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the private sector expects to win £20 billion of business from the NHS, according to the corporate finance adviser Catalyst

a few gluttonous companies—Virgin Care, Serco, Care UK—have secured dominant positions in the market

The biggest privatisations are taking place in community health services.

Local NHS bodies have already been instructed to outsource 39 types of service. Dubbed the “39 steps to privatisation,” this covers everything from autism care to wheelchair provision.

privatisation favours a few big winners over the co-ops, charities and social enterprises

Many Hospital Trusts are being pushed to the financial brink by the disastrous legacy of the Private Finance Initiative (PFI)

In a first for the private sector, in February 2012 Circle took over an entire general hospital at Hinchingbrooke in Cambridgeshire. The hospital has since fallen 19 places in the patient satisfaction rankings and its finances have worsened, forcing Circle to ask for a bailout after just six months. Despite being prepared to make a potential 20 percent cut to the hospital’s workforce, and while mostly owned by investment funds operating out of tax-havens like the Caymen Islands, Circle nevertheless vaunts its friendly-sounding business model under which doctors and nurses are given part-ownership of the company.

another controversial aspect of the Health and Social Care Act—the ability for NHS hospitals to earn half their income from private patients

revealed a tragic case where a consultant left half way through a dangerous birth to carry out a private caesarean section. The baby later died.

many of the dominant players in the new market are owned by ruthless private equity firms

the collapse of the Southern Cross care-home company

All of this comes before the most high-profile part of the Health and Social Care Act has even been fully implemented—the replacement of PCTs with Clinical Commissioning Groups (CCGs)

largely unaccountable new groups, who will in turn outsource the work to privatised “commissioning support units”

NHS Gloucestershire had not put this work out to tender, nor explored in-house/NHS options which, campaigners say, would have made tendering unnecessary in the first place

only reduced staff terms and conditions upon the service leaving the NHS, would offer a key cost saving

any cost gain would be significantly reduced by the new social enterprise VAT bill

which would not have applied under the internal NHS model

“The South West is leading the charge to social enterprise – with 15,000 of 25,000 staff in the UK, likely to be affected by reduced terms and conditions, coming from the region.”

Lansley’s ‘do it quick never mind the risk’ stick, the underbelly of which we highlighted last week

the Hull example, where aside from the one-off transfer costs, when NHS Hull morphed into a social enterprise, they found the need to build an entire new wing to house the extra administrative staff – those who had been ‘cut loose’ from the NHS – because the new enterprises are required to have their own duplicate back office functions where previously they could draw on NHS central resources.

as long as matters are kept within the NHS there is no contract on which EU procurement law ‘actually bites’,

this result at the High Court also begs the question: now the Bill is passed, exactly how far are our current NHS providers obliged to put existing services out to competitive tender?

The Gloucestershire example seems to demonstrate there are more angles to take than even the government themselves had considered in their own search for profiteering loopholes.

Will it really be possible, as Professor Allyson Pollock advises, to “stop all commercial contracts”, citing the danger of the government continuing to claim commercial confidentiality trumps the public’s right to know about contract decisions.

The PCT is legally obliged to: 1). Involve public; 2). Consider NHS options; 3). Invite ‘expressions of interest’ (in bidding) – crucially, not the same as ‘inviting bids’; before 4). Deciding what to do, which may or may not involve ‘inviting bids’, depending on whether NHS bodies come forward, which would mean they didn’t need to go to stage of open tender, i.e. inviting bids.

Labour MPs are particularly angry because London’s University College Hospital – one of the best NHS brain treatment centres in the country – has been told to stop treating brain cancer patients and send them to HCA.

Patients who were being treated there have been told to move to Barts. NHS England have told UCHL that they won’t pay for any more NHS patients to be treated there because they’ve signed a contract with two private hospitals – one of which is HCA

HCA has a chequered history in the US and has been fined more than $1billion for mis-selling healthcare.

A senior hospital source told the Mirror: “The radiotherapy community is very concerned about the way NHS England is handing out contracts for NHS patients.

HCA is already at the centre of a massive row after being accused of overcharging the NHS by millions of pounds in a damning report released last week.

