Will the government really penalise GPs whose patients opt out of data sharing?

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It seems the government has found a way to dissuade GPs from letting patients opt out of having their medical records sold to private firms – the threat of penalties or even an investigation into the way they run their practice.

Vox Political revealed earlier this month that the government is planning to make a profit from selling the private records of NHS patients in England to healthcare and pharmaceutical firms.

The records are said to be ‘anonymised’, but in fact anyone buying your details will be able to identify you.

The system, originally called the General Patient Extraction Service (GPES), now the Health and Social Care Information Centre, may also be described as the care.data scheme. Health Secretary Jeremy Hunt wants you to think the information will be used for medical research and screening for common diseases, but in fact it could be used by private health companies as evidence of failures by the National Health Service, and could help them undercut NHS bids to continue running those services – accelerating the privatisation that nobody wanted.

Patients have the right to withhold their data, but they must specifically inform their medical practice of their wishes. This is why medConfidential created a web page containing a special opt-out form, along with a form letter in various formats, allowing patients to opt out themselves, their children and any adults for whom they are responsible.

Now GPs are living in fear of reprisals if they don’t deliver enough details to the new system.

According to GPonline.com, Health minister Dr Daniel Poulter failed to rule out penalising GP practices with a higher-than-average proportion of patients opting out of new NHS data sharing arrangements.

In a written answer to Labour MP and health select committee member Rosie Cooper, Dr Poulter also refused to say what level of patient opt-out from the scheme would trigger an investigation.

Asked whether practices would be penalised, who would investigate practices with a high opt-out rate, and at what threshold this would apply, Mr Poulter said: “NHS England and the Health and Social Care Information Centre will work with the BMA, the RCGP, the Information Commissioner’s Office and with the Care Quality Commission to review and work with GP practices that have a high proportion of objections on a case-by-case basis.”

Ms Cooper took this as an admission that GPs were “being threatened and bullied into ensuring patients don’t choose to opt-out”.

Reacting on Twitter, NHS national director for patients and information Tim Kelsey ruled out fines for practices where large numbers of patients opt not to share data. He wrote: “Nobody is going to get fined if patients opt out.”

None of this offers a good reason for you to leave your medical records unprotected – in fact, it gives you more reasons to opt out than before, and might provide GPs with the excuse they need to retaliate.

Doctors have been pushed further and further by the Conservative-led government’s changes to the NHS. For example, they were told they would have a greater say in where the money went, as members of Clinical Commissioning Groups (CCGs), but that was not true – they don’t have the time to take part in such decisions so they have been handed over to firms that are often part of the private companies now offering services to the NHS (for a price).

Now they are being told they may face reprisals if they do not betray the principle of doctor-patient confidentiality.

But you can only push a person a certain distance before they push back.

How will NHS doctors in England respond?

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How much can YOU pay? A&E charges would speed NHS privatisation

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Health-CARE? It seems increasing number of GPs want the person on the stretcher to stump up a fiver or a tenner before the medical staff in the photograph can begin treatment. (Image: BBC – intentionally left fuzzy to preserve anonymity of those involved)

It is strange that more has not been made of the revelation that one-third of GPs apparently believe a £5 or £10 charge should be imposed on everybody turning up at hospital Accident and Emergency departments.

This seems to be a clear next step towards the marketisation of what used to be the National Health Service, disguised with a claim that it would “reduce frivolous use of the NHS and the growing pressure on emergency departments”.

It seems that a poll of more than 800 doctors found 32 per cent said “fees would be the most cost-effective way of cutting the number of people who go to A&E, who could have gone to their GP or a pharmacist instead or did not need medical attention at all”. Presumably they have already tried simply telling people what to do, then.

The story in The Guardian states that “specialists believe between 30 per cent and 40 per cent of all visits are unnecessary and that many patients could have sought help elsewhere because their illness was minor or not urgent”. That leaves 60-70 per cent of visitors paying extra for services their taxes have already funded!

