Monday, May 20, 2013

Snorkel to Serco: QinetiQ to Harmoni!


©2013 Am Ang Zhang
Whenever I went snorkeling, something happened to our beloved NHS!


The Care Quality Commission’s report on Harmoni, Britain’s biggest provider of out-of-hours care which runs services across the country and earns £100m a year from NHS contracts, is the first evidence from an official body that cost-cutting by private companies may be harming patient care.

Jeremy Hunt will say “disastrous” changes to GPs’ working hours have led to an extra four million people attending hospitals annually, a situation he will demand is reversed.

The growing pressure on hospital emergency departments is the “biggest operational challenge” facing the health service, he will warn.

The NHS is conducting a review of out-of-hours care which may lead to GPs again taking responsibility for looking after patients outside normal working hours.
Controversial changes to GPs’ contracts made under Labour in 2004 allowed them to opt out of treating patients outside normal office hours. The review could see that policy reversed.

When the contract was initially renegotiated in 2004, GPs had their salaries reduced by £6,000 if they stopped providing care out of hours. However, other changes to the contract meant that average pay rose by a third, with many GPs earning six-figure salaries.
Following the changes, 90 per cent of family doctors stopped providing emergency cover, leaving patients to rely on phone services, agency doctors or hospital visits. In 2004/05, 17.7million people used England’s A&E departments. By last year, that had risen to 21.7million.
In opposition, the Conservatives pledged to renegotiate the contracts. However, attempts to change them have proved difficult, and the Government is scrutinising other ways of improving the out-of-hours service. The official review on the issue is expected to report at the end of the May.

Last time, this was in the news!
Three doctors working at Yarl's Wood immigration detention centre are facing investigation by the General Medical Council, amid calls for healthcare at the centre to be transferred from the private sector to the NHS.

Any GMC investigation would increase pressure on ministers to address growing concerns about healthcare at Yarl's Wood, which is the responsibility of Serco, the private company that runs the centre. Last month the children's commissioner raised concerns about "significant areas" of care for the 1,000 children held at Yarl's Wood, saying it fell below NHS standards.

On Wednesday the chief inspector of prisons, Anne Owers, will publish a report into Yarl's Wood, which is also expected to criticise conditions at the centre.

Last night two MPs called for Serco to be stripped of responsibility for healthcare at Yarl's Wood. John McDonnell, Labour MP for Hayes and Harlington, said: "There is an underlying conflict of interest when you have a private company which is run for profit running healthcare. The best way of ensuring openness, transparency and avoiding conflict of interest, and ensuring that people are getting a fair standard of healthcare, is to have it run by the NHS.

Will future doctors (GPs and Consultants) working for such private companies risk being “looked at” by the GMC?

They are not as lucky as another person I read about:
Reuters: David Steeds:

Mr. David William Howitt Steeds is Independent Non-Executive Director of Jetion Holdings Limited. Mr. Steeds was a member of the team that built up Serco Group plc as one of the UK’s support services companies and then joined DERA (now QinetiQ Group plc) as corporate development director.

QinetiQ: Ten former civil servants at the Ministry of Defence who made more than £100m in one day from the privatisation of its research agency are today accused by MPs of behaving "dishonourably" in arranging the sale. A report from the Commons public accounts committee on the part-sale of QinetiQ accuses the 10 of a "serious conflict of interest" in selling the idea to the MoD without explaining they stood to benefit personally from the sale.

Mr. Steeds is currently non-executive chairman of Telspec plc, and non-executive director of Tinci Holdings Ltd., a company listed on AIM. He is a former chief executive of the Private Finance Panel, the UK government agency previously responsible for the Private Finance Initiative (PFI). He was conferred a Degree of Bachelor of Arts by Cambridge University in June 1970, a Master of Arts in industrial relations by Warwick University in July 1972 and qualified as a Chartered Accountant in England & Wales with Coopers & Lybrand in 1974. Mr. Steeds is considered to be an independent nonexecutive director.

