Wednesday, January 14, 2015

There are two futures: NHS future now!

As the sun sets and it was clear that we have lost the first privatised NHS hospital :
©2014 Am Ang Zhang


CAROLINE MOLLOY 14 January 2015

Hinchingbrooke - the flagship of NHS privatisation - was given the CQC’s worst ever rating for ‘caring’. Both safety and leadership were also bottom of the heap.  Circle’s cleverly branded ‘mutual’ model, far from ‘liberating’ NHS professionals’ to make grassroots-led improvements, had in fact replicated some of the worst hierarchical, bullying practices to be found in the NHS. And it had lost the caring and expertise that are the NHS’s strengths, principally as a result of poor leadership and financially-driven staff cuts to satisfy investors.
But does that mean privatisation is dead?
No. Too many have staked their careers - and their fortunes - on it, for them to back off that easily.
No-one who understands the NHS has ever really expected the private sector to make profits from running full service hospitals with A&E departments.
Just as opponents to the Health & Social Care Act pointed out, what the private sector really want to do is cherry pick, taking the government money to run all the predictable and easy stuff - starving the rest of the NHS of funds as a result.
But the government had to pretend otherwise, to get through the Health & Social Care Act, and Ali Parsa's hyperactive hyperbole was very useful during those turbulent months.
“Forget the cherries - give us the potatoes” Ali Parsa told the Times in November 2011 on winning the contract. That years’ business plan set outgrand visions of Circle taking over 20 or more hospitals across the country. Parsa even told Newsnight "We would love to run a major teaching hospital".
But Parsa left at the end of 2012 for pastures new - his PR job done. And with the Act secured, and former Vice President of US healthcare giant United Health, Simon Stevens, now at the helm of the NHS, private health companies see better profits (and less brand damage) than openly taking over full service hospitals, as Circle’s statement on Friday hinted:
If doctors running local Clinical Commissioning Groups won’t hand over the NHS cash, there’s various ways decisions are being quietly wrenched away from them, from ‘commissioning support’ and ‘personal budgets’ to ‘chain hospital networks’, ‘Kaiser-style integration’ and ‘prime contractor’ models.
All of this will help companies like Circle sort the cherries from the potatoes.
And if the tariffs paid for many treatments are currently too low to squeeze a profit from, well, it's only a waiting game till the cherry picking undermines the NHS to the point the private sector providers can start flexing their muscles and demanding more money.
It's already starting.
In nearby Bedfordshire, Circle recently won a huge ‘integrated’ ‘prime contractor’ contract for all musculo-skeletal services in the area - and promptly tried to sub-contract the undesirable bits back to the NHS on Circle’s own terms. As the local NHS hospital told the BBC, “Our concern is that if we don't have the planned work coming through, then with the way the NHS is financed, we don't know whether we will have sufficient money to provide the emergency service.” Recent reports suggest Bedford Hospital is now in severe financial difficulties.

A little further afield in Nottingham, Circle runs the largest Independent Sector Treatment Centre in Europe, having pulled off an eyebrow-raising deal to force the NHS to pay it £42 million to buy its clinic in the hospital grounds, then lease it back to it. Circle then continued to expand, recently successfully bidding to take over the hospital’s routine NHS dermatology services - to thedisgust of the doctors who left rather than be transferred to Circle. Now, the local NHS hospital is closing its acute dermatology services too, because it can’t afford to provide only the more expensive dermatology services Circle doesn’t want. Patients will be forced to travel ever further afield for anything more complicated or less profitable.  


Hinchingbrooke, As it failed I am putting out my future blog again:
The future is now!!


“There are two futures, 
the future of desire and the future of fate, 
and man's reason has never learnt to separate them.”



 J. D. Bernal, Professor of Physics, Birkbeck College, London, FRS ( 1901—1971)



Scenario 1: Grandpa, why didn’t you save the NHS when you were Prime Minister?

But, why, we had enough money; you do not need the money like some third world leader?

But why did you let the private firms get in. All the papers and bloggers were warning you?

I know you did buy the hospitals back, but at what cost.

Hindsight? It is not hindsight, everybody was saying it.

Scenario 2: Grandpa, you were great. You listen to your own advisers from King’s Fund, and the bloggers and you stopped privateers taking over any health care.

No, the privateers only want to sell the land, float the hospitals and make money and leave. Many are not from here.

We had enough money and you do not need a job from them when you are not Prime Minister.

Lets enjoy the sunset.

 
©2010 Am Ang Zhang


LONDON -(Dow Jones)- Circle Holdings PLC, an employee co-owned healthcare provider, said Wednesday it plans to float on AIM June 9.
MAIN FACTS:
-Circle is 50.1% owned by the Company and 49.9% owned by the Circle Partnership which is 100% beneficially owned by Circle's clinicians and employees.
-Circle's objective is to redefine secondary healthcare delivery in theU.K..

Circle’s CEO, ex-Goldman Sachs banker Ali Parsadoust set out his view that the NHS is “an unsustainable industry” that costs too much to run. “In his view, Britain has world class retailers, telecoms and financial services firms, as these sectors have been opened to competition over the past few decades,”

Really?

Retailer:
The collapse of national retailer Focus DIY has sparked a fresh wave of attacks on private equity firms as details emerged of a decade of deal-making and financial engineering in which buyout specialists shared payouts of nearly £1bn.

An analysis by the Observer has found that one private equity firm, Duke Street Capital, which made an initial investment of £68m in 1998, took £700m out of Focus after presiding over a series of capital and debt restructurings that turned the small Midlands-based chain into a DIY giant with sales of £1.5bn. Apax, its investment partner, which put in £120m, pocketed £183m when the Wickes chain was carved out in a £950m deal that ultimately left the remnants of the chain struggling.

