NHS White Paper.
Andrew Lansley, the Health Secretary, last month set out his vision of “liberating the NHS” by which commissioners will be able to buy care from “any willing provider”, which prompted observers to herald an opportunity for private sector companies to step in and provide more NHS services.
Exactly how these reforms will be implemented is yet to be clarified, but the likes of Parsa have welcomed Lansley’s ideas as refreshingly radical.
The ex-banker says he believes there is an “absolute need to fundamentally re-engineer the way health care is delivered”. That, he adds, comes down to re-balancing what he calls the “value equation”, defined as quality – clinical outcome plus patient experience – over price.
“You need to be unrelenting and uncompromising in increasing patient experience – you need to push up the nominator of the value equation. Equally, you need to be uncompromising in getting rid of waste and reducing cost to reduce the denominator. The difficulty is how.”
Parsa believes that part of the solution could lie in Circle’s model of employee-ownership. “We’re the agent of our patients and that almost defines who we’re owned by: we’re not owned by capital; we’re not owned by government; we’re owned by everybody who works here,” says Parsa, who would like to see the White Paper go further and faster in encouraging employee ownership so that multiple partnerships can work on a scale allowing them to put “a system in place that fixes a lot of hospitals”.
Circle is 50pc owned by doctors, nurses and support staff and the other half is owned by institutional investors. The partnership now runs services including an NHS clinic in Nottingham and a new hospital in Bath – designed by none other than Norman Foster.
Circle is also down to the final two – opposite outsourcing giant, Serco – in the contest to find a franchise partner for Hinchingbrooke hospital in Huntingdon; a decision on the winner is due in December.
The East of England Health Authority turned to the marketplace in 2009 to find a partner – public or private – to run the hospital after it clocked up debts of almost £40m. But the last NHS body pulled out in February, meaning that for the first time, a private sector organisation will take over the running – and risks – of an NHS hospital.
Andrew MacPherson, director of strategic projects at the health authority, said it provided an opportunity for “fresh thinking and a fresh approach”.
But the British Medical Association has warned it is “very concerned about the impact of this development and the precedent it sets”.
While analysts caution that what happens at Hinchingbrooke does not provide a blueprint for future health care delivery, it nonetheless does throw into relief the possibilities offered by a white paper that is agnostic about who provides health care.
Robin Speakman, an analyst at Shore Capital says the problems Hinchingbrooke faced were “somewhat unique”. “Whatever happens there, it’s not necessarily the model going forward,” he says. “What is interesting is that Serco is commercial and Circle is third-sector driven. It will be interesting to see the reasons for the choice of partner.”
Serco, might run along more traditional commercial lines, but it is bidding for Hinchingbrooke with Peterborough and Stamford Hospitals NHS Foundation Trust, echoing its joint venture pathology service partnership with Guy’s and St Thomas’ NHS Foundation Trust.
Alastair Dick, managing director of Serco Health, says that at Guy’s and St Thomas’, the hospital brings a range of clinical skills and capabilities, while Serco brings its ability to “get into the ‘nuts and bolts’ of improving a service bringing organisational management expertise and new ways of working. Together we are creating a highly successful pathology provider.”
“The NHS has great capabilities and great people. Working with the NHS, Serco can help to deliver improved service by bringing our specialist skills in service management – helping the NHS to do what it does better,” he added.
David Brockton, an analyst at Execution Noble, says the joint venture approach Serco takes to working with the public sector allowed the company to manage risk. “In terms of breaking into an evolving market, it is the most sensible model,” he adds.
Speakman thinks the White Paper could, in the long term, open up different routes for managing some hospitals. With GPs having the option of offering more services, hospitals will have to compete in a more open market, he says, which could – perhaps not in this parliament, but in the next – lead to organisations such as Serco, Circle and others running groups of hospitals.
But he cautions that any changes are likely to be much further down the line. “We have to remember that the NHS is one of the most highly valued institutionse. Doing this in stages has to be the natural way.”
Get the government out of British University education
I’m beginning to wonder whether any government programme or regulation actually helps the deserving groups that it is advertised as helping. Too often, I think, they help rather well-paid administrators, anti- poverty lobbyists, special interest groups and the friends of politicians.
Take higher education. It is heavily subsidised by taxpayers because it is supposed to help the whole country. But does it? By far the greatest beneficiaries are students themselves. The association of university heads has calculated that, over a lifetime, graduates earn £160,000 more than non-graduates. But graduates leave university with an average debt of just £23,000. That’s a pretty spectacular return on investment.