HCA, along with two other private hospital groups, was at the centre of a scathing report from the Competition Commission last week which showed that between 2009 and 2011 they overcharged by up to £193million

Public spending on the NHS is due to fall as a proportion of gross domestic product, from a peak of 8% in 2009-10 to just over 6% in 2020-21.1 The proportion of NHS and foundation trusts in deficit rose from 10% in 2012-13 to 26% in 2013-14, highlighting the scale of the financial challenges facing NHS organisations.2 The payments that trusts are obliged to make under private finance initiative (PFI) deals are a source of budgetary pressure.2 By March 2013 a total of 121 PFI deals had been procured by NHS bodies in England, with an aggregate capital value of £11.8bn ($18.3bn; €16.6bn) and a projected cash cost to the NHS of £81.5bn, £70.1bn of which remained outstanding at that date.3 Two thirds of trusts with a deficit greater than £25m have a PFI deal.2Numerous calls have been made for PFI contracts to be renegotiated.4 Although there is limited scope to reduce the payments to PFI consortiums, NHS bodies normally have the right to terminate them for a price. Interest in the termination approach has grown among NHS bodies after the decision by Northumbria Healthcare NHS Foundation Trust to borrow money from a local county council to buy out the PFI contract for Hexham General Hospital. The termination was completed in October 2014, at which point the PFI was costing the trust approximately £8m a year and had a further 18.5 years left to run.3

Former NHS hospitals, free to generate half their income from private patients, will dedicate their staff and facilities to that end, making it impossible to monitor what is public and what people are paying for.

Billing, invoicing, marketing and advertising will add between 30% and 50% to costs compared with 6% in the former NHS bureaucracy.

some of HCA's American hospitals are under investigation for refusing care and performing unnecessary investigations and treatment, including cardiac surgery. A decade ago it paid the federal government $1.7bn to settle fraud charges, while former chief executive Rick Scott – now the Republican governor of Florida – managed to avoid prosecution.

Unitedhealth, which is currently providing services to the NHS, paid hundreds of millions of dollars in settlement of mischarging allegations in the US; Medtronic paid $23.5m for paying illegal kickbacks to physicians to induce them to implant the company's pacemakers and defibrillators; GlaxoSmithKline and Abbott paid $4.5bn in fines relating to improper marketing and coercion of physicians to prescribe antidepressants and antidementia drugs respectively. Novartis, AstraZeneca, Pfizer and Eli Lilly have all paid large fines for regulatory breaches.

Along with the health unions, the doctors' British Medical Association, the Royal College of Nurses and the Royal College of Midwives are now all demanding the bill be scrapped.

Cameron and Lansley insist they don't plan to privatise the NHS, of course. But that's exactly what's happening on the ground even before the bill hits the statute book. The first private company to take over an NHS hospital, the Tory-linked Circle Health, won the contract to run Hinchingbrooke hospital in Cambridgeshire in November, even as it admitted it may not be able to "provide a consistent level of service to its patients".

And the government has been in talks with international health corporations about taking over 20 more, while private companies are already running local doctors' services and preparing to administer the clinical commissioning groups of GPs

Add to that ministers' announcement last month that they would raise the cap on the proportion of income English hospitals can raise from private work from about 2% to 49%

whereas the existing law allows private provision, the coalition bill will require it

it also opens the way for the privatisation of funding, the introduction of charging and top-up payments for services that are currently free, and the cherry-picking of patients by commissioning groups

Dozens of people have lost some of their sight after undergoing botched operations provided by a private healthcare firm at an NHS hospital.The hospital in Somerset is facing a string of claims for compensation after half the 60 patients who underwent the procedure suffered complications.

Dozens of people have been left with impaired vision, pain and discomfort after undergoing operations provided by a private healthcare firm at an NHS hospital.

The son of the 84-year-old patient, who asked not to be named, said his father was referred for the cataract surgery by his GP. The retired salesman, from the Somerset Levels, did not consider he needed the operation but agreed to the treatment.

The routine cataract operations were carried out by the private provider in May to help to reduce a backlog at Musgrove Park hospital in Taunton. But the hospital's contract with Vanguard Healthcare was terminated only four days after 30 patients, most elderly and some frail, reported complications, including blurred vision, pain and swelling.

The trust refused to talk in detail about what happened pending the conclusion of its own investigation. It also refused to discuss who would pick up any bill for compensation or details of its contract with Vanguard.