Telecom:

BT’s pension trustees are going to court to find out if there really is a crown guarantee covering a large portion of the company’s £40 billion pension fund.
They’re asking: if the company goes bust, will the government (and the RBS-owning U.K. taxpayer knows what that means) step in to plug any gap in funding for the thousands of pensioners who were in the scheme in 1984 when Margaret Thatcher was waving her privatization wand.


Financial Services Firm:
Goldman Sachs:
Goldman Sachs has been fined £17.5 million by the FSA for not letting it know that Fabrice Tourre, a trader who moved to Londonfrom New York in 2008, was being investigated by the U.S. Securities and Exchange Commission.
Goldman is a bad, bad boy. But if you think the firm is the only to be blamed in this game, think again.
On the Goldman side, what else can we expect from the firm that has already admitted making a bigger mistake in the same case? To refresh the memory, the firm agreed to pay $500 million in July to settle SEC civil charges that it duped clients by selling mortgage securities that were secretly designed by a hedge-fund firm to cash in on the housing market’s collapse. The firm didn’t admit to, or deny the charges, but it acknowledged it made a “mistake” by not disclosing to investors the role of the hedge fund, Paulson & Co.

Ali Parsadoust was with Goldman Sachs.



Backed by some of the City's most powerful hedge fund tycoons and run by former Goldman Sachs vice-president Ali Parsadoust, Circle was selected in November as the first private company to run an NHS hospital. But with losses of over £27.4m, according to accounts filed at Companies House last year, Circle recently lost two lucrative contracts with the NHS worth £27m, representing more than 42% of its £63m turnover.



Looks like some clever Financial manouvres!!!

Best money is government money: our money!


Caring for vulnerable older people is a statutory obligation under the 1948 National Assistance Act and is exercised on a means-tested basis through local authorities. The National Health Service and Community Care Act 1990 allowed councils to farm out care to any willing provider.
The big companies moved in, including Southern Cross, buying up small care companies or building new homes. As they grew, private equity firms started to show an interest, among them the US firm Blackstone Capital Partners. Investors, when they look at a home full of older people, see a stream of guaranteed income, most of it from local authorities and underpinned by the 1948 legal requirement to provide care. Since the elderly population is rising, investing in care looked like a one-way bet for long-term profit.
Money can be made by separating the income flows from the actual business of care and packaging them as saleable investment instruments – securitisation. Blackstone took control of Southern Cross in 2004 from another private equity firm, West Private Equity. Significantly, that year it also bought NHP (Nursing Home Properties), whose business included leasing care homes to providers (Southern Cross was its biggest tenant) and turning the resulting rental income into high-yield bonds to be sold to investors.
Blackstone floated Southern Cross on the stock market, selling up in 2007. It also sold NHP to an investment fund, Three Delta, with controversial upward-only rental agreements with Southern Cross. This has left Southern Cross with an annual rent bill of around £240m.


Latest: Southern Cross

From one of your own advisers: Prof Chris Ham
Parliament debate: Public Bill Committee
Chris Ham"May I add something briefly? The big question is not whether GP commissioners need expert advice or patient input or other sources of information. The big problem that we have had over the past 20 years, in successive attempts to apply market principles in the NHS, has been the fundamental weakness of commissioning, whether done by managers or GPs, and whether it has been fundholding or total purchasing."                             


“………The barriers include government policies that risk further fragmenting care rather than supporting closer integration. Particularly important in this respect are NHS Foundation Trusts based on acute hospitals only, the system of payment by results that rewards additional hospital activity, and practice based commissioning that, in the wrong hands, could accentuate instead of reduce divisions between primary and secondary care.”


Cassius:
"The fault, dear Brutus, is not in our stars,

But in ourselves."



Julius Caesar (I, ii, 140-141)

Hinchingbrooke, this is their timeline of how the hospital was put up for tender:
July 2007 – Department of Health gives the Strategic Health Authority approval to examine different options, including franchises.
July 2009 – Department of Health approves the business case for an open competitive tender for a franchise.
October 2009 – Open competitive tender announced and 11 organisations submit bids, six are selected to move to the next stage. Of those six, only one was NHS-only: Addenbrooke’s in Cambridge. Circle say there was no mention of a preferred provider at any point in the tender.
February 2010 -
 Addenbrooke’s pull out of the bidding process.
March 2010 – Shortlist for the franchise announced: Serco, Ramsay and Circle. Serco’s bid did include a partnership with Peterborough NHS Trust.(May 2010 – General Election in which Labour leaves office)August 2010: shortlist narrowed to the final two: Serco and Circle.
November 2010 – Circle announced as preferred bidder.
November 2011 – Contract signed with Circle, which began work in February 2012.


Mayo Clinic: Health Care is not a Commodity!!!

NHS 1978: Hope, Faith & Supermarket

3 comments:

Clare Willison said...

Reading this on 1st June 2017 while social media is alerting anyone who'll listen to the Naylor Report and the fact it's the only thing that Theresa May has confirmed the Tories are committed to. The final comments about the land grab were prophetic. Very afraid for the NHS I'd the Tories win Ge17.

Clare Willison said...

Typo due to autocorrect and only partial vision! Last bit *if Tories win* (God forbid)!

Cockroach Catcher said...

Thanks Clare: http://www.bmj.com/content/350/bmj.h3161/rr

http://www.nottinghampost.com/report-reveals-reasons-collapse-nottingham-s/story-26636386-detail/story.html