Accountability and Transparency in the NHS

Andy Slaughter Excerpts

Thursday 14th March 2013 Commons Chamber

[Mr Andy Slaughter (Hammersmith) (Lab)]

Two NHS stories were leading the news this morning, both of which are relevant to the subject of this debate. The hon. Member for North East Cambridgeshire (Stephen Barclay) and my hon. Friend the Member for Ealing, Southall (Mr Sharma) have talked about the important issue of whistleblowers. I want to talk about the other subject, which is the conflicted interests of clinical commissioning group members.

All hon. Members should be grateful for the British Medical Journal report that was the basis of this morning’s new stories. In case anyone has not seen it, let me read the headline points. It states:

“More than a third of GPs on the boards of the new clinical commissioning groups (CCGs) in England have a conflict of interest resulting from directorships or shares held in private companies”.

It continues:

“conflicts of interest are rife on CCG governing bodies, with 426 (36%) of the 1179 GPs in executive positions having a financial interest in a for-profit private provider beyond their own general practice—a provider from which their CCG could potentially commission services.

The interests range from senior directorships in local for-profit firms set up to provide services such as diagnostics, minor surgery, out of hours GP services, and pharmacy to shareholdings in large private sector health firms that provide care in conjunction with local doctors, such as Harmoni and Circle Health.

In some cases most of the GPs on the CCG governing body have financial interests in the same private healthcare provider.”

Yet the cheerleader for the privatisation, Dr Michael Dixon of NHS Alliance says:

“The priority is to move services out of hospital and into primary care. The reason this hasn’t happened to date is because of blocks in the system. It’s more important to remove those blocks than be preoccupied with conflicts of interest.”

I say that the British Medical Journal has done a good job, but it has only just scratched the surface. I shall refer to my own experience of trying to get to the bottom of this matter in north-west London.

On 10 November an article by the social affairs editor of The Guardian began:

“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.”

It went through the individual shareholdings of those doctors who had sold out to Care UK and it continued:

“Another winner seems to be NHS reform champion Ian Goodman. The north-west London GP chairs the Hillingdon clinical commissioning group and was also a board director of Harmoni. He could make as much as £2.6 million.”

[John McDonnell (Hayes and Harlington) (Lab)]

This Dr Goodman chairs my local CCG and tried to force Hillingdon hospital to put £13 million of operations out to tender, which would have destabilised the whole hospital. I pay tribute to the Treasurer of Her Majesty’s Household, the right hon. Member for Uxbridge and South Ruislip (Mr Randall) and the Parliamentary Secretary, Cabinet Office, the hon. Member for Ruislip, Northwood and Pinner (Mr Hurd), who joined me in preventing that from happening. It would have meant Hillingdon hospital being financially destabilised in the long term.

[Mr Slaughter]

I am grateful for that. I did a company profile for Harmoni. It revealed that, although he might have sold his shares for that amount of money, Dr Goodman is still listed as head of clinical spine. A series of press articles deals with the failings of Harmoni—failures that have caused deaths through under-staffing or poor-quality staffing—and why it is under investigation.

Let me return in the time I have available to my attempts to get to the bottom of the matter. The same day as I read the article in The Guardian, I wrote a short letter to the chief executive of the NHS in north-west London. I said:

“I attach the front page article from today’s Guardian, which you may have seen, regarding the sale of out of hours GP service provider Harmoni to Care UK. The article states that a number of GPs will make substantial sums from the sale.

I note that four of the CCG chairs in NW London declare shareholding or directorship in Harmoni, as does your Medical Director. It would be helpful to know if they are beneficiaries of the sale and by what amount.”

I then asked for assurances as to the future.

A month later I received a non-reply reply, the most relevant sentence of which was:

“Any member who declares an interest in a meeting is expected to take no part in discussions and step out of the meeting.”

I wrote back a much longer reply, in which I pointed out that the chair of the Royal College of General Practitioners had said:

“it is not about excluding yourself from the room whenever there is a discussion; it is about how it will drive your decision-making overall”.

I pointed out that, as a consequence of hospital closures in north-west London, there had been a shift in funding from hospital to primary care, a greater involvement of private companies in the primary care sector, and an opportunity for those companies to increase their profits by cutting back on the level of service offered.

I principally raised the fact that the information that should be provided is not provided on declaration of interest forms, especially the scope and value of any interest. I listed doctor by doctor and CCG chair by CCG chair what those interests were and how they were not adequately declared. I dealt with seven out of the nine CCG chairs and the medical director. That was in a letter on 20 December.

I received a reply on 3 February which said:

“The Cluster does not hold this data.”

So three months on from my original inquiry, I am none the wiser in relation to these matters.

I advise any hon. Member to look at their CCG declarations of interest online—not Hillingdon, because it does not publish them online. I use Hammersmith and Fulham as an example here. The husband of one member is a partner of Drivers Jonas Deloitte. The first thing I found on the website of Drivers Jonas Deloitte was that it had been appointed to sell the Kent and Sussex hospital in Royal Tunbridge Wells when it closes in 2011. Another member is the owner of a provider of home care services. Another is the brother of the director of a design company that holds a number of contracts with NHS organisations. It might be that none of them has a direct financial pecuniary interest now or in the future, but it shows touching naivety, complacency or worse.

Before the 28 members of the joint PCT board made the decision to close the four A and Es in north-west London, I said at the public meeting that if any of them had or was likely to have interest of a pecuniary nature they should not take part in that decision. One of them rather touchingly volunteered the information that they had sold their shares. What world are we living in when a third of GPs on the new CCGs can hold financial interests in anything from land sales to an alternative provider?

I raised the question with the Prime Minister yesterday and mentioned Dr Goodman, although not by name, and his estimated minimum return of £2.6 million. Again, I got a non-reply in reply. Sooner or later the Government will have to address these matters.

There is another story in the Daily Mail today that states:

“In 1981 there were eight NHS press officers in Britain. Now there are 82 in London alone”.

It is not that there is a lack of spending on publicity in the NHS. Indeed, almost £1 million has been spent on a private consultancy firm simply to carry out the bogus and botched consultation on the closure of A and Es.

We are seeing the creation of a second-grade health service in north-west London.

[Barbara Keeley]

A number of months ago, I raised the case of a person who rejoices in the title “NHS head of brands”. There seem to be a whole set of units that keep cropping up.

[Mr Slaughter]

I am sure that all Members will have similar examples. It is an obscenity that millions of pounds are being spent on spin and disinformation while basic information is not being provided even to Members of Parliament after three months and persistent requests. Sooner or later, these issues will have to be addressed.

Of course, our main preoccupation is to maintain our first-rate health service—our blue light A and Es, our stroke centres and our major hospitals—rather than having it replaced by urgent care centres and minor primary care facilities. That is what we face in north-west London and, I am sure, around the rest of the country. It adds insult to injury if the individuals who are making the decisions to sell the land and to transfer services into the private sector are also the shareholders and owners or if they benefit in any other way. This is a corrupt act and it must be addressed by the Government. They cannot continue to turn a blind eye to it.

[Several hon. Members]

rose—