“We do not want a system in which our ill-health is a source of profit”

Cllr Sarah James gives an update on the campaign to stop the takeover of London GP surgeries

The take-over of a large number of London GP surgeries by Operose – a wholly-owned UK subsidiary of the US healthcare giant Centene – has been reported here previously. Islington Councillor Anjna Khurana, who is a patient at one of the affected GP surgeries, is seeking judicial review (JR) of the takeover. Her case is being crowdfunded and relates specifically to the approval given to the take-over of contracts previously held by AT Medics to provide GP services in the North Central London area. However, if successful it will have implications for the entire takeover. Initial representations have been made and they are now waiting for the judge’s decision as to whether the case can proceed to full JR.

The deal with AT Medics made Operose the largest provider of NHS GP services in England with more than half a million patients. The change of control was virtually unknown until after the event. This lack of transparency remains a cause for serious concern, with the original decision by the North Central London Clinical Commissioning Group (NCL CCG)  being buried in the proceedings of a previously little known committee – the Primary Care Commissioning Committee (PCCC). If the request for JR is granted, it would be a significant achievement, given that the legal advice on which the approval of the takeover was given came from NHS England and Improvement (NHSE&I).

Another way in which local councillors and campaigners are trying to push back against this takeover is by challenging the automatic continuation of the APMS contracts when they come up for renewal. This means providing a relatively short contract extension to allow time for the procurement process to be undertaken and potentially for another entity to be awarded the contract for those services. Operose contracts are being challenged in this way in both North West London and North Central London, with other areas likely to follow as the opportunity arises.

However, these local attempts to pushback should not be allowed to obscure the bigger picture. In March, barely a month after the Operose takeover of AT Medics was approved, Chief Eexecutive of Operose Health, Samantha Jones, was appointed as an “expert adviser for NHS transformation and social care” at No 10’s policy team.

The career path of Samantha Jones helps to highlight the close relationship between private healthcare companies and the NHS. She joined Operose in January 2019, having previously been Director of New Care Models at NHS England, a position she was appointed to in 2015 by its Chief Executive Simon Stevens. Jones places great emphasis on the importance of data in healthcare systems and what she refers to as ‘a single source of truth’. This raises big questions about who owns and controls that data – who produces the ‘single source of truth’.

It is from No 10 that the impetus to publish the Health and Care Bill has come, regardless of its shortcomings and heedless of the terrible timing – coming straight off the back of the pandemic. The new Secretary of State, Sajid Javad, has been widely reported as having reservations about the Bill but No 10 was adamant that it should proceed.

Regarding the role of the private sector in the NHS, there are big questions that remain unanswered in this legislation. The establishment of the new Integrated Care Boards, that will replace CCGs, promise a whole-population approach to health, a focus on health inequalities and a new co-operative approach that will do away with the hated Lansley reforms and the era of competitive tendering. However, the private sector is already deeply embedded in the NHS and if the new boards give those private providers a seat at the table, then the reforms may serve to entrench competitive advantage rather than improve healthcare for the public.

The kind of emergency measures that have been undertaken during the pandemic – such as the block booking of private hospitals, the hugely lucrative contracts for PPE and Test and Trace, etc., – have shed a light on the profits to be made in healthcare. This was a kind of buccaneering venture capitalism that was prepared to take advantage of a prolonged crisis. In comparison, the Health and Care Bill, with its new ICS Boards, accountable to the Secretary of State, could further entrench the private sector in the long term provision of healthcare.

There are positive elements in the Health and Care Bill but without adequate resourcing and a governance structure that provides real local accountability, they will be lost.

Samantha Jones thinks it is unhelpful to get caught up in discussions about governance: “Don’t get caught in arguments about governance, organisational form and templates, but do be clear how decisions will be made.”

But without good governance there is no transparency and no accountability. When decisions involve the disbursement of hundreds of millions of pounds of public money, such an approach is ripe for exploitation.

The question for the Parliamentary Labour Party is whether they are capable of providing an effective opposition to this legislation and whether they are prepared to mobilise the party membership to stand up for the NHS. For far too long the party has hidden behind the mantra of a health service ‘free at the point of need’, shying away from the uncomfortable realities that this masks. For many of us it does matter who provides our healthcare, who owns our data, who profits from our illness. We do not want a system in which our ill-health and lack of wellbeing are a source of profit. Is Labour capable of rising to this challenge?

Sarah James is a Councillor in the London Borough of Haringey

Image: An NHS health centre in the United Kingdom. Author: David Totterdale, licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license.

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