Gordon Brown used to spend much of his available spleen, which was considerable, on chiding the universities for taking too many students from well-off families, and too many with a public school education. Try as he might, with all kinds of financial bullying and incentives, he just couldn’t make it any different. So it’s a double imbalance; not only do we subsidise universities that raise the incomes of their graduates well beyond the benefit to anyone else, but those students also come from better off backgrounds too. The young person who leaves school to become a bricklayer in Bootle pays higher taxes to send Old Etonians to Oxford to become Prime Minister.
If the universities were privatised, this would change in short order. For a start they would probably introduce, like the private University of Buckingham, snappy two-year degrees that kept down the cost and made student loans less daunting. If they charged those who could afford it realistic fees, and used the money for bursaries to gifted but poorer students, it would do more to open up opportunity, increase access, and spread benefit through the whole country than what we do today.
And what is true of universities is probably true of other government programmes. If you really want to help the people you say you want to help, rather than well-off people and public-sector administrators, the market can probably help you do it far more effectively than some public sector programme.
Call for ‘sunshine vitamin’ in milk to help beat cancer in Britain
I understand that this is already done in some parts of the USA. It seems reasonable but there should be some opt-out available for those who don’t like their food messed around with — or feel that they may be at risk of getting an overdose.
What about babies who are fed entirely on milk? Would they run a risk of getting an overdose? Infant formula would surely have to be produced under its own rules
Milk could be fortified with vitamin D to strengthen bones and prevent heart disease and cancer. In England, half of the population is low in the ‘sunshine vitamin’ when winter ends – in Scotland, it is two-thirds.
Government scientific advisors are looking for ways to boost levels. Options include fortifying milk, something already done in countries such as Canada.
Dr Ann Prentice, chairman of the scientific advisory committee on nutrition, said: ‘It is widely recognised within Government circles that we have a problem now that needs to be addressed. Milk is one of the potential vehicles that could be used.’
The vitamin is vital for calcium absorption and bone health and may help to prevent Alzheimer’s. Recent research has shown that vitamin D supplements are as good as some drugs at keeping prostate cancer under control – and it is said that taking supplements of the vitamin in pregnancy and childhood could wipe out 80 per cent of cases of multiple sclerosis.
Low levels of vitamin D are linked to a higher risk of dying from cancer, heart disease and diabetes.
Dr Susan Lanham-New, a SACN member and a Surrey University nutritionist, said that a study of 14,000 pregnant women in Bristol during the 1990s found that more than 90 per cent of them were not getting enough of the vitamin. She said: ‘Vitamin D is known to be vital for a wide range of body functions. A lot of us are very worried about [deficiencies] and think it needs looking at.’
Vitamin D-rich foods include oily fish and eggs but with 90 per cent coming from the action of sunlight on the skin there are concerns that advice on abstaining from sunbathing is unnecessarily restrictive.
Finland became the first country to add vitamin D to milk supplies in 2003. Fortification is carried out – but not mandatory – in Canada, Israel and Jordan.
Opinions on the success of the Finnish initiative are mixed. A 2006 study of young men found that fortification led to a ‘ substantial’ rise in vitamin D of more than 50 per cent. But a similar study the following year concluded that fortification only slightly boosted vitamin D levels.
Any plans for compulsory fortification of milk in the UK could lead to criticisms that consumers were being stripped of choice, although the vitamin has been added to margarine for many years by law.
The Department of Health said the SACN’s report into fortification would take at least three years to complete.
The Food Standards Agency says most people should be able to get all the vitamin D they need from their diet and sun exposure but recommends ten micrograms per day for over-65s and pregnant and breastfeeding women.
It warns that high doses can weaken bones but says that taking up to 25 micrograms in supplements a day is unlikely to cause any harm.
British cities pay for prostitutes for the disabled
Taxpayers’ money is being spent on prostitutes, lap dancing clubs and exotic holidays under schemes designed to give more independence to the disabled. One local authority is using its budget to pay for the services of a prostitute in Amsterdam, while others have said visits to lap dancing clubs are permissible under new policies which transfer funds directly to those who receive care from social services.
Holidays abroad, subscriptions for internet dating and driving lessons have all been funded by the taxpayer under a national initiative introduced by the last Government.
The £520 million scheme promised to give elderly people and those with disabilities more control over the care they received, by passing on cash so individuals could choose the services they needed, such as home help, or mobility aids.
An investigation by The Sunday Telegraph can disclose that exotic holidays, internet dating subscriptions and adventure breaks, as well as visits to sex workers and lap dancing clubs have been permitted under the system.
