How to campaign against NHS privatisation happening

near you

Welcome to the new NHS campaigning guide This guide aims to help you find out which local NHS services are at risk of privatisation who might be bidding for them and how to influence which provider wins

Hopefully yoursquoll find it useful ndash whether yoursquore new to NHS campaigning and research or very experienced If you have any feedback on the guide or if you find out something you think others should know about email emailtheteam38degreesorguk

38 Degrees guide to investigating private companies trying to take over our NHS

Your notes

www38degreesorguk

How are decisions made about who provides NHS services

In recent years the English NHS has been split into separate local organisations of lsquopurchasersrsquo and lsquoprovidersrsquo

The lsquopurchaserrsquo organisations manage the NHS budget choose what healthcare services they want and decide which lsquoprovidersrsquo to buy them from ndash either NHS organisations or private companies (or occasionally charities)

The main lsquoprovidersrsquo of healthcare were initially NHS organisations (called lsquoTrustsrsquo and lsquoFoundation Trustsrsquo) But since the Health amp Social Care Act 2012 private companies are getting increasingly involved In 2014-5 the amount of NHS cash going to private companies soared by 5001

1 httpswwwopendemocracynetournhspaul-evansnhs-privatisation-soars-500-in-last-year-finds-indepth-new-study

I

The main lsquopurchasingrsquo (or lsquocommissioningrsquo) organisations are the 211 local Clinical Commissioning Groups (CCGs) About a quarter of NHS services are however centrally commissioned by NHS England including most GPs (this varies by area) and some specialist services

www38degreesorguk

Welcome to the new NHS campaigning guide This guide aims to help you find out which local NHS services are at risk of privatisation who might be bidding for them and how to influence which provider wins

Hopefully yoursquoll find it useful ndash whether yoursquore new to NHS campaigning and research or very experienced If you have any feedback on the guide or if you find out something you think others should know about email emailtheteam38degreesorguk

38 Degrees guide to investigating private companies trying to take over our NHS

Your notes

www38degreesorguk

How are decisions made about who provides NHS services

In recent years the English NHS has been split into separate local organisations of lsquopurchasersrsquo and lsquoprovidersrsquo

The lsquopurchaserrsquo organisations manage the NHS budget choose what healthcare services they want and decide which lsquoprovidersrsquo to buy them from ndash either NHS organisations or private companies (or occasionally charities)

The main lsquoprovidersrsquo of healthcare were initially NHS organisations (called lsquoTrustsrsquo and lsquoFoundation Trustsrsquo) But since the Health amp Social Care Act 2012 private companies are getting increasingly involved In 2014-5 the amount of NHS cash going to private companies soared by 5001

1 httpswwwopendemocracynetournhspaul-evansnhs-privatisation-soars-500-in-last-year-finds-indepth-new-study

I

The main lsquopurchasingrsquo (or lsquocommissioningrsquo) organisations are the 211 local Clinical Commissioning Groups (CCGs) About a quarter of NHS services are however centrally commissioned by NHS England including most GPs (this varies by area) and some specialist services

www38degreesorguk

How are decisions made about who provides NHS services

In recent years the English NHS has been split into separate local organisations of lsquopurchasersrsquo and lsquoprovidersrsquo

The lsquopurchaserrsquo organisations manage the NHS budget choose what healthcare services they want and decide which lsquoprovidersrsquo to buy them from ndash either NHS organisations or private companies (or occasionally charities)

The main lsquoprovidersrsquo of healthcare were initially NHS organisations (called lsquoTrustsrsquo and lsquoFoundation Trustsrsquo) But since the Health amp Social Care Act 2012 private companies are getting increasingly involved In 2014-5 the amount of NHS cash going to private companies soared by 5001

1 httpswwwopendemocracynetournhspaul-evansnhs-privatisation-soars-500-in-last-year-finds-indepth-new-study

I

The main lsquopurchasingrsquo (or lsquocommissioningrsquo) organisations are the 211 local Clinical Commissioning Groups (CCGs) About a quarter of NHS services are however centrally commissioned by NHS England including most GPs (this varies by area) and some specialist services

www38degreesorguk

How much freedom do CCGs really have

CCGs are under a number of obligations when they make their decisions But they may well follow required processes poorly secretively or both

In a nutshell CCGs are expected to

bull Be able to publicly account for their decisions on how they spend public money and show they were based on evidence

bull Obey the law

bull Act in a way that is open and transparent

bull Avoid conflicts of interest

bull Not go over their budgets (which are set by central government and are being squeezed)

bull Follow lsquogood practicersquo guidelines unless they can reasonably justify it

bull Not practice lsquoanti-competitiversquo behaviour In practice this means they are expected to put services out to competition unless they can show that competition would damage the provision of an lsquointegratedrsquo service or the CCG is reasonably satisfied there is only

one potential provider (See pages 30-31 37-38 and 63-64 of the Monitor guidance)2

bull Abide by the NHS constitution3 which says they must ldquoprovide you with the information and support you need to influence and scrutinise the planning and delivery of NHS servicesrdquo

bull Have a proper patient and public engagement strategy ndash and follow it

CCGs are most accountable to Monitor and NHS England not to the public But you can still make demands of them and expose problems as with any public servants

2 httpswwwgovukgovernmentuploadssystemuploadsattachment_datafile283505SubstantiveGuidanceDec2013_0pdf3 httpswwwgovukgovernmentuploadssystemuploadsattachment_datafile448466NHS_Constitution_WEBpdf

www38degreesorguk

Case Studies

4 httpswwwopendemocracynetournhscarl-walkercarnival-of-incompetence-or-how-nobody-knows-how-to-privatise-health-service-well5 httpwwwunitetheunionorgnewspatients-victory-against-private-healthcare-companies-in-cambridgeshire

West Sussex In West Sussex last year the CCG took a pound235 million contract for most non-emergency muscular-skeletal services away from the local NHS hospital They gave it to BUPA ndash who had cheekily argued it would be better at providing an lsquointegratedrsquo service than the NHS But campaigners pressured the councilrsquos Scrutiny Committee which in turn demanded the CCG carry out a proper impact assessment The assessment found4 that the privatisation would destabilise the local hospital and even jeopardise its AampE department Under strong political pressure BUPA walked away from the contract even though it was due to start very shortly ndash a victory for campaigners

If you think your CCG might be failing to follow the required processes as well as pursuing the avenues in this guide you could contact the 38 Degrees staff team to ask lawyers if therersquos scope for a legal challenge (known as a lsquojudicial reviewrsquo)

Cambridgeshire

Faced with an enormous privatisation of older peoplersquos health services in Cambridgeshire campaigners launched a legal challenge5 to force commissioners to release documents they had said were lsquocommercially confidentialrsquo arguing that proper consultation was not possible without this information After the documents were released the private sector bidders pulled out and services stayed within the NHS

The main thing is to encourage CCGs to try to protect services from break-up and damage that would harm patients interests either by grouping services in a way that would not be suitable to put out to competition andor by being very tough with what they ask of any potential contractor (see below for more)

T

Top Tip - Donrsquot just ask your CCG to publicly commit to simply preferring NHS services That is against the law as it currently stands

www38degreesorguk

www38degreesorguk

Getting started

6 httpwwwnhsukService-SearchClinical20Commissioning20GroupLocationSearch1 7 httpsyou38degreesorguklocal-groups

Your notes

Find your CCG here6

Before you approach your CCG itrsquos a good idea to start by finding fellow local campaigners and people who know about the NHS including staff unions and governors

You can meet them online (try searching NHS + privatise + your area) and when petitioning leafleting attending public meetings or organising your own public meetings ndash make sure to collect contacts

You can also look into whether therersquos a 38 Degrees local group near you by searching here7

Such contacts may give you clues about what to look for in the CCGrsquos papers ask for they may know things which arenrsquot in the CCG paperwork

And of course the more united campaigners ndash and staff ndash the more influence you are likely to have

Other good sources of information about current or past moves towards privatisation in your local NHS are the trade press (Health Services Journal (HSJ) Health Investor Pulse and GP Online) and specialist campaigning websites (OurNHS openDemocracy Keep Our NHS Public Health Emergency and NHS Support Federation as well as 38 Degrees of course)

Search within these sites for mentions of whatrsquos going on in your local area You may need to search on your town county region andor local hospital names to get a full picture HSJ is the most comprehensive though fairly privatisation-friendly and its articles are often behind a paywall

How to find out which services are being put out to competition or are under threat of being put out to competition

The earlier in the process you can get your campaign going the better But of course this depends on finding out whatrsquos going onhellip

You could ndash as Lewisham NHS campaigners have done ndash write to the local CCG asking them to promise to alert the public and your campaign to any moves to lsquoout-sourcersquo (ie privatise) NHS services at a formative (ie early) stage

But yoursquoll probably need to turn detective too

www38degreesorguk

Your notes

How can I find out whatrsquos going on and what can I do at each stage

www38degreesorguk

If you find out the CCG is doing this

The CCG is discussing the need to lsquoimproversquo an existing service ndash or an existing contract is coming to an end

The CCG may have identified problems (missed targetspoor reports from the regulator) or it may be looking to achieve savings (sometimes called lsquoQOF savingsrsquo)

You can

Challenge any assumption that improvements need to be made by opening the service up to competition between different providers