According to the book NHS SOS (edited by Jacky Davis & Raymond Tallis; published by Oneworld), the plan is to convert the publicly-funded nationwide health service into one of “managed” care along the lines provided by Kaiser Permanente in the USA.

This is based on a flawed use of figures (p.39) so Kaiser is in fact far more expensive, but that didn’t stop then-Department of Health strategy director Chris Ham from defending the claims and allowing Kaiser to emerge as the model for NHS reform. This was seen as particularly useful for those with cash to invest in the company or other MCOs (Managed Care Organisations) as they reaped huge profits – until market saturation, government and employer schemes to keep health care costs down, and a series of scandals made the pendulum swing the other way. Then these companies started lowering patient benefits, increasing premium fees and withdrawing from unprofitable markets, and this is very similar to the current situation in England.

Finally, these firms began to expand internationally, to countries including the UK, where the NHS was seen as a hugely attractive business opportunity.

MCOs decide how services are organised and funded for their clients, through contracts with selected providers and rigorous control of hospital admissions. This seems uncannily close to the work of Clinical Commissioning Groups, which were set up under the pretext that they would allow GPs to control budgets, but in practice allow the money to be controlled by private firms that have been hired by overworked doctors – as was always intended by the Tory-led Coalition government.

Government regulations mean private companies must be allowed to bid to provide as many services as possible. Freedom of Information rules mean they can find out how the public service operates and then undercut its bid. Without funding, the public service will close, leaving the way clear for the private provider to pump up its prices – so they will eat up more and more of the limited NHS budget. But which services do they choose?

They choose those that are easiest and cheapest to provide – the services that provide the most opportunity to make a profit.

Accident & Emergency is not one of those services. It will remain with the public sector providers who are being “continuously cut and squeezed into downsizing, mergers, centralisation and closures”, reducing care to “short-staffed, overloaded, ‘centralised’ units”, covering “only those services that the private sector does not wish to provide” (ibid, p.18).

How can services like A&E continue, if the private operators are taking all the cash? The only answer, it seems, is to bring in health insurance. That is the plan, at least – and the proposed A&E charges seem intended to be a palatable way of opening that door to a public that would once have treated the very idea as anti-British and voted the government that proposed it out of office for a considerable period of time.

Next it seems likely that “top-up” insurance will be offered to people whose complex ongoing conditions qualify them for so-called Personal Care Budgets. The budget money will be limited, forcing patients (or rather, customers) to “top them up” with insurance.

Be very clear on this: You are not looking at the thin end of the wedge. The wedge has already been driven in and England is well on the way to having a privatised health service, with the NHS as nothing but a brand under which taxpayers’ money can be handed out to private firms that handle only the simplest procedures.

The intention, it seems clear, is to allow publicly-funded services to wither over a period of time, in order to soften you up – make you more receptive to the idea of paying for healthcare that once was free but may not even be available in the future if you don’t come up with some cash.

Are you going to sit there and wait for that to happen? Private health care, and health insurance, is far – far – more expensive than the NHS, which was the most cost-effective and efficient health provider in the world until the Tory-led Coalition got hold of it. Don’t believe the propaganda – the service had record satisfaction levels in 2010.

You can still stop the rot. To find out how you can work to reverse the damage being done to the most cherished organisation in the UK, visit www.keepournhspublic.com and www.nhscampaign.org.uk

If you’re living in Wales, Northern Ireland or Scotland, don’t think that devolution of healthcare will save you because it won’t. Budgets are already under pressure from Westminster and the Tories will do whatever they can to force regional governments into the same, or similar, patterns.

One of life’s certainties is that you will become ill at some point. Don’t wait until that happens, because it will be too late.

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Dilemma for private bosses as Labour unveils transparency plan for public service work

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An end to the corporate backhander? [Picture: This Is Money}

A Labour government would make private companies who provide services at the taxpayers’ expense obey public sector transparency rules, it has been revealed.

The change means firms and charities that sell services to the state – for example, all the private companies now working in the NHS – would lose their right to commercial confidentiality.