But, when the problems surfaced, a senior member of staff at Musgrove Park appeared to concede that the hospital would be liable for any payments.

One 84-year-old man claimed he has lost his sight and his family is calling for a full independent inquiry after it emerged that half of the 60 patients who underwent surgery suffered complications.

The son said the procedure took 15 minutes and his father felt it was "very rushed".

"My father is traumatised and depressed with the loss of his eyesight. Previous pleasures of gardening and watching sport on the TV have been taken away from him.

Among the questions the family want addressed in an independent inquiry is whether Vanguard was brought in to save the trust from paying a financial penalty because of the backlog.

Laurence Vick, a medical negligence lawyer, who has been approached by some of the victims, said the case highlighted the "uneasy relationship" between the NHS and the private sector.

He said the question of who paid when outsourced NHS treatment failed was of growing importance as more services were handed over to the private sector.

When Serco made its bid to run NHS community-health services in Suffolk – district nursing, physiotherapy, OT, end-of-life palliative care, wheelchair services – it reckoned it could do it for £140m over three years – £16m less than the existing NHS "provider" had managed, which would eventually allow for their standard profit margin of around 6% a year. When it started to become clear that Serco was the frontrunner, there was some opposition, but perhaps not nearly enough.

We are meant to be known by the 5,000 not the five billion.

"There's also the inability of the public sector to monitor effectively,

The strangest thing, though, is the gap between Serco's size and how little the public knows about it. Not for nothing does so much coverage of its work include the sentence "the biggest company you've never heard of".

We've still got the same number of patients," she says, "so the workload has massively increased." As a result, she and her colleagues are having to cut people out of their previous entitlement to treatment at home. "That completely goes against our ethics," she says, "but that's what we're having to do.

The NHS is a relatively new area of controversy for Serco, but concerns about their practices run across many other areas

Serco was officially awarded the contract in October 2012, which meant that hundreds of staff would leave the NHS, and become company employees. Within weeks, the company proposed a huge reorganisation, which involved getting rid of one in six jobs. This has since come down to one in seven, two thirds of which will apparently go via natural wastage. In terms of their pay and conditions, the hundreds of people who have been transferred from the NHS to Serco are protected by provisions laid down by the last government, but it is already becoming clear that many new staff are on inferior contracts: as one local source puts it, "they've got less annual leave, less sick pay … it's significantly worse."

great wall of commercial confidentiality

they're good at winning contracts, but too often, they're bad at running services."

The National Audit Office is doing work around the development of quasi-monopoly private providers, which is the world we're moving into. We don't really understand the size of their empires.

But after initially supporting the idea of social enterprises when they were first mooted, the trade unions are now broadly against their creation, with Amicus claiming that a two-tier workforce is being created, and with employees transferring from the NHS securing comparable pension arrangements, whilst new staff have no such guarantee.

a step towards eventual privatisation

unions have launched successful campaigns against some

the bizarre situation where health visitors currently working in partnership with children's centres would be involved in bidding against each other to provide the same services

there have been a number of social enterprises founded across the NHS

health partnerships – as social enterprises are now termed in the NHS

So far, 27 trusts have created social enterprises and a further 20 will be created this coming October.

After a public outcry and criticism from the House of Lords at the way the Government had slipped in the Section 75 regulations at the eleventh hour, Hunt had them hastily rewritten. But most experts agree that there was no meaningful change. GPs are allowed to keep some services within the NHS, but only in particular circumstances, such as when no private sector provider comes forward to bid. Everything else is up for grabs.

Labour’s shadow health secretary Andy Burnham said the move was the clearest sign yet of the government’s determination “to turn our precious NHS into a US style commercial system, where hospitals are more interested in profits than people.”

“This free market NHS re-organisation opens the door to an explosion of private work in the NHS, meaning longer waits for NHS patients,” he said.

£7 an hour, receives an extra £1 an hour for a night shift and £2 an hour for weekends.

"The NHS encourages you to have these NVQs, all this training, improve your knowledge, and then they [private care companies] come along and it all comes to nothing.

