Accountability and Transparency in the NHS

John McDonnell 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.

Hospital Services (West London)

John McDonnell Excerpts

Wednesday 11th July 2012 Westminster Hall

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

I associate myself with the sentiments expressed by the hon. Member for Cities of London and Westminster (Mark Field), particularly about the Royal Brompton and its specialist services. I will focus briefly on the impact of what is happening on my constituency, but I follow what my hon. Friend the Member for Hammersmith (Mr Slaughter) said: there has been an attempt to divide and rule Members over whether to save some A and E units and close others. Yet it is healthy that all Members across west London are working on a common cause to try to get a long-term view of the health care needs of our areas.

I was reminiscing a few weeks ago with one of our chief executives, who has been dealing with this issue in our area for about as long as I have—almost 40 years. I think that this is our ninth reorganisation. On average, a reorganisation takes place over roughly a two-year period and operates for about 18 months, and then we start all over again. I started off in my area with a network of GPs, a community hospital, a district hospital and specialist services. In the first reorganisation, we lost the community hospital. After that, I was promised five GP centres; I got two. Then we had the wonderful idea from Lord Darzi about polyclinics, which looked awfully like community hospitals, but I did not get one of those. By the time that they had been discarded, it was decided there should be a walk-in centre. After that, we lost a lot of the capital investment in relation to GP improvements, so I am left with some GP centres, but many GPs still working out of converted houses and many single practitioners. Many of them are about to retire. The walk-in centre is about to be closed and relocated to Hillingdon hospital, where I am told that all the basic triage will be performed. We seem to have come full circle but have cut out some of the basic elements.

I am now told that, under the present consultation, the coming plan is to devolve services into the community, with more community care and improved GP services, which will then reduce the need and desire to go to accident and emergency and make it possible for specialist services to be concentrated into fewer units. The problem with that form of devolution is that the walk-in centre in central Hayes is being lost; no further capital investment in GP centres is planned; many GPs, although they have given good service over the years, are ageing, will soon retire and, as I have said, are working in poor quality settings; and there are, to be frank, cuts in community care support as well, particularly those that are happening in personal budgets. Some bizarre judgments are being made at local authority and other levels about qualification for community care. People are winding up in my office to attend my constituency surgery because the care that they have had for years has been withdrawn.

The next stage of the proposal is the closure of Ealing accident and emergency. Ealing dealt with 84,000 people in 2010-11, with 12,000 urgent care cases and 30,000 serious in-patient cases. If even half that number transfer to Hillingdon, it will be swamped. My fear is that in the next round of cuts A and E performance at Hillingdon hospital will be examined and criticised, because it has been swamped, and that it will eventually become a target for further closure. I worry also because it appears possible to extrapolate from the numbers in the consultation reports the cutting in the next 12 months of up to 1,700 NHS jobs, with the prospect of 5,000 being cut by 2015. That could be yet another reorganisation that exhausts staff, confuses patients and the community, and wastes large amounts of resources. In the end, it will reduce the quality of services and might result in further cuts. I predict that, within four years, we will be back here again if we continue on this path.

All that my community is pleading for is an element of stability. I agree with my hon. Friend the Member for Hammersmith that the consultation process has been tainted from the start, because information for the community and opportunities for engagement have been lacking and there has been a failure to disseminate information in a form that people can understand properly. I think that that has been done by what is now emerging in our sub-region as a group of elite GPs, who seem to control the process rather than engaging even with many of the other GPs. When, in our meetings with GPs, we ask whether they support the proposals, those at the grass roots say clearly they do not. They do not feel involved.

It is time to draw breath in the consultation, start a proper process of discussion and try to get some form of longer-term stability into the process. My hon. Friend the Member for Feltham and Heston (Seema Malhotra) is here, and there is a 17-year difference between life expectancy in some wards of our constituencies and in some wealthier constituencies represented by hon. Members present for the debate. It is clear to me that the eight or nine, or perhaps more, reorganisations of the past 40 years have not dealt with the real health care issues and needs in our area. What is happening will be another exercise involving abortive costs, which will frustrate the provision of real health care to whose who need it.

Southern Cross Care Homes

John McDonnell Excerpts

Tuesday 12th July 2011 Commons Chamber

[Paul Burstow]

I am grateful to the hon. Gentleman for his question, which allows me to deal with an earlier question on the same subject. The answer is absolutely yes. The continuity of care will be not just for the benefit of older residents of care homes, but for the benefit of any individual who relies on the services provided by the company.

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

I have been raising concerns about the management of Southern Cross in the House since 2007, in early-day motions and Adjournment debates. Despite assurances from the Care Quality Commission and from the company itself, the system resulted in neglect and abuse in my borough, which, at one point, suspended all placements in Southern Cross homes. I therefore view with some scepticism the assurances given today by the commission and participants in the company. Will the Minister be able to empower local authorities to take control of homes if they are threatened with closure and residents may be forcibly moved?

[Paul Burstow]

The hon. Gentleman has been raising those concerns in the way that he has, and I will certainly look at the points he has raised in the past. Local authorities have certain statutory powers in respect of their ability to respond to the closure of a care home by managing and resourcing that. We have been, and continue to be, in discussion with local authorities on that, so that they are able to respond in the event of a closure. I return to my key point, however, and the key reassurance we have not only from the company, but from the landlords: this is a solvent restructuring of the business, so that the care homes continue to operate and to provide homes for their residents.