The Freedom of Information Act would be extended to cover them and they would have to reveal their commercial secrets if a FoI request required them to do so.

If enacted, this is likely to be more effective in creating transparency of lobbying than the Parliamentary Bill of the same name that is currently working its way through Westminster.

The policy was revealed in a Sunday Times article which is paywall protected. Labour has yet to release an announcement on its website.

The article quotes shadow justice secretary Sadiq Khan, who said: “More and more of our public services are being delivered by private companies and charities, out of reach of freedom of information. We must demand the same openness from them as we expect from government. It’s not on to let these organisations hide behind a veil of secrecy.”

Bravo.

The new policy comes after a 10-minute rule motion by Labour’s Grahame Morris began its journey through Parliament earlier this month. Such motions rarely get very far because the government of the day usually opposes them in the later stages and there is often too little time to complete the debate.

But these bills stimulate publicity for their cause, and it seems clear that the Labour leadership has taken this particular cause on board.

So it should – concerns are high that unfair advantages are being handed to, for example, the private healthcare companies, who are then able to hide the facts behind the veil of commercial confidentiality. Why should they be allowed to do this when they are providing a public service, funded by the citizens of the UK?

Existing NHS operators do not have the advantage of commercial confidentiality and must provide details of the way they operate if a FoI request is submitted to them. This makes them vulnerable during the bidding process for NHS contracts, as private operators can ask about the current providers’ operations and then undercut them to get the work.

Then there’s the so-called “revolving doors” practice, in which government advisors move to lucrative contracts in the private sector, often after providing advice that changes government policy in favour of their new employer. Mr Morris’s motion noted that “at least five former advisors to the Prime Minister and the Chancellor of the Exchequer are now working for lobbying firms with private healthcare clients”.

This is a corrupt practice – the firms gain an unfair advantage because they have, if you like, a spy in government manipulating affairs to their advantage. Nothing is done about this at the moment, nor will the Labour proposal change that situation – but we will all be able to see who the spies are.

It would probably be advisable for a future Labour government to put powers in place to reverse any change in the law due to corrupt advice intended to engineer a commercial advantage to a private company. Restricting the movement of government employees to other jobs would be problematic, but if it is known that any changes they effect will be reversed after such a move, then the exercise would become pointless.

Companies would not be able to pay a person to influence the government while they remained in the taxpayers’ employ, as this would be a clear case of bribery and corruption.

A previous VP article on this subject mentioned the idea of the level playing field – and Labour is to be praised for producing policies intended to restore that principle to government in the face of Conservative and Liberal Democrat efforts to skew the field in favour of their corporate chums.

And the corporates themselves? Well, their bosses are likely to be furious and it’s possible that all kinds of threats will come in Labour’s direction.

That’s fine. A Labour government can take any such complaint in stride by launching a programme to revise government tax strategy with regard to corporates, and bring any complaining company to the top of the list.

How private firms take unfair advantage over the public sector to get government contracts

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Open and transparent: Grahame Morris, who called for a ‘level playing field’ for both private companies and public organisations when bidding for government contracts.

Did you know that £1 in every £3 spent by the government goes to an independent or private-sector service provider?

If you also recall government ministers bemoaning the fact that £1 in every £4 spent by the government was borrowed, as they said very often during the first year or so of the Coalition, and you bear in mind the fact that all private companies must make a profit, you’ll come to a fairly damning conclusion.

Did you know, also, that private companies – while free to hide behind commercial confidentiality regarding the conditions under which billions of pounds of taxpayers’ money are awarded to them in government contracts – may use Freedom of Information requests to gain detailed information about public sector organisations and then use that knowledge to undercut or outbid those bodies when government contracts are tendered or put up for renewal?

FoI regulations give private providers an unfair competitive advantage when bidding for contracts, due to unequal disclosure requirements.

Both of these were made clear in Grahame Morris’s short speech in support of his 10-minute rule motion to bring in a Bill amending the Freedom of Information Act 2000 to apply to private healthcare companies, and for connected purposes.

