The terrifying truth about those deciding the future of the NHS

Private hospitals generally employ the same doctors who are otherwise busy in the NHS – they don’t conjure them from thin air. So giving contracts to private hospitals means the same doctors do the same work, but with the added cost of extra buildings, more managers and shareholders’ cuts, and of course, lobbyists to secure the next contract.

Outsourcing failures were everywhere this year. The government’s spending watchdog, the National Audit Office, issued numerous reports that condemned outsourced COVID-19 responses led by management consultants, from PPE to testing, as poor value for money. Last week the office issued a highly critical report on contact tracing, saying that “substantial public resources have been spent on staff who provided minimal services in return” – with the outsourced national helpline staff busy only 1% of the time in summer, and even in October, only 50% of the time. The watchdog criticised the government for inflexible contracts, delays, poor planning, a lack of accountability and a failure to consider alternatives, such as not outsourcing.

The outsourcers themselves aren’t chastened. Serco announced it was considering paying a dividend on or around the day the government renewed its contact tracing contract in October. And its spokeswoman, Nicola Mortali, said in the summer that COVID-19 presented a “once in a generational opportunity to fundamentally change the health and care system” and that Serco was keen to help with “care navigation and coordination, remote monitoring and multi-channel contact centres”, among other things.

A Serco spokesperson said: “The size of our team is determined by DHSC. We have always delivered the numbers of trained people that have been required, and changed the size of our team to meet DHSC requirements during the year. The amount of work for our call handlers has increased substantially, particularly following the summer and into October and November and December.”

The same Serco spokesperson said: “Serco is proud of our call handlers and teams undertaking this important work in support of the government. All our call handlers receive the appropriate training and support for the work that that they are undertaking, following the procedures and scripts provided by Public Health England.”

Some commentators are nonetheless worried that we are becoming conditioned to accept health services from new armies of privately provided, low paid workers with minimal training. Minimally trained privatised call centre staff are now talking to “people who are actually dying in some cases”, a contact tracer told Radio 4’s Today programme recently, though it was not specified which company he worked for (Sitel and Serco are the two companies providing this service). Because, of course, whatever the MBA consultants tell you, there’s no magic privatisation efficiency fairy dust. Outsourcing companies offer cheap services by cutting corners.

Yet those currently planning the post-COVID NHS shake-up are steeped in the ideology of outsourcing, and of ‘private good, public bad’. And they’re now trying to persuade us the only thing we need to do to make it work better, is to call it “partnership”.

The management gobbledegook obscures a simple reality. They are trying to make private sector involvement in the NHS easier and less regulated, as one official admitted in a moment of frankness last year.

The danger of data giants

In the long term, it’s not the outsourcing companies such as Serco, and private hospital chains such as Circle, that we should be really afraid of. Instead, the risk lies with data giants who own the future. Where staff tend to demand autonomy and decent pay, algorithms, less so, producing a worrying vision of the future that raises concerns about privacy, control, exclusion and decision-making.

The NHS England proposals say: “We want to build on the experience of data sharing during COVID… we would support legislative change that clarifies that sharing data for the benefit of the whole health and care system is a key duty and responsibility of all health and adult social care organisations… this will require a more flexible legislative framework.”

But in the new, unaccountable models, who decides what is “of benefit”, and to whom?

openDemocracy’s work with Foxglove this year has exposed how US companies could profit from intellectual property, helped along by a massive leap in data sharing thanks to Hancock’s relaxation of rules during the pandemic.

These secretive deals pave the way for long-term, embedded influence over the NHS, including by controversial companies such as Faculty and Palantir, as well as Deloitte and McKinsey (which were both named in the contract documentation).

US companies are already starting to become involved in data-led calculations to determine who are the ‘costlier’ patients. And in advance of legislation, framework contracts are already in place, accrediting most of the big data and management consulting firms to provide a long list of obscure-sounding, but highly influential, services to the NHS, with descriptions like “risk stratification and decision support”, “transformation”,“patient empowerment and activation”, “actuarial assessment”, “self care programmes”, “personal health budgets”, and “marketplace platforms that enable individuals to identify and purchase care and support in line with their care plans”.

Again, gobbledygook. But what it means is worrying.

The pandemic increased data sharing between various health and care providers and led to an expansion in online healthcare options. And it also led to local and national decisions, often with little oversight, to put the breaks on many treatments and tests that then became impossible to access.

This post was originally published on Radio Free.