One local authority has agreed a care plan including payment for a 21-year-old with learning disabilities to have sex with a prostitute in Amsterdam next month. His social worker, who spoke on condition of anonymity, said social services were there to identify and meet the needs of their clients – which, in the case of an angry and frustrated young man, meant paying for sex.
Another care worker said staff at her council had been told that trips to lap dancing clubs could be funded, if it could be argued that it would help the “mental and physical well being” of their client.
In response to Freedom of Information (FOI) requests, four local authorities describe themselves as “condoning” the payment of sex workers by disabled clients, using money transferred from their budgets. Other councils said they took no moral judgement about the use of funds, but said care money could be spent on anything, as long as it was not illegal.
Paying for sex is not against the law but soliciting sexual services, kerb crawling and paying for sex with women who have been coerced into prostitution is.
In Greater Manchester and Norfolk, councils say payments to social care clients can be used to pay for internet dating subscriptions.
In the course of 12 months, one man with mental health problems from Norwich received a holiday in Tunisia, a subscription to an internet dating site, driving lessons, and expensive art materials. Department of Health documents describe how the man received the funding on top of his state benefits, after suffering from psychiatric problems when his wife asked for a divorce. In the report on his case, the man says he needed “some time out, some rest and a change of scenery” after suffering marital problems and says the break in Tunisia with a friend was cheaper than a week in institutional care.
Trafford council, in Greater Manchester, says its budgets cannot be spent on anything illegal, or anything that would bring the council into disrepute. It suggests personal budgets could be used for holidays, adventure breaks, subscriptions to dating agencies, horse riding or to buy a pet.
The FOI survey, by The Outsiders and TLC Trusts – two groups which campaign for the sexual rights of people with disabilities – found most local authorities said they did not “condone” transfer of their funds to pay for sex. But of 121 councils who responded, 97 per cent said they had no policy on the topic, allowing discretion for social workers and junior managers about how to manage such requests.
Several councils contacted by this newspaper said they did not know if they had ever funded visits by disabled people to sex workers. Stockton-on-Tees borough council said it did not think it had funded sex workers for clients. A spokesman said people “in receipt of our care can do whatever they wish, though we would not condone or be involved in anything illegal”.
A spokeswoman for Knowsley council said requests for funding to access sexual services would be “looked at on a case by case nature”.
Doncaster council said that so far it had not funded any requests for sexual services, but said future decisions would depends on the needs of the individual.
Norfolk county council said it did not believe it had funded any visits to sex workers, but Di Croot, assistant team manager for learning disabilities in North Norfolk said such requests would be looked on “favourably” with staff encouraged to be “as free thinking as possible” about how to ensure all the needs of clients were met. Zoe Grace Cozens, who wrote the council’s policy on learning disability and sexuality, said the authority also had a duty of care to ensure that those with learning disabilities were not being exploited financially, if they paid for prostitutes from their own money. “That could mean care workers phoning to check what rate sex workers were charging,” she added.
Belinda Schwer, a legal consultant who advises councils, said many local authorities agreed support plans for clients which did not specify how funds would be used, once they passed out of their hands. “From what I have seen, at least one quarter of local authorities are doing support plans which only state what outcome should be achieved – not which services are being employed.”
In the case of someone given funds to go to a sex worker, such documents might set out an intended emotional outcome, rather than the means by which it was achieved, she suggested. “If you have got a happy and calm person who was previously frustrated and angry, that might achieve a good outcome, but the case law says councils should be setting out which services are being used,” she said.
Neil Coyle, director of policy at Disability Alliance, said most people with disabilities did not want or expect the state to pay for sexual services. He said: “When people go to councils for help, they are looking for essential services to maintain some level of dignified existence – help to dress and wash. Given that councils have been drawing the most basic support from those who need it, I do not think this is the biggest concern of people with disabilities.”
Liz Sayce, chief executive of disability network Radar, said the desire for sexual relations was a matter of human rights, meaning cases involving payments should be carefully examined on a “case by case” basis.
Matthew Elliot, chief executive of The Taxpayers’ Alliance said it was “deeply worrying” that public money had been spent on the services of prostitutes, lapdancing clubs and to pay for holidays. He said: “Many taxpayers will be appalled and offended that money intended for social care has been used in this way. What’s more, it’s deeply worrying that this scheme has been so vulnerable to these abuses. It’s essential that where public funds are involved, there are the sort of checks and balances in place that prevent money being wasted in this way”.
Barnardo’s, butt out of the law
The British children’s charity wants to ‘fast track’ court cases that could result in the removal of a child from its family. No way
This week, the British children’s campaigning group Barnardo’s published data relating to care proceedings in England and Wales. It strongly criticised the delays experienced by families who are subject of proceedings under section 31 of the Children Act 1980.
