different standards for the private sector delivering NHS care – they are protected by ‘commercial confidentiality’. Information about their costs, profits and outcomes is unavailable and even parliamentary bodies struggle to find out the basic facts needed to assess their performance. Private companies are not subject to freedom of information requests. Despite promises to vet private companies bidding for NHS contracts there is no central register of ‘Any Qualified Providers’, nor any plan to establish one. Contrary to Lansley’s promise the NHS is now considerably less transparent and accountable than it was before the HSC Act came into force.
* * *
Freedom of Information Act flouted
Of course Lansley was not the first to offer a false prospect of transparency while in reality reducing the level of public accountability for local services and NHS bodies. But by opening up the NHS to greater involvement with the private sector, the HSC Act also meant the further surrender of public sector values and potential for accountability, in favour of the secretive approach that is common in the private sector.
New Labour was obsessed with transforming the NHS from a public service into a purchaser of care from a competitive market for healthcare services. This and the resultant increasing use of private sector providers alienated many of its supporters in the years from 2000. New Labour ministers also shrouded whole new areas which once were in the public domain under a dense cloud of ‘commercial confidentiality’ – including competitive tenders, the contracts for Independent Sector Treatment Centres and outsourced diagnostic services, and the details of contracts for new hospitals built under PFI.
PFI contracts and the process through which the final deal was negotiated have always been and remain especially opaque. In some cases – even where local union reps have battled for years to invoke their rights to see the finished text of PFI contracts under the Freedom of Information Act – they have been handed only heavily redacted versions, often missing the very sections of most interest to them. 5
While they were happy from time to time to take opportunist pot shots at secrecy under Labour, the Tories in government have been more than willing to behave in exactly the same way. The coalition government made clear from early on that they would pick and choose what information would be released not only to the wider public, but even to MPs deciding major policy changes.
Costly Powerpoint slides
One fascinating example of a complete lack of transparency was the major report from McKinsey that was commissioned by Labour ministers in 2009 (in the aftermath of the bankingcrash), some elements of which leaked out to the health service trade press. 10 In it McKinsey consultants put forward ideas for steps to bridge the widening gap between an NHS budget that would no longer be growing in real terms and the rising demand for services.
In place of a proper, evidence-based and fully argued report, McKinsey produced a set of 124 largely unconnected Powerpoint slides (with no accompanying narrative or evaluation of the strengths and weaknesses of the various proposals). McKinsey argued that by 2015 the cumulative spending gap could be as high as £20bn – and then set out a series of increasingly speculative and largely unexplained ideas on how to generate up to £20bn of ‘cost savings’.
The McKinsey document set out a wide range of proposals, but lacked any narrative explanation of how such measures were supposed to be implemented, or what any possible downsides and unintended consequences might be if they were. The evidence for most of their proposals was seriously deficient, or lacking altogether. But as news of the report leaked out in dribs and drabs, Labour ministers responded not only by denying that any of it was policy, and trying to distance themselves from having commissioned it – they refused point
* * *
Freedom of Information Act flouted
Of course Lansley was not the first to offer a false prospect of transparency while in reality reducing the level of public accountability for local services and NHS bodies. But by opening up the NHS to greater involvement with the private sector, the HSC Act also meant the further surrender of public sector values and potential for accountability, in favour of the secretive approach that is common in the private sector.
New Labour was obsessed with transforming the NHS from a public service into a purchaser of care from a competitive market for healthcare services. This and the resultant increasing use of private sector providers alienated many of its supporters in the years from 2000. New Labour ministers also shrouded whole new areas which once were in the public domain under a dense cloud of ‘commercial confidentiality’ – including competitive tenders, the contracts for Independent Sector Treatment Centres and outsourced diagnostic services, and the details of contracts for new hospitals built under PFI.
PFI contracts and the process through which the final deal was negotiated have always been and remain especially opaque. In some cases – even where local union reps have battled for years to invoke their rights to see the finished text of PFI contracts under the Freedom of Information Act – they have been handed only heavily redacted versions, often missing the very sections of most interest to them. 5
While they were happy from time to time to take opportunist pot shots at secrecy under Labour, the Tories in government have been more than willing to behave in exactly the same way. The coalition government made clear from early on that they would pick and choose what information would be released not only to the wider public, but even to MPs deciding major policy changes.
Costly Powerpoint slides
One fascinating example of a complete lack of transparency was the major report from McKinsey that was commissioned by Labour ministers in 2009 (in the aftermath of the bankingcrash), some elements of which leaked out to the health service trade press. 10 In it McKinsey consultants put forward ideas for steps to bridge the widening gap between an NHS budget that would no longer be growing in real terms and the rising demand for services.
In place of a proper, evidence-based and fully argued report, McKinsey produced a set of 124 largely unconnected Powerpoint slides (with no accompanying narrative or evaluation of the strengths and weaknesses of the various proposals). McKinsey argued that by 2015 the cumulative spending gap could be as high as £20bn – and then set out a series of increasingly speculative and largely unexplained ideas on how to generate up to £20bn of ‘cost savings’.
The McKinsey document set out a wide range of proposals, but lacked any narrative explanation of how such measures were supposed to be implemented, or what any possible downsides and unintended consequences might be if they were. The evidence for most of their proposals was seriously deficient, or lacking altogether. But as news of the report leaked out in dribs and drabs, Labour ministers responded not only by denying that any of it was policy, and trying to distance themselves from having commissioned it – they refused point
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