Care UK expects to make a profit "of under 6%" by the end of the three-year contract

£700,000 operating profit in the six months between September last year and March this year,

In 1993 the private sector provided 5% of the state-funded services given to people in their homes, known as domiciliary care. By 2012 this had risen to 89% – largely driven by the local authorities' need for cheaper ways to deliver services and the private sector's assurance that they could provide the answer. More than £2.7bn is spent by the state on this type of care every year. Private providers have targeted wages as a way to slice out profits, de-skilling the sector in the process.

1.4 million care workers in England are unregulated by any professional body and less than 50% have completed a basic NVQ2 level qualification, with 30% apparently not even completing basic induction trainin

Today 8% of care homes are supplied by private equity-owned firms – and the number is growing. The same is true of 10% of services run for those with learning disabilities

William Laing

report on private equity in July 2012

"It makes pots of money.

Those profits – which are made before debt payments and overheads – don't appear on the bottom line of the health firms' company accounts, and because of that corporation tax isn't paid on them.

Some of that was in payments on loans issued in Guernsey, meaning tax could not be charged. Its sister company, Silver Sea, responsible for funding the construction of Care UK care homes, is domiciled in the tax haven of Luxembourg

Bridgepoint

.voterDiv .ob_bctrl{display:none;} .ob_pdesc IMG{border:none;} .AR_1 .ob_what{direction:ltr;text-align:right;clear:both;padding:5px 10px 0px;} .AR_1 .ob_what a{color:#999;font-size:10px;font-family:arial;text-decoration: none;} .AR_1 .ob_what.ob-hover:hover a{text-decoration: underline;} .AR_1 .ob_clear{clear:both;} .AR_1 .ob_amelia, .AR_1 .ob_logo, .AR_1 .ob_text_logo {display:inline-block;vertical-align:text-bottom;padding:0px 5px;box-sizing:content-box;-moz-box-sizing:content-box;-webkit-box-sizing:content-box;} .AR_1 .ob_amelia{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_16x16.png') no-repeat center top;width:16px;height:16px;margin-bottom:-2px;} .AR_1 .ob_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_67x12.png') no-repeat center top;width:67px;height:12px;} .AR_1 .ob_text_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_text_logo_66x23.png') no-repeat center top;width:66px;height:23px;} .AR_1:hover .ob_amelia, .AR_1:hover .ob_logo, .AR_1:hover .ob_text_logo{background-position:center bottom;} .AR_1 .ob_org_header { border-top: 10px solid #D61D00; display: block; font-family: georgia,serif; font-size: 14px; font-weight: bold; padding-bottom: 10px; padding-top: 5px; } More from the guardian Rogeting: why 'sinister buttocks' are creeping into students' essays 08 Aug 2014 Theatre's decision to ban Jewish film festival is 'thin end of wedge' 09 Aug 2014 Sir Paul Nurse: 'I looked at my birth certificate. That was not my mother's name' 09 Aug 2014 Adventures in contraception: eight women discuss their choices 10 Aug 2014 Child prison deaths 08 Aug 2014 [?] .voterDiv .ob_bctrl{display:none;} .ob_pdesc IMG{border:none;} .AR_2 .ob_what{direction:ltr;text-align:right;clear:both;padding:5px 10px 0px;} .AR_2 .ob_what a{color:#999;font-size:10px;font-family:arial;text-decoration: none;} .AR_2 .ob_what.ob-hover:hover a{text-decoration: underline;} .AR_2 .ob_clear{clear:both;} .AR_2 .ob_amelia, .AR_2 .ob_logo, .AR_2 .ob_text_logo {display:inline-block;vertical-align:text-bottom;padding:0px 5px;box-sizing:content-box;-moz-box-sizing:content-box;-webkit-box-sizing:content-box;} .AR_2 .ob_amelia{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_16x16.png') no-repeat center top;width:16px;height:16px;margin-bottom:-2px;} .AR_2 .ob_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_67x12.png') no-repeat center top;width:67px;height:12px;} .AR_2 .ob_text_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_text_logo_66x23.png') no-repeat center top;width:66px;height:23px;} .AR_2:hover .ob_amelia, .AR_2:hover .ob_logo, .AR_2:hover .ob_text_logo{background-position:center bottom;} .AR_2 .ob_org_header { border-top: 10px solid #D61D00; display: block; font-family: georgia,serif; font-size: 14px; font-weight: bold; padding-bottom: 10px; padding-top: 5px; } /* updated via mysql on 2014-04-08 */ .AR_2 .ob_what { display: block; } /* added via mysql on 2014-06-20 */ .OUTBRAIN:hover .ob_what a { text-decoration: underline; } .ob_box_cont.AR_2 { padding-bottom: 5px; } /* end mysql add */ /* added via mysql on 2014-07-14 */ .AR_2 .ob_org_header span { color: #999; font-family: arial; font-size: 11px; font-weight: normal; display: block; } /* end 2014-07-14 */ More from around the webPromoted content by Outbrain http://paid.outbrain.com/network/redir?p=0iZOm4XuGW6R5uuT6ZFciNevzJlIfmxs0SRwpiMrH7gWrMXoPie4vIA9PlhaEW%2BXNi57pCgl9j8yOE3HuJT75pwCLNj4n18v3EKQDEV0YFQjOBxc46mOs