Ask what discussions the CCG has had with existing NHS providers Are they giving them a fair chance to improve the service in whatever way is needed Are they being realistic Are they relying on dubious methodology What do local medics think

Talk to people who know about the existing NHS provider ndash staff unions governors and campaigners If the problem is clearly one of money you can focus your campaign around this making clear privatisation isnrsquot a magic solution to cash shortages though they may take on lsquoloss leadersrsquo for a while

8 httpwwwenglandnhsukourworkfuturenhs5yfv-ch3new-care-models9 httpwwwenglandnhsukwp-contentuploads201312plan-del-serv-chge1pdf

www38degreesorguk

If you find out the CCG is doing this

The CCG has plans to or is in the process of lsquoreviewingrsquo a service

Such plans should be available somewhere in the CCGs published plans and in a publicly available lsquoprocurement strategyrsquo

Look for clues like lsquotransformationrsquo lsquochange improvement programmersquo lsquosuccess regimersquo lsquoalignmentrsquo or lsquopilotsrsquo

You can

Ask for reassurances that the CCG is not considering handing the service or parts of it to a different (ie private) provider

Ask if the review is being carried out by the CCG or with help from third parties (such as external consultants (see lsquowhorsquos whorsquo below for a list of the main ones) other CCGs (who may have formed a regional lsquoclusterrsquo local councils a regional Commissioning Support Unit (CSU) or teams from regulators like Monitor or the NHS Trust Development Authority or NHS England

Whoever is carrying out a review ask the CCG to give you all the relevant minutes and reports

Check whether they are a lsquovanguardrsquo area (these areas are piloting a wide variety of new lsquopartnershipsrsquo geared towards getting care lsquoout of hospitalsrsquo and with many opportunities for private involvement)8

If there are plans for major service changes you can also check they are following this9 guidance (though be aware that the new lsquosuccess regimersquo for some areas allows these requirements to be bypassed

Go jargon-bustingOnce you get these reports read them carefully Look for hints that the review risksbull More privatisation ndash look for mentions

of choice diversity partnership lsquoindependent sectorrsquo or lsquocharities and other providersrsquo

Andor bull Cutting services ndash look for mentions

of lsquoco-productionrsquo lsquoasset-basedrsquo solutions (ie patients and carers doing more for themselves) lsquomoving care out of hospitalrsquo (without a clear description of where care WILL take place and to what standard) or talk of lsquooutcomes-basedrsquo contracts ie no requirements to protect existing staff levels or buildings and wards

How can I find out whatrsquos going on and what can I do at each stage

www38degreesorguk

If you find out the CCG is doing this

The CCG is discussing the need to lsquoimproversquo an existing service ndash or an existing contract is coming to an end

The CCG may have identified problems (missed targetspoor reports from the regulator) or it may be looking to achieve savings (sometimes called lsquoQOF savingsrsquo)

You can

Challenge any assumption that improvements need to be made by opening the service up to competition between different providers

Ask what discussions the CCG has had with existing NHS providers Are they giving them a fair chance to improve the service in whatever way is needed Are they being realistic Are they relying on dubious methodology What do local medics think

Talk to people who know about the existing NHS provider ndash staff unions governors and campaigners If the problem is clearly one of money you can focus your campaign around this making clear privatisation isnrsquot a magic solution to cash shortages though they may take on lsquoloss leadersrsquo for a while

8 httpwwwenglandnhsukourworkfuturenhs5yfv-ch3new-care-models9 httpwwwenglandnhsukwp-contentuploads201312plan-del-serv-chge1pdf

www38degreesorguk

If you find out the CCG is doing this

The CCG has plans to or is in the process of lsquoreviewingrsquo a service

Such plans should be available somewhere in the CCGs published plans and in a publicly available lsquoprocurement strategyrsquo

Look for clues like lsquotransformationrsquo lsquochange improvement programmersquo lsquosuccess regimersquo lsquoalignmentrsquo or lsquopilotsrsquo

You can

Ask for reassurances that the CCG is not considering handing the service or parts of it to a different (ie private) provider

Ask if the review is being carried out by the CCG or with help from third parties (such as external consultants (see lsquowhorsquos whorsquo below for a list of the main ones) other CCGs (who may have formed a regional lsquoclusterrsquo local councils a regional Commissioning Support Unit (CSU) or teams from regulators like Monitor or the NHS Trust Development Authority or NHS England

Whoever is carrying out a review ask the CCG to give you all the relevant minutes and reports

Check whether they are a lsquovanguardrsquo area (these areas are piloting a wide variety of new lsquopartnershipsrsquo geared towards getting care lsquoout of hospitalsrsquo and with many opportunities for private involvement)8

If there are plans for major service changes you can also check they are following this9 guidance (though be aware that the new lsquosuccess regimersquo for some areas allows these requirements to be bypassed

Go jargon-bustingOnce you get these reports read them carefully Look for hints that the review risksbull More privatisation ndash look for mentions

of choice diversity partnership lsquoindependent sectorrsquo or lsquocharities and other providersrsquo

Andor bull Cutting services ndash look for mentions

of lsquoco-productionrsquo lsquoasset-basedrsquo solutions (ie patients and carers doing more for themselves) lsquomoving care out of hospitalrsquo (without a clear description of where care WILL take place and to what standard) or talk of lsquooutcomes-basedrsquo contracts ie no requirements to protect existing staff levels or buildings and wards

8 httpwwwenglandnhsukourworkfuturenhs5yfv-ch3new-care-models9 httpwwwenglandnhsukwp-contentuploads201312plan-del-serv-chge1pdf

www38degreesorguk

If you find out the CCG is doing this

The CCG has plans to or is in the process of lsquoreviewingrsquo a service

Such plans should be available somewhere in the CCGs published plans and in a publicly available lsquoprocurement strategyrsquo

Look for clues like lsquotransformationrsquo lsquochange improvement programmersquo lsquosuccess regimersquo lsquoalignmentrsquo or lsquopilotsrsquo

You can

Ask for reassurances that the CCG is not considering handing the service or parts of it to a different (ie private) provider

Ask if the review is being carried out by the CCG or with help from third parties (such as external consultants (see lsquowhorsquos whorsquo below for a list of the main ones) other CCGs (who may have formed a regional lsquoclusterrsquo local councils a regional Commissioning Support Unit (CSU) or teams from regulators like Monitor or the NHS Trust Development Authority or NHS England

Whoever is carrying out a review ask the CCG to give you all the relevant minutes and reports

Check whether they are a lsquovanguardrsquo area (these areas are piloting a wide variety of new lsquopartnershipsrsquo geared towards getting care lsquoout of hospitalsrsquo and with many opportunities for private involvement)8

If there are plans for major service changes you can also check they are following this9 guidance (though be aware that the new lsquosuccess regimersquo for some areas allows these requirements to be bypassed

Go jargon-bustingOnce you get these reports read them carefully Look for hints that the review risksbull More privatisation ndash look for mentions

of choice diversity partnership lsquoindependent sectorrsquo or lsquocharities and other providersrsquo

Andor bull Cutting services ndash look for mentions

of lsquoco-productionrsquo lsquoasset-basedrsquo solutions (ie patients and carers doing more for themselves) lsquomoving care out of hospitalrsquo (without a clear description of where care WILL take place and to what standard) or talk of lsquooutcomes-basedrsquo contracts ie no requirements to protect existing staff levels or buildings and wards

www38degreesorguk

If you find out the CCG is doing this

The CCG runs a consultation or lsquoengagement exercisersquo (check their website) They are legally obliged to do so if what they are planning is likely to lead to significant changes to the service ndash although they may try to argue a change to provider isnrsquot a significant change

You can

bull Demand a proper consultation that discusses the options under consideration in plain English is open to everyone (not just hand-picked lsquostakeholdersrsquo) and includes public meetings (not just online surveys or drop-in sessions)

bull If the consultation is inadequate or non-existent keep asking ldquoWhere is the patient involvementrdquo

bull Demand better clearer consultations and highlight any concerns you have about where this is going You could provide a template or guidance for people to complete the consultation

bull You could also organise your own consultation meetings and ballots asking the key questions you think are important

Lewisham went further and organised its own very successful lsquoPeoplersquos Commissionrsquo as part of its ultimately successful campaign to protect Lewisham hospital

bull Read any new consultation carefully Behind the reassuring language what is it actually proposing

bull Be especially alert to leading questions (which that sound innocent but could be used in future to justify cuts or privatisation) For example questions that encourage people to say

bull That patients should do more for themselves or lsquobe equal partners in their carersquo

bull that lsquooutcomesrsquo matter more than who where or what is provided

bull that more services should be delivered lsquocloser to homersquo or lsquoin the communityrsquo (itrsquos easier to privatise home- or high-street based provision)

bull You could ask for (anonymised) copies of the consultation responses to check that any official report of its findings is accurate

Case study

www38degreesorguk

If you find out the CCG is doing this

You can

1 The CCG may decide that therersquos only one provider able to provide the service

If this is an NHS provider then congratulations Time to celebrate and make sure you tell people about your victory

If not challenge their decision publicly and ask lawyers if there are grounds for legal challenge Ask for all the information listed on the right hand side