Under these proceedings, parental responsibility for a child can pass to a local authority where that local authority has demonstrated that the child is ‘suffering or likely to suffer significant harm’ and that the harm is ‘attributable to the care being given to the child’ or ‘the child being beyond parental control’. Barnardo’s said the fact that these proceedings can take as long as 62 weeks to get through the County Courts was ‘damaging vulnerable children’. The time spent awaiting a ruling in care proceedings places children in a ‘desperate limbo’ and leaves them ‘very possibly at risk’. The ‘evident lack of credence given to social workers’ today is one of the causes of ‘significant delays’, said Barnardo’s, before suggesting that a time limit of 30 weeks be placed on all cases, with a ‘fast-track’ system for cases involving children who are under 18 months old.
Of course, if a long period of time is spent making a decision about the care of a child, that could be extremely unsettling for the child involved. But still, we should think carefully about what Barnardo’s is advocating. A fixed limit on the amount of time a court has to dispose of a case would be extremely unusual for England and Wales. With limited exceptions in the criminal courts, there are no statutory time limits to force the conclusion of cases. Courts have the discretion to allot an appropriate amount of time in consideration of the complexity of the facts in an individual case. This discretion is particularly important in relation to care proceedings, where determinations can vary hugely from the straightforward to the enormously complex.
The language employed by Barnardo’s suggests that it thinks the decisions taken during care proceedings are simple. Its campaign materials flippantly use terms like ‘abusive households’, with children straightforwardly categorised as ‘at risk’ and ‘not at risk’. With such a black-and-white, abstract worldview, where everything is defined almost in terms of good and evil, it’s no wonder Barnardo’s thinks the amount of time spent on care proceedings should be capped and everything should be sped up to ‘save children’.
Yet anyone familiar with the law in this area will know that there are many intricacies involved. The courts have frequently disagreed on how to apply various provisions in the Children Act and have developed reams of case law attempting to formulate applicable definitions. The job of the practitioners in this area of law is to apply these concepts to the breadth of circumstances being weighed up in court. It is often a painstaking process. And considering that the proceedings can result in the state removing a child from its family – a very serious move – it is only right that it is a painstaking process. We should feel reassured that it often takes a long time to make these life-changing decisions.
Of course it is true that there are many unnecessary delays in the family courts. Concerns about such delays are not new. In 2006, the UK Department of Constitutional Affairs published its Review of the Child Care Proceedings System in England and Wales. It identified a number of factors causing unnecessary delay in hearings relating to the Children Act, including: the poor quality of legal representation; poorly prepared applications; the scarcity of judicial resources. But none of these issues would be solved by enforcing a Barnardo’s-style time limit; instead we need greater investment in the UK’s sclerotic civil legal aid system, which currently fails to provide legal protection for the poorest in society from some of the state’s most draconian powers. Fixing legal aid, however, is not something Barnardo’s is very interested in; it only wants to rush cases through the courts.
This is because Barnardo’s is not really concerned with the ins and outs of various complex cases, but rather with pushing its own interventionist agenda. In the aftermath of the horrific Edlington assault case, in which two young boys were jailed following a prolonged assault on a nine-year-old boy, the chief executive of Barnardo’s, Martin Narey, criticised social services in Britain for ‘trying to fix families that are completely broken’. He went on to say that ‘if you take a baby young and get them quickly into a permanent adoptive home, then we know that is where we have success’.
In May 2010, Barnardo’s assistant director for policy, Enver Solomon, said at a conference on service provision for vulnerable children that social services had ‘failed to crack neglect’ due to their ‘reluctance to make proactive decisions to remove children living in chronically neglectful circumstances’. It seems that, for Barnardo’s, taking children away from families should be a priority, and care proceedings are simply a question of how quickly a child can be removed.
This is why the administration of the law should not be influenced by the prejudices of individual charities. The law should not bend its rules to suit campaigners’ simplistic classification of legal problems in black-and-white moralistic terms. The issues dealt with by the family courts are frequently complex and carry the most serious consequences for those on the receiving end of the state’s powers. As such, the courts should be free to determine the amount of time required for the proper consideration of each matter on a case-by-case basis. Barnardo’s may like to think that the decisions made in care proceedings are simply a case of deciding who is and who is not ‘at risk’ – thankfully, adhering to due process is never that simple.
There is a new lot of postings by Chris Brand just up — on his usual vastly “incorrect” themes of race, genes, IQ etc.