The first Foundations were set up from the wealthiest, most successful hospitals, and have accumulated surpluses of £2 billion – while NHS hospitals which are not foundations face mounting financial problems. Now ministers want to let them make unlimited money from private medicine, while funding for NHS patients is being sharply reduced.

the damage done to hospital cleaning standards by Margaret Thatcher’s government putting cleaning and other support services out to tender in the 1980s

Two decades later hospitals are still struggling with the rising tide of infections and hygiene problems caused.

100 hospitals have been built since 1997 using the “private finance initiative”

Some early PFI hospitals have already paid back double the cost of the hospitals, but still have 15-20 years to pay. Many PFI hospitals are closing beds and wards in the new hospitals and sacking staff to cut costs: some need rescuing by government.

Now services in the English NHS could be opened up by the new government to competitive bids by “any qualified provider”. But the private sector will only bid for services where it is certain of a profit.

“We know centralised, large units with concentrated expertise and technology work best in providing the most effective care so we need to ensure this approach is applied to other parts of the service, for people with very rare conditions and for significant planned surgery.”

Nicholson said that the NHS could not rely on further funding increases in the future and warned that services may not be sustainable without radical change.

“Like every major health system in the world we face a big financial problem for the future: the sums don’t add up,” he wrote.

“If we don’t change, we face a funding gap that could be £30bn by 2021.

The NHS must stop closing cottage-style hospitals and return to treating more patients in their local communities, the new head of the health service has said in his first interview. In a marked reversal of current policy, Simon Stevens said the NHS must expand its local services because too many patients are being robbed of “dignity and compassion”. Mr Stevens warned that British hospitals have become among the worst in western Europe at caring for local populations, because too many services have been stripped out and centralised. He said Britain must learn from countries such as Sweden, the Netherlands and the United States, which have pioneered ways of bolstering community care around small hospitals to meet the needs of their populations. “A number of other countries have found it possible to run viable local hospitals serving smaller communities than sometimes we think are sustainable in the NHS,” Mr Stevens said in an interview with The Telegraph.

This briefing explains what the government is doing and why an urgent bill to reinstate the NHS in England is required. 

Speaking before his appearance at the Health Select Committee, he conceded that urgent care services were “getting closer to the cliff edge,” with A&E admission increasing by 51 per cent over the past 10 years

The letter from the 20 A&E leaders talks of the “institutional exhaustion” of the nursing, medical and even clerical staff who being pushed ever harder by the growing volume of work with little outside support

. It also describes how doctors and nurses are being forced to work in what are verging on dangerous environments

They further warn that overcrowding is likely to lead to more deaths in hospitals and reveal that standards of care are deteriorating as serious clinical incidents and delays are rising.

The letter states: “The aforementioned issues have led to us routinely substituting quality care with merely safe care; while this is not acceptable to us, what is entirely unacceptable is the delivery of unsafe care; but this is now the prospect we find ourselves facing on too frequent a basis

Recent developments such as the introduction of 111 and financial penalties for holding ambulance crews in ED are touted as solutions to the crisis: however we as ED physicians recognise that these measures will actually make the problem worse instead of better, and evidence is already emerging to support our opinions.

Furthermore, we firmly believe and strongly recommend that ED leads should be intimately involved with and consulted on the commissioning of Emergency services in the region, as well as other related emergency care changes-such as 111.

There is toxic ED overcrowding, the likes of which we have never seen before.