Keep the pressure on the CCG to reverse this decision Ask how much the procurement exercise is costing (both for CCG and NHS organisations that have to bid)Ask for copies of thebull Risk assessment (what if the

service collapses what about the transition period What about staff morale)

bull Impact assessment (have they considered the impact on other local NHS providers)

bull Equalities assessment (have they considered the impact on protected groups like disabled people)

bull patient public involvement strategybull strategy for dealing with conflicts of

interestbull strategy for dealing with

confidentialitybull Scoring methodology for evaluating

bids

1 2

2 The CCG seems determined to go ahead with competitive procurement

www38degreesorguk

If you find out the CCG is doing this

You can

They will need to lsquospecifyrsquo the service contract and decide how they will evaluate bids

Ask the CCG to ensure that the contract is specified and bids are evaluated in a way thatbull Does not allow providers to lsquocherry

pickrsquo lucrative services and patients andor cut services to certain groups of patients (for example children)

bull Takes into account past performance not just claims on a glossy bid document

bull Protects (or improves) existing levels of skilled staff training workforce planning hospital and clinic provision

bull Rules out any charging of patientsbull Ensures clear substantial penalties

for service or reporting failures including paying for the cost of any harm to patients or additional costs incurred by the NHS as a result of failures

bull Protects the publicrsquos right to be consulted and to access information

bull Ensures all these duties transfer onto any sub-contractor or lsquopartnerrsquo

bull Weights the assessment to prevent bids winning if they score lower on quality (ie lsquocompetition on pricersquo)

If CCGs tell you any of these requirements are against the law ask them which law Our reading is that there is nothing in the Public Contracts Regulations 2006 or 2015 (which come into force for the NHS in April 2016) that prohibit them nor in the infamous lsquoSection 75 Regulationsrsquo

10 httptedeuropaeuTEDmiscchooseLanguagedo

www38degreesorguk

If you find out the CCG is doing this

You can

The CCG decides to go ahead with a competitive procurement process This has to be published for all but the smallest contracts (insert OJEU ref)

The process can take many months or even years The steps are typicallyCall for Expression of Interest (EOI)Invitation to submit Pre-Qualification

How to get an idea of which companies might be going for contractsAt each stage ask for names of bidders CCGs may tell you that information about which companies are interestedbidding or about the terms of the bid is lsquocommercially confidentialrsquo If sobull Challenge that decision on the grounds

of lsquopublic interestrsquo See wwwcfoiorguk for more info

bull Ask the CCG what information they plan to publish at what stage

Be aware that such routes can be painfully slow and have no guarantee of success so you will also need to turn detectivebull If you have built up inside contacts in

the CCG or local NHS Trust currently providing the service they may have heard rumours about who is (and isnrsquot) bidding and may be willing to talk to you in confidence Be aware this may

be risky for them bull You can also get a pretty good idea

of which companies are likely to be bidding by researching who has bid for ndash and won ndash similar contracts on the EUrsquos online tender site (TED)10 Enter the name of the type of service (eg ambulance) in the lsquofree text boxrsquo and select the UK as the geographical area Experiment with different time-frames depending on when you are looking at Note not all contracts that are actually won are reported on this site but all those advertised over a certain value should be

OPPORTUNITY ndash to get the most out of the OJEU website is quite a technical process If you are interested in taking part in an online masterclass sign up by contacting [xxxxx]

Questionnaire (PQQ)Invitation to Tender (ITT)Shortlisting round (often two rounds)Selection of lsquopreferred bidderrsquo 10 day lsquocooling off periodrsquo before contract award is announced

Sometimes the CCG hands this process over to one of the lsquoinvolved partiesrsquo listed above

www38degreesorguk

If you find out the CCG is doing this

You can

They will need to lsquospecifyrsquo the service contract and decide how they will evaluate bids

Ask the CCG to ensure that the contract is specified and bids are evaluated in a way thatbull Does not allow providers to lsquocherry

pickrsquo lucrative services and patients andor cut services to certain groups of patients (for example children)

bull Takes into account past performance not just claims on a glossy bid document

bull Protects (or improves) existing levels of skilled staff training workforce planning hospital and clinic provision

bull Rules out any charging of patientsbull Ensures clear substantial penalties

for service or reporting failures including paying for the cost of any harm to patients or additional costs incurred by the NHS as a result of failures

bull Protects the publicrsquos right to be consulted and to access information

bull Ensures all these duties transfer onto any sub-contractor or lsquopartnerrsquo

bull Weights the assessment to prevent bids winning if they score lower on quality (ie lsquocompetition on pricersquo)

If CCGs tell you any of these requirements are against the law ask them which law Our reading is that there is nothing in the Public Contracts Regulations 2006 or 2015 (which come into force for the NHS in April 2016) that prohibit them nor in the infamous lsquoSection 75 Regulationsrsquo

10 httptedeuropaeuTEDmiscchooseLanguagedo

www38degreesorguk

If you find out the CCG is doing this

You can

The CCG decides to go ahead with a competitive procurement process This has to be published for all but the smallest contracts (insert OJEU ref)

The process can take many months or even years The steps are typicallyCall for Expression of Interest (EOI)Invitation to submit Pre-Qualification

How to get an idea of which companies might be going for contractsAt each stage ask for names of bidders CCGs may tell you that information about which companies are interestedbidding or about the terms of the bid is lsquocommercially confidentialrsquo If sobull Challenge that decision on the grounds

of lsquopublic interestrsquo See wwwcfoiorguk for more info

bull Ask the CCG what information they plan to publish at what stage

Be aware that such routes can be painfully slow and have no guarantee of success so you will also need to turn detectivebull If you have built up inside contacts in

the CCG or local NHS Trust currently providing the service they may have heard rumours about who is (and isnrsquot) bidding and may be willing to talk to you in confidence Be aware this may

be risky for them bull You can also get a pretty good idea

of which companies are likely to be bidding by researching who has bid for ndash and won ndash similar contracts on the EUrsquos online tender site (TED)10 Enter the name of the type of service (eg ambulance) in the lsquofree text boxrsquo and select the UK as the geographical area Experiment with different time-frames depending on when you are looking at Note not all contracts that are actually won are reported on this site but all those advertised over a certain value should be

OPPORTUNITY ndash to get the most out of the OJEU website is quite a technical process If you are interested in taking part in an online masterclass sign up by contacting [xxxxx]

Questionnaire (PQQ)Invitation to Tender (ITT)Shortlisting round (often two rounds)Selection of lsquopreferred bidderrsquo 10 day lsquocooling off periodrsquo before contract award is announced

Sometimes the CCG hands this process over to one of the lsquoinvolved partiesrsquo listed above

10 httptedeuropaeuTEDmiscchooseLanguagedo

www38degreesorguk

If you find out the CCG is doing this

You can

The CCG decides to go ahead with a competitive procurement process This has to be published for all but the smallest contracts (insert OJEU ref)

The process can take many months or even years The steps are typicallyCall for Expression of Interest (EOI)Invitation to submit Pre-Qualification

How to get an idea of which companies might be going for contractsAt each stage ask for names of bidders CCGs may tell you that information about which companies are interestedbidding or about the terms of the bid is lsquocommercially confidentialrsquo If sobull Challenge that decision on the grounds

of lsquopublic interestrsquo See wwwcfoiorguk for more info

bull Ask the CCG what information they plan to publish at what stage

Be aware that such routes can be painfully slow and have no guarantee of success so you will also need to turn detectivebull If you have built up inside contacts in

the CCG or local NHS Trust currently providing the service they may have heard rumours about who is (and isnrsquot) bidding and may be willing to talk to you in confidence Be aware this may

be risky for them bull You can also get a pretty good idea

of which companies are likely to be bidding by researching who has bid for ndash and won ndash similar contracts on the EUrsquos online tender site (TED)10 Enter the name of the type of service (eg ambulance) in the lsquofree text boxrsquo and select the UK as the geographical area Experiment with different time-frames depending on when you are looking at Note not all contracts that are actually won are reported on this site but all those advertised over a certain value should be

OPPORTUNITY ndash to get the most out of the OJEU website is quite a technical process If you are interested in taking part in an online masterclass sign up by contacting [xxxxx]

Questionnaire (PQQ)Invitation to Tender (ITT)Shortlisting round (often two rounds)Selection of lsquopreferred bidderrsquo 10 day lsquocooling off periodrsquo before contract award is announced

Sometimes the CCG hands this process over to one of the lsquoinvolved partiesrsquo listed above

How can I influence my CCG

www38degreesorguk

You may be struggling to get clear information out of the CCG ndash so you may not even be sure where in this timeline you are

See below for ideas on how to both influence your CCG and uncover information from them ndash and how to rope in others to help with both including GPs and other health staff local media local politicians regulators and the law

Remember itrsquos a win-win when yoursquore asking the CCG for information or for guarantees that services will be protected If they give you what you want great ndash if they donrsquot you can use that to publicise the secretive undemocratic and worrying way in which decisions about NHS privatisation are being made

To be fair to CCGs even experts admit the legal situation is unclear and sometimes seems contradictory and some of the promised government guidance has not materialised

You may need to remind the CCG that they need to produce the evidence you are asking for to show (not just assert) that they are acting in accordance with patient interests as they are obliged to

Many campaigners feel that regular contact with CCGs (for example attending their governing board meetings writing to them andor meeting individuals like the Chair lsquoAccountable Officerrsquo or lsquopatient representative) has helped them build

relationships understand where people are coming from and get answers to some questions