Five family doctors have this week become millionaires from the sale of their NHS-funded firm to one of the country's biggest private healthcare companies in a deal that reveals how physicians can potentially profit from government policy in the new NHS.

On Tuesday, the private health company Care UK announced that it had paid £48m for England's biggest out-of-hours GP service, Harmoni, originally set up as a GP co-operative, creating a new private health concern that could treat 15 million patients. The deal shows how GPscould profit from the coalition's health reforms by using their expertise to bid for contracts, then cashing in when a corporation buys them out.

Death & Harmoni:

The family of a young woman is suing the country's biggest out-of-hours GP provider and one of its nurses, whose failures meant her fatal condition was not diagnosed, because neither will accept liability in a test case over legal responsibility in a privatised NHS.

Clare Secker, 19, died of bronchopneumonia in December 2008 after a nurse working for the privately-run telephone service told her parents to give her paracetamol and fluids.

Earlier this year the nurse admitted through her lawyers that she had been "in breach of her duty by failing to arrange for [Secker] to be seen by a doctor". If the young mother, who died when her son Tyler was less than a year old, had been prescribed antibiotics she would have recovered fully.

Despite this neither the firm, which was part of the Harmoni out-of-hours service until it was bought by Care UK in November 2012, nor the nurse has offered compensation to the family.

The nurse claims she does not need to pay out as her employment contract specifically states that the company had insurance in place "to indemnify … for any claim arising from any wrongful act committed by … any employee while carrying out their contractual obligations". But Harmoni says its insurance excludes responsibility for negligence by nurses.

With the Health and Social Care Act 2012 leading to more NHS contracts going to private providers, lawyers are concerned that the fragmented system will lead to a loss of accountability.

"It cannot be right that patients no longer know who is actually providing their care, or for those who are harmed to have the additional stress of providers trying to dodge responsibility by pointing to a clause in a contract or insurance policy. Until something disastrous happens we, the public, think we are still within the safety net of the NHS and increasingly that's just not the case. There is little transparency or protection, it seems to me."

Brittle Seastars invading corals ©2013 Am Ang Zhang
Hospitals now fight other hospitals and the failed ones will be handed over to privateers. Some of these have the highest mortality rates. I am surprised that they are not sold  off for just a single pound.

The more failed hospitals, the better for the government. Once they washed their hands off, it is not their problem. If the privately run hospital failed, they change CEO, change ownership and continue. 

In less than 10 years with GP cooperatives had built up a great deal of expertise in organising out of hours cover and their management boards comprised local GPs. It might be supposed that PCTs would automatically want to use this expertise.

But this was not the case. The NHS Confederation (the managers own organisation) told the Health Select Committee that few PCTs were working positively with GP co-operatives, often instead being adversarial and generating conflict. 

In Buckinghamshire the GP cooperative was forced out of business literally overnight when the PCTs awarded the contract to a large company called Harmoni.  In Cornwall the exemplary Kernowdoc was passed over in favour of Serco. Both Harmoni and Serco has since been the subject of major complaints and in particular have been accused of failing to employ sufficient doctors. Ironically these cases mirror the very situation which led to the Carson Report. Despite these experiences a recent bid by a group of East London GPs to take back organisation of Out of Hours care for their patients was passed over in favour of a private company.

The GMC has been quiet about them as they have with the Breast Implant ones and many other plastic surgery private hospitals.

Yet, right now the NHS picked up the mess of the PIP implants. The private companies pocketed the money. Lots of money.                                                                                                   


May 11, 2011

“……Tom Clark our leader writer says the real problem with the bill is the fact that the new regulator has a duty to promote competition where appropriate. He points out that in a previous life as a special adviser the regulator used his powers to squeeze state bodies in order to open up the space for private providers. It's why he is so against competition.”

For my money, the most important line in the whole of the health and social care bill is found – if I have the chapter and verse citation system right – at clause 56 1(a). It lists the first duty of the regulator Monitor, which is being transformed from the Foundation Trust hospital's overlord into being the economic regulator of the whole healthcare market, as being "promoting competition where appropriate".

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