Friday 5 July 2013

Harmoni and the perils of out of hours services privatisation

Guest post by Patrick Vernon - first published on Cooperative Party website LINK

The Secretary of State for Health, Jeremy Hunt MP recently called on GPs to take on more responsibility for home visits and out of hours care. However, Clare Gerada, Chair of Royal College of General Practitioners, in response reminded the Minister of the current crisis in A&E services is linked deprivation of areas where primary care services are under invested and the recent NHS reforms. 

Dr Mark Reynolds, Chair of Urgent Health UK which represents 15 urgent care and out of hours co-operatives in the UK defended the important role of his members where they deal with over 90% of callers which are managed within the community than people going to hospitals. The debate on the future of Out of Hours (OOH) and it relationship with A&E services highlight some of the challenges facing the cooperative movement in running health services under the aegis of any qualified provider and the use of EU procurement rules.

Since the creation of the NHS in 1948 we have witnessed increased life expectancy especially over the last 30 years along with changing life styles and consumption. This has put extra pressure on the demand for healthcare and social services particularly in areas of long term conditions such Diabetes, Cancer, and Stroke. We also have an ageing population with increasing health issues around Dementia and Alzheimer.

These pressures along with lobbying by private providers and big national charities have seduced successive governments to remove the mantra of the NHS being a preferred to provider to the growing privatisation of health care. The best example of the marketisation has been in the whole area of Out of Hours services. Since 2004 with GPs opting out of this responsibility which was subsequently transferred PCTs and now CCGs. 

This has led to the stampede by range of private providers and the growing demise of GP co-operatives. 

This sector is often the Cinderella area of the NHS which has been historically under invested and not valued (the only exception was the creation of NHS Direct) with junior and inexperienced commissioners employed to deal with basically our 4th emergency service which deals with over 8 million calls a year. Yes, you can ask any parent when their baby has a high fever 3 am in the morning to see the importance of this service!

I  have witnessed this myself when I was a  lay committee member between 2007 to 2010 of Camidoc a GP led social enterprise meeting the needs of 1 million Londoners covering  City and Hackney, Camden, Islington and Haringey.  I lead on patient and community engagement and helped to organise listening events involving local MPs such as Jeremy Corbyn, Meg Hiller, Frank Dobson, and Lynne Featherstone along with patients groups and clinicians to make the case that a GP led social enterprise run by local doctors with local knowledge was better than a private provider with no roots in the community. Any profits made by Camidoc went either back in the local health economy or reinvested back in to services. However, Camidoc services were put out to tender in 2009 by a cluster of PCTs leading to a protracted period of procurement creating uncertainty to staff, GPs, patient groups and our cash flow.

However after about 14 months we won the contact but were forced by the North London PCTs for the contract to reprovided by the private health care provider Harmoni as we ran out of money and lost confidence with our commissioners despite the fact that four of us were appointed as non-clinicians to the committee with a range of skills and experiences around corporate governance, human resources, finance, working with local government and patient /public engagement

Although nearly all staff was TUPE over to Harmoni and within 12 months the majority were made redundant.  A number of local GPs stopping working for Harmoni due to their working practice and ethics. Sadly for patients this has resulted in unfilled shifts and Harmoni not keeping to their contractual obligations. The company also similar problems where it operated in Brent, Harrow and Ealing etc. of North West London

In December 2012 Harmoni was taken over by Care UK for £48m which makes them the largest private provider of out of hour’s services in the country covering a population of 15 million people

That is why my local CCG in Hackney are fighting and taking a stand against Harmoni in  running our local GP Out of Hours Services by getting local people to sign a petition to stop the imposition by NHS England.

The sad story of Camidoc is similar to other failed social enterprises over the last 10 years in the out of hours sector. The irony of this tale is that Harmoni first started off in the Brent and Harrow as a GP social enterprise and lost its way as a private provider.

I guess this is a warning for the potential future route of CCGs and NHS England (would a future Tory government make NHS England or CCGs become private commissioning entities  similar to the sell offs of our utility providers and railways?). Also, a number of Foundation Trusts have lost their original value base and at times pay lip service to the Board of Governors whilst becoming semi led private providers and competing aggressively with full support of commissioners to become market player/leaders in the UK or now in the Middle East. 

All the research evidence points out that competition prevent and inhibit full integration of health and social care services. Also information about NHS services now becomes market sensitive leading to a defensive approach around information sharing and complaints. The Francis Report identified this culture and its impact on how patient’s complaints are not being taken seriously by hospital trusts as they fight for Premier League status or avoid being relegated to the Vauxhall Conference League.

Although there has been a number of initiatives around training and soft loans that has been developed by the Department of Health over the last several years these have not looked at the structural issues on how cooperatives can be developed and survived in an evolving predatory NHS market system. 

I believe that we need to make the NHS the preferred provider in the first instance and then consider how to established clear principles and solutions as a Party to develop cooperative approach to improve health and social care and tackle health inequalities. Without any intervention in the market place the future will look bleak for the future of the Co-operative movement and social enterprise in health as as the private sector will undercut, drive down standards and working conditions for staff which will have an impact on patient care.

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