However some campaigners are uncertain how much useful information and pressure these routes really exert If you ever feel like you are being lsquostrung alongrsquo you might need to move to the ideas below

Other avenues set up to channel public concerns to the CCG that you could use include the local lsquoHealthWatchrsquo organisation and possibly a CCG lsquopatient grouprsquo These bodies have little power (and HealthWatch is legally obliged not to directly criticise CCG policy) ndash but they can be a useful way of learning from and sharing information with other interested people and sometimes getting preferential access to consultations as a lsquostakeholderrsquo Lastly you could become a patient governor of your local hospital Foundation Trust as a way of finding out information

Case Study

Make early contact with your MP your local councillor and councillors who are on the local Health Scrutiny Committee to find out whether they share your concerns and are willing to echo them

If a politician agrees with you that services should not be handed to private companies you can ask them to

bull Directly raise all your concerns and questions about privatisation and cuts with the CCG ndash publically where possible

bull Ensure the local Health Overview amp Scrutiny Committee asks your questions (it can summons CCG officials) Scrutiny Committees can also recommend that a full consultation or proper impact assessment must be carried out and if they are not satisfied may be able to delay the process or even refer matters to the Secretary of State (which certainly raises the political profile of the issue)

bull Your council also has a Health amp Wellbeing Boards which is supposed to scrutinise the CCGrsquos plans

If your MP councillor tells you that it doesnrsquot matter who provides a service (often saying lsquoitrsquos not privatisation so long as it remains free at the point of usersquo yoursquoll need to expose why this causes concern

Check what theyrsquove said publicly about the NHS ndash have they talked about the need for quality openness choice efficiency Highlight how these things are undermined by privatisation

Publicly ask them to support concrete but reasonable-sounding pledges for example

ldquoI call on the CCG to guarantee that there will be no reduction in bed numbers clinics the number and skill level of nurses and clinicians staffing the [name of service]rdquo

Getting your MP and councillors on side

www38degreesorguk

In Gloucestershire where 9 district hospitals were due to be privatised campaigners called on the local (Conservative) MP to sign a pledge saying

ldquoI support the right of my constituents to choose whether the local hospitals stay publicly provided by the NHS or notrdquo

Although the MP did not sign the pledge he was put under considerable pressure by the local media and ended up putting pressure on government behind the scenes The campaigners ultimately got the result they wanted ndash local decision makers u-turned and kept services within the NHS

Campaigning ndash keeping the pressure on influencing through the media and your own publicity

www38degreesorguk

8 httpswwwopendemocracynetournhssteve-sweeneypatients-occupy-threatened-mental-health-clinic-some-signs-of-victory

T

Top Tip - Learn how to frame lsquono newsrsquo as lsquonewsrsquo Tell the media when you ask questions but also if there are lsquounanswered questionsconcernssecrecyvaguenesslack of reassurancesrsquo Point out that if the CCG cannot guarantee that a contract will not be taken over by a particular provider ndash or that they will not provide a bargain basement service ndash that may well happen

Start with milder actions like attending meetings submitting formal public questions to the meetings and sending letters The next step might be postcard campaigns and petitions (like this one httpssecure38degreesorgukkick-out-care-uk) escalating to lobbies demonstrations and other protests8 if that doesnrsquot yield results

Brief the media on every action (making it as simple locally-focused and jargon-free as possible) and invite them along to take

photos Highlight any mismatch between what the CCG is saying (in their policies about public engagement for example) and doing As well as press releases use the local newspaper letters pages (38 Degrees has an excellent online tool) and produce your own local leafletselectronic newsletters

Keep it focused on principles not personalities ndash but donrsquot be afraid to be challenging and critical though civil

Your notes

Case Study

Make early contact with your MP your local councillor and councillors who are on the local Health Scrutiny Committee to find out whether they share your concerns and are willing to echo them

If a politician agrees with you that services should not be handed to private companies you can ask them to

bull Directly raise all your concerns and questions about privatisation and cuts with the CCG ndash publically where possible

bull Ensure the local Health Overview amp Scrutiny Committee asks your questions (it can summons CCG officials) Scrutiny Committees can also recommend that a full consultation or proper impact assessment must be carried out and if they are not satisfied may be able to delay the process or even refer matters to the Secretary of State (which certainly raises the political profile of the issue)

bull Your council also has a Health amp Wellbeing Boards which is supposed to scrutinise the CCGrsquos plans

If your MP councillor tells you that it doesnrsquot matter who provides a service (often saying lsquoitrsquos not privatisation so long as it remains free at the point of usersquo yoursquoll need to expose why this causes concern

Check what theyrsquove said publicly about the NHS ndash have they talked about the need for quality openness choice efficiency Highlight how these things are undermined by privatisation

Publicly ask them to support concrete but reasonable-sounding pledges for example

ldquoI call on the CCG to guarantee that there will be no reduction in bed numbers clinics the number and skill level of nurses and clinicians staffing the [name of service]rdquo

Getting your MP and councillors on side

www38degreesorguk

In Gloucestershire where 9 district hospitals were due to be privatised campaigners called on the local (Conservative) MP to sign a pledge saying

ldquoI support the right of my constituents to choose whether the local hospitals stay publicly provided by the NHS or notrdquo

Although the MP did not sign the pledge he was put under considerable pressure by the local media and ended up putting pressure on government behind the scenes The campaigners ultimately got the result they wanted ndash local decision makers u-turned and kept services within the NHS

Campaigning ndash keeping the pressure on influencing through the media and your own publicity

www38degreesorguk

8 httpswwwopendemocracynetournhssteve-sweeneypatients-occupy-threatened-mental-health-clinic-some-signs-of-victory

T

Top Tip - Learn how to frame lsquono newsrsquo as lsquonewsrsquo Tell the media when you ask questions but also if there are lsquounanswered questionsconcernssecrecyvaguenesslack of reassurancesrsquo Point out that if the CCG cannot guarantee that a contract will not be taken over by a particular provider ndash or that they will not provide a bargain basement service ndash that may well happen

Start with milder actions like attending meetings submitting formal public questions to the meetings and sending letters The next step might be postcard campaigns and petitions (like this one httpssecure38degreesorgukkick-out-care-uk) escalating to lobbies demonstrations and other protests8 if that doesnrsquot yield results

Brief the media on every action (making it as simple locally-focused and jargon-free as possible) and invite them along to take

photos Highlight any mismatch between what the CCG is saying (in their policies about public engagement for example) and doing As well as press releases use the local newspaper letters pages (38 Degrees has an excellent online tool) and produce your own local leafletselectronic newsletters

Keep it focused on principles not personalities ndash but donrsquot be afraid to be challenging and critical though civil

Your notes

Campaigning ndash keeping the pressure on influencing through the media and your own publicity

www38degreesorguk

8 httpswwwopendemocracynetournhssteve-sweeneypatients-occupy-threatened-mental-health-clinic-some-signs-of-victory

T

Top Tip - Learn how to frame lsquono newsrsquo as lsquonewsrsquo Tell the media when you ask questions but also if there are lsquounanswered questionsconcernssecrecyvaguenesslack of reassurancesrsquo Point out that if the CCG cannot guarantee that a contract will not be taken over by a particular provider ndash or that they will not provide a bargain basement service ndash that may well happen

Start with milder actions like attending meetings submitting formal public questions to the meetings and sending letters The next step might be postcard campaigns and petitions (like this one httpssecure38degreesorgukkick-out-care-uk) escalating to lobbies demonstrations and other protests8 if that doesnrsquot yield results

Brief the media on every action (making it as simple locally-focused and jargon-free as possible) and invite them along to take

photos Highlight any mismatch between what the CCG is saying (in their policies about public engagement for example) and doing As well as press releases use the local newspaper letters pages (38 Degrees has an excellent online tool) and produce your own local leafletselectronic newsletters

Keep it focused on principles not personalities ndash but donrsquot be afraid to be challenging and critical though civil

Your notes

Campaigning ndash keeping the pressure on influencing through the media and your own publicity

To underpin your actions you need a simple message for your publicity and press releases ndash that you stick to In general terms Remind people that privatisation is bad because

bull It is happening stealthily against public opinion ndash and wersquore headed towards a tipping point where we move towards a US-style system

bull It costs more ndash in private profits and administration9 of a fragmented competing system ndash leading to cuts and the threat of future charges

bull It lsquocherry picksrsquo the easy services and patients taking away government cash from the NHS which is left struggling with the difficult and expensive treatments and emergencies

bull Service quality is damaged as corners are cut ndash especially on skilled staff

bull Itrsquos more secretive ndash lsquocommercial confidentialityrsquo makes it hard to find out whatrsquos happening and hold providers to account

(You can give examples such as those contained in this guide or from your background research)10

Positive messages are good ndash say that you are working to protect an NHS that is

1 Comprehensive (providing all the healthcare we need)

2 Universal (providing it to everyone who needs it)

3 Quality (providing it through well-trained decently-rewarded staff)

4 Timely (providing it when we need it)5 Tax-payer funded (provided in the

fairest most efficient way)6 Ethical (provided with high standards

of privacy consent and respect for all)7 Publicly-provided not privatised (as

the only way to ensure all the above)

www38degreesorguk

9 httpswwwopendemocracynetournhscaroline-molloybillions-of-wasted-nhs-cash-noone-wants-to-mention10httpswwwopendemocracynetcaroline-molloy-richard-whittellresearching-health-companies-web-search-guide