He even pointed out that we are living in a society where freedom of information is routinely censored – stating that he attended a demonstration against NHS privatisation in Manchester at the start of the Conservative Party conference there, “but which was barely reported by our public sector broadcaster”.

He said the government should be chastened by recent events. “For example, the tagging scandal — involving Serco and G4S and uncovered by the Serious Fraud Office — showed that these companies had defrauded the taxpayer of more than £50 million.

“Perhaps we need a hard-hitting advertising campaign, with advertising hoardings on vans driven around the City of London, warning off corporate fraudsters from bidding for public contracts?

“The danger for our NHS is that we are inviting convicted fraudsters into our health system.”

He said HCA, the world’s biggest private healthcare company, recently won the contract to provide cancer treatment for NHS brain tumour patients, “stopping patients receiving world-class treatment at London’s University College Hospital”.

Mr Morris continued: “The Competition Commission has already caught HCA overcharging private patients in the United Kingdom. In the United States, HCA has had to pay fines and costs in excess of $2 billion for systematically defrauding federal healthcare programmes.

“The public are right to be concerned about these providers coming into the NHS. If that is to happen, it is essential that their operations and their contracts with the NHS should be open, transparent and subject to public scrutiny.”

Introducing his Freedom of Information (Private Healthcare Companies) Bill, he said its purpose was to strengthen FoI legislation and introduce vital safeguards, so members of the public can see how their money is being spent.

It seems he may even have read Vox Political‘s earlier article on his motion, as he said: “I hope that Members on both sides of the House will support fair competition, a level playing field and the duty of equal disclosure throughout the bidding process for NHS services.

“The public have a right to know the record of public and private providers before contracts are awarded. Those safeguards can work only if the Information Commissioner has the same rights to seek information and carry out investigations, and to make all providers of public services comply with freedom of information legislation.

“I understand that the Information Commissioner expressed concern to the Justice Select Committee that accountability would be undermined if FOI did not apply to private providers of public services.”

He said: “Freedom of information is one of the Labour Government’s greatest achievements, ensuring transparency and accountability in modern government and allowing the public access to information on what is being done in their name and how their money is being spent.

“In recent years, we have witnessed an acceleration in the number of public services being outsourced, and today roughly £1 in every £3 that the Government spend goes to independent or private sector providers.

“Owing to the Government’s policy of opening up public services to the private and voluntary sectors, billions of pounds of NHS contracts are now being made available to the private sector, following the implementation of the Health and Social Care Act 2012.

“Unfortunately, while more and more taxpayer money is being handed to the private sector, especially in the NHS, FOI responsibilities are not following the public pound.

“There is a big issue here about transparency, because the public should know what is happening in their name, as was brought home to me recently in a demonstration against NHS privatisation in Manchester that I attended, along with more than 50,000 other people, but which was barely reported on by our public sector broadcaster.

“Private health care companies should not be permitted to hide behind a cloak of commercial confidentiality. Billions of pounds of taxpayers’ money is being awarded to private sector companies under barely transparent contracts.

“Meanwhile, private companies are free to benefit by gaining detailed knowledge of public sector bodies through their use and submission of FOI requests. The same information is then used by the private sector to undercut or outbid the very same public sector bodies when contracts are tendered or put up for renewal.”

Although no objection was raised to the Bill going forward, it seems the Coalition has performed an about-face on the issue. Mr Morris said: “I understand that in opposition the Prime Minister was convinced about this matter, having previously promised to increase the range of publicly funded bodies subject to scrutiny using section 5 of the Freedom of Information Act.

“The coalition agreement also promised to extend the scope of the Act to provide greater transparency, but unfortunately it would appear that nothing is being done to address the democratic deficit caused by the outsourcing of public services.”

Sadly, it seems likely that this Bill won’t get very far, for reasons this blog has already mentioned – the Government usually opposes Private Member’s Bills in the later stages and, given their low priority in the schedule, there is often insufficient time for the debate to be completed.

But this may not matter, as the information already provided by Mr Morris makes fascinating reading that is damning for the government.