Case Study

The government said its creation of CCGs was about lsquogiving power to doctorsrsquo But in practice this mostly amounts to having a few GPs sitting on the governing boards of the CCGs (along with at least one nurse and hospital doctor) The CCGrsquos Chair at least may be elected by local GPs ndash but most GPs are not at all involved in the workings of the CCG and their formal routes of influence are ndash according to the British Medical Journal ndash unclear

However if you can mobilise doctors (and other health staff) in your area to speak out publicly about CCG decisions that could be very powerful enabling you to question whether power is really being lsquogiven to doctors and cliniciansrsquo You could approach doctors directly or (if they are well organised in your area) through the Patient Participation Groups that many GP practices have

Can I influence my CCG through my local GPdoctor

www38degreesorguk

Some groups have done this ndash for example one NHS group got over 80 practices to send a template letter to the CCG urging them not to re-commission the private provider of an Independent Sector Treatment Centre

10 httpwwwbbccouknewsuk-england-nottinghamshire-3300710311httpswwwopendemocracynetournhscaroline-molloyshock-uturn-as-selloff-of-george-eliot-hospital-cancelled

Case Study

NHS staff in general are an important source of informationIf staff are mobilised and prepared to speak out they can be a vital source of information and influence Approach the local union branches (the main ones are Unite Unison GMB RCN BMA RCM) offer your help with research and find out what would be most useful to them They have a little more protection if they speak out ndash though note that theyrsquore only allowed to take industrial action over issues like lsquostaff conditionsrsquo not lsquopoliticalrsquo issues like privatisation per se

Try to avoid being critical - understand that many NHS staff are demoralised are under huge top-down pressure and plans may have been presented to them as the lsquoleast worst optionrsquo Yoursquoll need to cultivate ongoing relationships and informal chats and show that you understand and value their concerns about terms and conditions and job security

Donrsquot expect staff to reveal everything they know in public meetings or on first conversation ndash they may have valid fears about getting into trouble at work if they speak out publicly or fears that what they say may be used to criticise the NHS in general Show them your main concern is problems theyrsquove encountered because of privatisation - for example if they had to wait hours with a patient because the private ambulance didnrsquot show up or treat a patient whorsquod had poor care in a privatised service

A new private employer may be reluctant to take over if itrsquos obvious that staff are prepared to put up a fight If it can be made clear they are likely to leave other local decision makers might intervene hopefully before it gets to a stage like Circlersquos takeover of dermatology in Nottingham10 where most of the doctors quit rather than work for a private company

Can I influence my CCG through my local GPdoctor

www38degreesorguk

The proposed privatisation of George Eliot hospital11 in Nuneaton was abandoned after a vigorous campaign by unions and local campaigners which particularly targeted local MPs the expense of the whole process and poor precedents elsewhere

10 httpwwwbbccouknewsuk-england-nottinghamshire-3300710311httpswwwopendemocracynetournhscaroline-molloyshock-uturn-as-selloff-of-george-eliot-hospital-cancelled

Case Study

NHS staff in general are an important source of informationIf staff are mobilised and prepared to speak out they can be a vital source of information and influence Approach the local union branches (the main ones are Unite Unison GMB RCN BMA RCM) offer your help with research and find out what would be most useful to them They have a little more protection if they speak out ndash though note that theyrsquore only allowed to take industrial action over issues like lsquostaff conditionsrsquo not lsquopoliticalrsquo issues like privatisation per se

Try to avoid being critical - understand that many NHS staff are demoralised are under huge top-down pressure and plans may have been presented to them as the lsquoleast worst optionrsquo Yoursquoll need to cultivate ongoing relationships and informal chats and show that you understand and value their concerns about terms and conditions and job security

Donrsquot expect staff to reveal everything they know in public meetings or on first conversation ndash they may have valid fears about getting into trouble at work if they speak out publicly or fears that what they say may be used to criticise the NHS in general Show them your main concern is problems theyrsquove encountered because of privatisation - for example if they had to wait hours with a patient because the private ambulance didnrsquot show up or treat a patient whorsquod had poor care in a privatised service

A new private employer may be reluctant to take over if itrsquos obvious that staff are prepared to put up a fight If it can be made clear they are likely to leave other local decision makers might intervene hopefully before it gets to a stage like Circlersquos takeover of dermatology in Nottingham10 where most of the doctors quit rather than work for a private company

Can I influence my CCG through my local GPdoctor

www38degreesorguk

The proposed privatisation of George Eliot hospital11 in Nuneaton was abandoned after a vigorous campaign by unions and local campaigners which particularly targeted local MPs the expense of the whole process and poor precedents elsewhere

Going Deeper

A range of community healthcare services including physiotherapy speech and language therapy audiology and diabetes specialist care are also being offered through a wide range of private companies through the lsquoAny Qualified Providerrsquo scheme (an extension of the lsquoChoose and Bookrsquo scheme)

A new trend is to bundle together services in large packages like lsquoend of life carersquo or lsquoolder peoplersquos servicesrsquo or lsquochildrenrsquos servicesrsquo

General outsourcing firms like Capita12

supply much lsquoback-office supportrsquo - everything from patient records payroll payments management and IT to estates management patient engagement and referrals management (rationing GP referrals) Capita has recently won a pound1bn contract13 to provide such services across the whole of primary care (ie to GPs)

The government is keen to encourage CCGs to use other (largely privatised) bodies to make commissioning decisions for them including lsquoCommissioning Support Unitsrsquo14 (CSUs) and lsquoLead Provider Frameworksrsquo

Many consultancy firms international services conglomerates insurance legal healthcare and pharmaceutical

companies are now getting in on this lsquocommissioning supportrsquo act including KPMG PwC EY Deloitte BDO McKesson McKinsey PA Consulting FTI Consulting GE Healthcare Atos Dr Foster Qinetiq Merck Pfizer Rand DLA Piper and AXA The market is increasing as CCGs struggle under squeezed budgets and as some areas lsquodevolversquo decisions to local councils who are even more inexperienced at commissioning healthcare (and used to privatising social care)

Some CCGs are even handing decisions over completely to a lsquolead providerrsquo where private companies decide whether to provide the service themselves cut it or sub-contract it back to another private company or even back to the NHS Companies involved include Virgin15 UnitedHealth16 CSC17 and Interserve18

Finally there are several ways a private bid might be presented as lsquonot privatersquobull By lsquopartneringrsquo with an NHS Trust and

or with charitiesbull Doctors are being encouraged

(including by Simon Stevens head of the NHS) to form themselves into commercial trading companies and take over NHS hospital services (presented as lsquoproviding services closer to home)

Donrsquot take the statements lsquoNHS-ledrsquo or lsquodoctor-ledrsquo at face value ndash ask questions about who is involved

www38degreesorguk

httpwwwnhsforsaleinfoprivate-providerscapitahtmlhttp38dgs1NA03f9httpswwwopendemocracynettamasin-cavewhy-are-gps-being-told-to-hand-decisions-to-private-health-firms-and-their-lobbyistshttpswwwopendemocracynetournhscaroline-molloycameron27s-biggest-broken-promise-on-nhshttpswwwopendemocracynetournhscaroline-molloyleak-reveals-worrying-truth-behind-biggest-nhs-privatisation-yethttpwwwhealthinvestorcoukShowArticleaspxID=4146

Your notes

Whorsquos who in the race to privatise the NHS

In a brief guide like this this is just a taster For more information check out wwwnhsforsaleinfo and the OurNHSCorporateWatch guide to researching private companies in healthcare

Alliance Medical a leading provider of diagnostic scans in NHS hospitals and clinics

Alpha provides three psychiatric hospitals and three elderly peoplersquos care homes Both have been plagued by allegations of substandard care and negative CQC reports Arriva a German-owned bus company ndash is taking over much non-emergency ambulance provision

Atos the hugely unpopular company that formerly run the lsquowork capability assessmentrsquo is now moving into the lsquocommissioning supportrsquo market providing services to the Midlands amp Lancashire and South and West England CSU

Boots widely criticised for tax evasion - is taking over hospital pharmacies and providing audiology and an expanding array of other services in its high street stores

BUPA provides planned operations to the NHS through its Independent Sector Treatment Centres and its own private hospitals Recently pulled out of a botched privatisation of muscular-skeletal services in West Sussex

Care UK started life as a provider of care homes for the elderly but now provides GP services diagnostic tests mental health and learning disability services referral management services services in prisons and is the largest provider of the 111 out of hours helpline The 111 line has been criticised for employing less well qualified staff and sending out ambulances inappropriately with the College of Emergency Medicine saying it was lsquolargely responsiblersquo for the crisis in AampE CareUK (and Harmoni which it absorbed) has been the subject of a number of high-profile criticisms of their care homes home carer service urgent care centres out of hours care (see also here) Another of its centres was recently found to be discharging patients before treatment to meet 4 hour targets that their payments depended upon

Whorsquos who in the race to privatise the NHS

General Healthcare (including BMI and Netcare) ndash provides planned operations to the NHS through its Independent Sector Treatment Centres and its own private hospitals

Circle ndash the much-vaunted lsquosocial enterprisersquo failed spectacularly in its running of the whole of Hinchingbrooke Hospital (which was the first hospital ever to be failed on lsquocaringrsquo by the CQC watchdog) ndash but is finding it easier to takeover select bits like elective operations dermatology and muscular-skeletal services ndash though in the latter two cases at least there have been damaging effects on local NHS hospitals

G4S ndash despite debacles in other government contracts (including the Olympics and tagging of prisoners) G4S runs a wide range of services from ambulances to prisons secure mental health and lsquoforensicrsquo medical services (for example examining survivors of sexual assault)

Healthcare at Home ndash the private equity-owned firm is a key player in the rapidly expanding are of healthcare at home

Inhealth ndash one of the leading providers of diagnostic services including MRI CT x-ray and ultrasound scans audiology cardiology and endoscopy They work in over 200 hospitals and 80 community

health clinics and their contracts are likely to be with the Trust or NHS England rather than with the CCG

Interserve ndash the well-connected general outsourcing company is becoming a key player in the new lsquoLead Providerrsquo model and in back-office commissioning

Lloyds ndash now owned by a pharmaceutical company the high street chain is taking over hospital pharmacies and is keen to provide many lsquocommunityrsquo health services

HCA International ndash provides planned operations to the NHS through its Independent Sector Treatment Centres and in its hospitals

Maximus - the controversial US Medicaid administrator is now offering an increasing range of services to both benefits offices and doctors surgery through lsquoFit For Workrsquo schemes including taking over the lsquowork capability assessmentrsquo from Atos and assessing people off work sick for more than 4 weeks

NSL - is taking over much non-emergency ambulance provision Complaints have soared for example in Northamptonshire

Partnerships in Care - provider of secure mental health services

Whorsquos who in the race to privatise the NHS

Priory Group - provider of residential secure and step down mental health services and drug and alcohol treatment

Ramsay healthcare ndash provides planned operations to the NHS through its Independent Sector Treatment Centres and its own private hospitalsSerco - announced last year that it would no longer be bidding to directly provide healthcare after a string of scandals including Cornwall out of hours where Serco were found to have falsified data on how fast calls were answered and were alleged to have only one GP on duty covering the whole county some nights They are now moving into the back office commissioning support market offering their services to commissioners through North and East London CSU

Spire ndash provides planned operations to the NHS through its Independent Sector Treatment Centres and its own private hospitals

Turning Point - provider of drug and alcohol treatment services Despite being a lsquosocial enterprisersquo and charity they have come under heavy criticism for their treatment of staff

UnitedHealth - the largest healthcare corporation in the world its first foray into NHS provision ended badly when it pulled out of GP practices it was

running leaving patients in the lurch It is now focused on lsquoback-officersquo services (commissioning health needs assessment service redesign) where it has an increasing role in shaping patients access to health services in developments many critics see as similar to the gatekeeper role it plays in the insurance-based US system Its offshoot Optum is one of the main winners of a pound5bn contract to provide lsquocommissioning supportrsquo to CCGs

Virgin - Virgin runs over 230 NHS services including GP services urgent care centres sexual health muscular-skeletal services integrated childrenrsquos services (in Devon) community services (in Surrey) and prison services It recently won a pound280m lsquoprime providerrsquo contract (one of the first of its kind) to both commission and provide (or sub-contract) cancer services in Staffordshire It was criticised by the CQC for putting patients at risk by employing receptionists to assess staff at its Urgent Care Centre in Croydon

You are entitled to know what companies are getting taxpayer money to provide health services ndash there is no justification to keep this secret Simply write to the CCG asking it to give you a list of the clinical and support contracts it has with private (and third sector) providers their value how long they are for and what they are for Check their website first to ensure they havenrsquot already published a complete list (some have and all will have to by April 2016)

If you want to submit this (or any other question) as a lsquoFreedom of Informationrsquo request simply state on the letter lsquoplease treat this as a Freedom of Information requestrsquo) and send it to their FOI officer (all CCGs and other public organisations have one) Itrsquos a good idea to do this if you want to ensure you get a full response within a month

Keep FOI requests simple ndash just a few straightforward questions or a list of particular types of documents you want They can be refused if it would take more than a few days to collect the information You can send FOI requests to any public organisation (including all parts of the NHS) asking about any aspect of their work including dealings with private companies (not just contracts but meetings correspondence etc) ndash but do not send it directly to the private company theyrsquore under no obligation to answer you

Be aware that if you ask for a lot of details about contractual terms and the like you may well be refused some of the information on the grounds of lsquocommercial confidentialityrsquo You can appeal this but itrsquos wise to seek advice ndash see wwwcfoiorguk

Going further -

To get a complete list you will need to ask local hospitals (who may sub-contract services like scans as well as cleaning and catering and may even pay companies for private beds) and NHS England who may commission both GPs and specialist services for your area

Also make sure you ask the CCG to give you details of contracts it holds not just directly but jointly or through other parties (for example if it has clustered with other CCGs for a particular service that covers a wide area like ambulances)

Take a closer look ndash is there another company logo on your local NHS premises letters and vehicles perhaps alongside the NHS logo (Note ndash this isnrsquot failsafe some companies hide their own logo altogether just using the NHS one)

How to find out which private companies already operate in your local NHS

www38degreesorguk

Encourage people to give their personal experience of care

Before you go down this route itrsquos a good idea to get a list of what services are already privatised publicise that and focus your efforts particularly on those services

People may simply not realise that some of the problems they encounter with the NHS are due to privatisation either directly (because the service has in fact been privatised) or indirectly (because the NHS is losing money on administering privatisation and having private companies cherry pick the more lucrative bits)

As well as telling you about problems encourage people them to complain at the time as well particularly if their GP referred them for surgery or other treatment and they were not offered an NHS option (or were heavily steered towards a private sector option)

Ask the local HealthWatch if you can get involved and help conduct on-site inspections Frankly neither the CCGs nor the CQC have been given resources to properly monitor the service delivered by private contractors on the ground ndash so itrsquos important for activists to do so

How to find out which private companies already operate in your local NHS

www38degreesorguk

Whorsquos who in the race to privatise the NHS

In a brief guide like this this is just a taster For more information check out wwwnhsforsaleinfo and the OurNHSCorporateWatch guide to researching private companies in healthcare

Alliance Medical a leading provider of diagnostic scans in NHS hospitals and clinics

Alpha provides three psychiatric hospitals and three elderly peoplersquos care homes Both have been plagued by allegations of substandard care and negative CQC reports Arriva a German-owned bus company ndash is taking over much non-emergency ambulance provision

Atos the hugely unpopular company that formerly run the lsquowork capability assessmentrsquo is now moving into the lsquocommissioning supportrsquo market providing services to the Midlands amp Lancashire and South and West England CSU

Boots widely criticised for tax evasion - is taking over hospital pharmacies and providing audiology and an expanding array of other services in its high street stores

BUPA provides planned operations to the NHS through its Independent Sector Treatment Centres and its own private hospitals Recently pulled out of a botched privatisation of muscular-skeletal services in West Sussex

Care UK started life as a provider of care homes for the elderly but now provides GP services diagnostic tests mental health and learning disability services referral management services services in prisons and is the largest provider of the 111 out of hours helpline The 111 line has been criticised for employing less well qualified staff and sending out ambulances inappropriately with the College of Emergency Medicine saying it was lsquolargely responsiblersquo for the crisis in AampE CareUK (and Harmoni which it absorbed) has been the subject of a number of high-profile criticisms of their care homes home carer service urgent care centres out of hours care (see also here) Another of its centres was recently found to be discharging patients before treatment to meet 4 hour targets that their payments depended upon

Whorsquos who in the race to privatise the NHS

General Healthcare (including BMI and Netcare) ndash provides planned operations to the NHS through its Independent Sector Treatment Centres and its own private hospitals

Circle ndash the much-vaunted lsquosocial enterprisersquo failed spectacularly in its running of the whole of Hinchingbrooke Hospital (which was the first hospital ever to be failed on lsquocaringrsquo by the CQC watchdog) ndash but is finding it easier to takeover select bits like elective operations dermatology and muscular-skeletal services ndash though in the latter two cases at least there have been damaging effects on local NHS hospitals

G4S ndash despite debacles in other government contracts (including the Olympics and tagging of prisoners) G4S runs a wide range of services from ambulances to prisons secure mental health and lsquoforensicrsquo medical services (for example examining survivors of sexual assault)

Healthcare at Home ndash the private equity-owned firm is a key player in the rapidly expanding are of healthcare at home

Inhealth ndash one of the leading providers of diagnostic services including MRI CT x-ray and ultrasound scans audiology cardiology and endoscopy They work in over 200 hospitals and 80 community

health clinics and their contracts are likely to be with the Trust or NHS England rather than with the CCG

Interserve ndash the well-connected general outsourcing company is becoming a key player in the new lsquoLead Providerrsquo model and in back-office commissioning

Lloyds ndash now owned by a pharmaceutical company the high street chain is taking over hospital pharmacies and is keen to provide many lsquocommunityrsquo health services

HCA International ndash provides planned operations to the NHS through its Independent Sector Treatment Centres and in its hospitals

Maximus - the controversial US Medicaid administrator is now offering an increasing range of services to both benefits offices and doctors surgery through lsquoFit For Workrsquo schemes including taking over the lsquowork capability assessmentrsquo from Atos and assessing people off work sick for more than 4 weeks

NSL - is taking over much non-emergency ambulance provision Complaints have soared for example in Northamptonshire

Partnerships in Care - provider of secure mental health services

Whorsquos who in the race to privatise the NHS

Priory Group - provider of residential secure and step down mental health services and drug and alcohol treatment

Ramsay healthcare ndash provides planned operations to the NHS through its Independent Sector Treatment Centres and its own private hospitalsSerco - announced last year that it would no longer be bidding to directly provide healthcare after a string of scandals including Cornwall out of hours where Serco were found to have falsified data on how fast calls were answered and were alleged to have only one GP on duty covering the whole county some nights They are now moving into the back office commissioning support market offering their services to commissioners through North and East London CSU

Spire ndash provides planned operations to the NHS through its Independent Sector Treatment Centres and its own private hospitals

Turning Point - provider of drug and alcohol treatment services Despite being a lsquosocial enterprisersquo and charity they have come under heavy criticism for their treatment of staff

UnitedHealth - the largest healthcare corporation in the world its first foray into NHS provision ended badly when it pulled out of GP practices it was

running leaving patients in the lurch It is now focused on lsquoback-officersquo services (commissioning health needs assessment service redesign) where it has an increasing role in shaping patients access to health services in developments many critics see as similar to the gatekeeper role it plays in the insurance-based US system Its offshoot Optum is one of the main winners of a pound5bn contract to provide lsquocommissioning supportrsquo to CCGs

Virgin - Virgin runs over 230 NHS services including GP services urgent care centres sexual health muscular-skeletal services integrated childrenrsquos services (in Devon) community services (in Surrey) and prison services It recently won a pound280m lsquoprime providerrsquo contract (one of the first of its kind) to both commission and provide (or sub-contract) cancer services in Staffordshire It was criticised by the CQC for putting patients at risk by employing receptionists to assess staff at its Urgent Care Centre in Croydon

You are entitled to know what companies are getting taxpayer money to provide health services ndash there is no justification to keep this secret Simply write to the CCG asking it to give you a list of the clinical and support contracts it has with private (and third sector) providers their value how long they are for and what they are for Check their website first to ensure they havenrsquot already published a complete list (some have and all will have to by April 2016)

If you want to submit this (or any other question) as a lsquoFreedom of Informationrsquo request simply state on the letter lsquoplease treat this as a Freedom of Information requestrsquo) and send it to their FOI officer (all CCGs and other public organisations have one) Itrsquos a good idea to do this if you want to ensure you get a full response within a month

Keep FOI requests simple ndash just a few straightforward questions or a list of particular types of documents you want They can be refused if it would take more than a few days to collect the information You can send FOI requests to any public organisation (including all parts of the NHS) asking about any aspect of their work including dealings with private companies (not just contracts but meetings correspondence etc) ndash but do not send it directly to the private company theyrsquore under no obligation to answer you

Be aware that if you ask for a lot of details about contractual terms and the like you may well be refused some of the information on the grounds of lsquocommercial confidentialityrsquo You can appeal this but itrsquos wise to seek advice ndash see wwwcfoiorguk

Going further -

To get a complete list you will need to ask local hospitals (who may sub-contract services like scans as well as cleaning and catering and may even pay companies for private beds) and NHS England who may commission both GPs and specialist services for your area

Also make sure you ask the CCG to give you details of contracts it holds not just directly but jointly or through other parties (for example if it has clustered with other CCGs for a particular service that covers a wide area like ambulances)

Take a closer look ndash is there another company logo on your local NHS premises letters and vehicles perhaps alongside the NHS logo (Note ndash this isnrsquot failsafe some companies hide their own logo altogether just using the NHS one)

How to find out which private companies already operate in your local NHS

www38degreesorguk

Encourage people to give their personal experience of care

Before you go down this route itrsquos a good idea to get a list of what services are already privatised publicise that and focus your efforts particularly on those services

People may simply not realise that some of the problems they encounter with the NHS are due to privatisation either directly (because the service has in fact been privatised) or indirectly (because the NHS is losing money on administering privatisation and having private companies cherry pick the more lucrative bits)

As well as telling you about problems encourage people them to complain at the time as well particularly if their GP referred them for surgery or other treatment and they were not offered an NHS option (or were heavily steered towards a private sector option)

Ask the local HealthWatch if you can get involved and help conduct on-site inspections Frankly neither the CCGs nor the CQC have been given resources to properly monitor the service delivered by private contractors on the ground ndash so itrsquos important for activists to do so

How to find out which private companies already operate in your local NHS

www38degreesorguk

Whorsquos who in the race to privatise the NHS

General Healthcare (including BMI and Netcare) ndash provides planned operations to the NHS through its Independent Sector Treatment Centres and its own private hospitals

Circle ndash the much-vaunted lsquosocial enterprisersquo failed spectacularly in its running of the whole of Hinchingbrooke Hospital (which was the first hospital ever to be failed on lsquocaringrsquo by the CQC watchdog) ndash but is finding it easier to takeover select bits like elective operations dermatology and muscular-skeletal services ndash though in the latter two cases at least there have been damaging effects on local NHS hospitals

G4S ndash despite debacles in other government contracts (including the Olympics and tagging of prisoners) G4S runs a wide range of services from ambulances to prisons secure mental health and lsquoforensicrsquo medical services (for example examining survivors of sexual assault)

Healthcare at Home ndash the private equity-owned firm is a key player in the rapidly expanding are of healthcare at home

Inhealth ndash one of the leading providers of diagnostic services including MRI CT x-ray and ultrasound scans audiology cardiology and endoscopy They work in over 200 hospitals and 80 community

health clinics and their contracts are likely to be with the Trust or NHS England rather than with the CCG

Interserve ndash the well-connected general outsourcing company is becoming a key player in the new lsquoLead Providerrsquo model and in back-office commissioning

Lloyds ndash now owned by a pharmaceutical company the high street chain is taking over hospital pharmacies and is keen to provide many lsquocommunityrsquo health services

HCA International ndash provides planned operations to the NHS through its Independent Sector Treatment Centres and in its hospitals

Maximus - the controversial US Medicaid administrator is now offering an increasing range of services to both benefits offices and doctors surgery through lsquoFit For Workrsquo schemes including taking over the lsquowork capability assessmentrsquo from Atos and assessing people off work sick for more than 4 weeks

NSL - is taking over much non-emergency ambulance provision Complaints have soared for example in Northamptonshire

Partnerships in Care - provider of secure mental health services

Whorsquos who in the race to privatise the NHS

Priory Group - provider of residential secure and step down mental health services and drug and alcohol treatment

Ramsay healthcare ndash provides planned operations to the NHS through its Independent Sector Treatment Centres and its own private hospitalsSerco - announced last year that it would no longer be bidding to directly provide healthcare after a string of scandals including Cornwall out of hours where Serco were found to have falsified data on how fast calls were answered and were alleged to have only one GP on duty covering the whole county some nights They are now moving into the back office commissioning support market offering their services to commissioners through North and East London CSU

Spire ndash provides planned operations to the NHS through its Independent Sector Treatment Centres and its own private hospitals

Turning Point - provider of drug and alcohol treatment services Despite being a lsquosocial enterprisersquo and charity they have come under heavy criticism for their treatment of staff

UnitedHealth - the largest healthcare corporation in the world its first foray into NHS provision ended badly when it pulled out of GP practices it was

running leaving patients in the lurch It is now focused on lsquoback-officersquo services (commissioning health needs assessment service redesign) where it has an increasing role in shaping patients access to health services in developments many critics see as similar to the gatekeeper role it plays in the insurance-based US system Its offshoot Optum is one of the main winners of a pound5bn contract to provide lsquocommissioning supportrsquo to CCGs

Virgin - Virgin runs over 230 NHS services including GP services urgent care centres sexual health muscular-skeletal services integrated childrenrsquos services (in Devon) community services (in Surrey) and prison services It recently won a pound280m lsquoprime providerrsquo contract (one of the first of its kind) to both commission and provide (or sub-contract) cancer services in Staffordshire It was criticised by the CQC for putting patients at risk by employing receptionists to assess staff at its Urgent Care Centre in Croydon

You are entitled to know what companies are getting taxpayer money to provide health services ndash there is no justification to keep this secret Simply write to the CCG asking it to give you a list of the clinical and support contracts it has with private (and third sector) providers their value how long they are for and what they are for Check their website first to ensure they havenrsquot already published a complete list (some have and all will have to by April 2016)

If you want to submit this (or any other question) as a lsquoFreedom of Informationrsquo request simply state on the letter lsquoplease treat this as a Freedom of Information requestrsquo) and send it to their FOI officer (all CCGs and other public organisations have one) Itrsquos a good idea to do this if you want to ensure you get a full response within a month

Keep FOI requests simple ndash just a few straightforward questions or a list of particular types of documents you want They can be refused if it would take more than a few days to collect the information You can send FOI requests to any public organisation (including all parts of the NHS) asking about any aspect of their work including dealings with private companies (not just contracts but meetings correspondence etc) ndash but do not send it directly to the private company theyrsquore under no obligation to answer you

Be aware that if you ask for a lot of details about contractual terms and the like you may well be refused some of the information on the grounds of lsquocommercial confidentialityrsquo You can appeal this but itrsquos wise to seek advice ndash see wwwcfoiorguk

Going further -

To get a complete list you will need to ask local hospitals (who may sub-contract services like scans as well as cleaning and catering and may even pay companies for private beds) and NHS England who may commission both GPs and specialist services for your area

Also make sure you ask the CCG to give you details of contracts it holds not just directly but jointly or through other parties (for example if it has clustered with other CCGs for a particular service that covers a wide area like ambulances)

Take a closer look ndash is there another company logo on your local NHS premises letters and vehicles perhaps alongside the NHS logo (Note ndash this isnrsquot failsafe some companies hide their own logo altogether just using the NHS one)

How to find out which private companies already operate in your local NHS

www38degreesorguk

Encourage people to give their personal experience of care

Before you go down this route itrsquos a good idea to get a list of what services are already privatised publicise that and focus your efforts particularly on those services

People may simply not realise that some of the problems they encounter with the NHS are due to privatisation either directly (because the service has in fact been privatised) or indirectly (because the NHS is losing money on administering privatisation and having private companies cherry pick the more lucrative bits)

As well as telling you about problems encourage people them to complain at the time as well particularly if their GP referred them for surgery or other treatment and they were not offered an NHS option (or were heavily steered towards a private sector option)

Ask the local HealthWatch if you can get involved and help conduct on-site inspections Frankly neither the CCGs nor the CQC have been given resources to properly monitor the service delivered by private contractors on the ground ndash so itrsquos important for activists to do so

How to find out which private companies already operate in your local NHS

www38degreesorguk

Whorsquos who in the race to privatise the NHS

Priory Group - provider of residential secure and step down mental health services and drug and alcohol treatment

Ramsay healthcare ndash provides planned operations to the NHS through its Independent Sector Treatment Centres and its own private hospitalsSerco - announced last year that it would no longer be bidding to directly provide healthcare after a string of scandals including Cornwall out of hours where Serco were found to have falsified data on how fast calls were answered and were alleged to have only one GP on duty covering the whole county some nights They are now moving into the back office commissioning support market offering their services to commissioners through North and East London CSU

Spire ndash provides planned operations to the NHS through its Independent Sector Treatment Centres and its own private hospitals

Turning Point - provider of drug and alcohol treatment services Despite being a lsquosocial enterprisersquo and charity they have come under heavy criticism for their treatment of staff

UnitedHealth - the largest healthcare corporation in the world its first foray into NHS provision ended badly when it pulled out of GP practices it was

running leaving patients in the lurch It is now focused on lsquoback-officersquo services (commissioning health needs assessment service redesign) where it has an increasing role in shaping patients access to health services in developments many critics see as similar to the gatekeeper role it plays in the insurance-based US system Its offshoot Optum is one of the main winners of a pound5bn contract to provide lsquocommissioning supportrsquo to CCGs

Virgin - Virgin runs over 230 NHS services including GP services urgent care centres sexual health muscular-skeletal services integrated childrenrsquos services (in Devon) community services (in Surrey) and prison services It recently won a pound280m lsquoprime providerrsquo contract (one of the first of its kind) to both commission and provide (or sub-contract) cancer services in Staffordshire It was criticised by the CQC for putting patients at risk by employing receptionists to assess staff at its Urgent Care Centre in Croydon

You are entitled to know what companies are getting taxpayer money to provide health services ndash there is no justification to keep this secret Simply write to the CCG asking it to give you a list of the clinical and support contracts it has with private (and third sector) providers their value how long they are for and what they are for Check their website first to ensure they havenrsquot already published a complete list (some have and all will have to by April 2016)

If you want to submit this (or any other question) as a lsquoFreedom of Informationrsquo request simply state on the letter lsquoplease treat this as a Freedom of Information requestrsquo) and send it to their FOI officer (all CCGs and other public organisations have one) Itrsquos a good idea to do this if you want to ensure you get a full response within a month

Keep FOI requests simple ndash just a few straightforward questions or a list of particular types of documents you want They can be refused if it would take more than a few days to collect the information You can send FOI requests to any public organisation (including all parts of the NHS) asking about any aspect of their work including dealings with private companies (not just contracts but meetings correspondence etc) ndash but do not send it directly to the private company theyrsquore under no obligation to answer you

Be aware that if you ask for a lot of details about contractual terms and the like you may well be refused some of the information on the grounds of lsquocommercial confidentialityrsquo You can appeal this but itrsquos wise to seek advice ndash see wwwcfoiorguk

Going further -

To get a complete list you will need to ask local hospitals (who may sub-contract services like scans as well as cleaning and catering and may even pay companies for private beds) and NHS England who may commission both GPs and specialist services for your area

Also make sure you ask the CCG to give you details of contracts it holds not just directly but jointly or through other parties (for example if it has clustered with other CCGs for a particular service that covers a wide area like ambulances)

Take a closer look ndash is there another company logo on your local NHS premises letters and vehicles perhaps alongside the NHS logo (Note ndash this isnrsquot failsafe some companies hide their own logo altogether just using the NHS one)

How to find out which private companies already operate in your local NHS

www38degreesorguk

Encourage people to give their personal experience of care

Before you go down this route itrsquos a good idea to get a list of what services are already privatised publicise that and focus your efforts particularly on those services

People may simply not realise that some of the problems they encounter with the NHS are due to privatisation either directly (because the service has in fact been privatised) or indirectly (because the NHS is losing money on administering privatisation and having private companies cherry pick the more lucrative bits)

As well as telling you about problems encourage people them to complain at the time as well particularly if their GP referred them for surgery or other treatment and they were not offered an NHS option (or were heavily steered towards a private sector option)

Ask the local HealthWatch if you can get involved and help conduct on-site inspections Frankly neither the CCGs nor the CQC have been given resources to properly monitor the service delivered by private contractors on the ground ndash so itrsquos important for activists to do so

How to find out which private companies already operate in your local NHS

www38degreesorguk

You are entitled to know what companies are getting taxpayer money to provide health services ndash there is no justification to keep this secret Simply write to the CCG asking it to give you a list of the clinical and support contracts it has with private (and third sector) providers their value how long they are for and what they are for Check their website first to ensure they havenrsquot already published a complete list (some have and all will have to by April 2016)

If you want to submit this (or any other question) as a lsquoFreedom of Informationrsquo request simply state on the letter lsquoplease treat this as a Freedom of Information requestrsquo) and send it to their FOI officer (all CCGs and other public organisations have one) Itrsquos a good idea to do this if you want to ensure you get a full response within a month

Keep FOI requests simple ndash just a few straightforward questions or a list of particular types of documents you want They can be refused if it would take more than a few days to collect the information You can send FOI requests to any public organisation (including all parts of the NHS) asking about any aspect of their work including dealings with private companies (not just contracts but meetings correspondence etc) ndash but do not send it directly to the private company theyrsquore under no obligation to answer you

Be aware that if you ask for a lot of details about contractual terms and the like you may well be refused some of the information on the grounds of lsquocommercial confidentialityrsquo You can appeal this but itrsquos wise to seek advice ndash see wwwcfoiorguk

Going further -

To get a complete list you will need to ask local hospitals (who may sub-contract services like scans as well as cleaning and catering and may even pay companies for private beds) and NHS England who may commission both GPs and specialist services for your area

Also make sure you ask the CCG to give you details of contracts it holds not just directly but jointly or through other parties (for example if it has clustered with other CCGs for a particular service that covers a wide area like ambulances)

Take a closer look ndash is there another company logo on your local NHS premises letters and vehicles perhaps alongside the NHS logo (Note ndash this isnrsquot failsafe some companies hide their own logo altogether just using the NHS one)

How to find out which private companies already operate in your local NHS

www38degreesorguk

Encourage people to give their personal experience of care

Before you go down this route itrsquos a good idea to get a list of what services are already privatised publicise that and focus your efforts particularly on those services

People may simply not realise that some of the problems they encounter with the NHS are due to privatisation either directly (because the service has in fact been privatised) or indirectly (because the NHS is losing money on administering privatisation and having private companies cherry pick the more lucrative bits)

As well as telling you about problems encourage people them to complain at the time as well particularly if their GP referred them for surgery or other treatment and they were not offered an NHS option (or were heavily steered towards a private sector option)

Ask the local HealthWatch if you can get involved and help conduct on-site inspections Frankly neither the CCGs nor the CQC have been given resources to properly monitor the service delivered by private contractors on the ground ndash so itrsquos important for activists to do so

How to find out which private companies already operate in your local NHS

www38degreesorguk

Encourage people to give their personal experience of care

Before you go down this route itrsquos a good idea to get a list of what services are already privatised publicise that and focus your efforts particularly on those services

People may simply not realise that some of the problems they encounter with the NHS are due to privatisation either directly (because the service has in fact been privatised) or indirectly (because the NHS is losing money on administering privatisation and having private companies cherry pick the more lucrative bits)

As well as telling you about problems encourage people them to complain at the time as well particularly if their GP referred them for surgery or other treatment and they were not offered an NHS option (or were heavily steered towards a private sector option)

Ask the local HealthWatch if you can get involved and help conduct on-site inspections Frankly neither the CCGs nor the CQC have been given resources to properly monitor the service delivered by private contractors on the ground ndash so itrsquos important for activists to do so

How to find out which private companies already operate in your local NHS

www38degreesorguk