Calderdale NHS Commissioning Plan

While Calderdale Clinical Commissioning Group does not officially come into being until 1 April 2013, the “Shadow” CCG has published a 2012-13 Commissioning Plan. A copy of this can be downloaded from this page

Calderdale Save Our Services fears that the NHS will become fragmented as key public services are privatised. The following extracts from the 2012-13 Commissioning Plan show that Private providers have a substantial role in Calderdale CCG’s plans (Our emphasis):


“What are Our Plans …

“(g) We have worked with our other main providers

“… All NHS contract trading positions are reviewed at our internal Contract Management Group.

“We take a pragmatic, risk-based approach to aligning contracting capacity and clinical leadership with the range of providers with whom we have contracts. In addition to the large NHS providers, we also have close working relationships with providers in the independent sector – particularly BMI and Spire …” (p. 37)


“Collaborative Arrangements …

“(g)  Working with and strengthening the local ‘market’

“As a CCG we are committed to ensuring that local people are able to make choices about where they access care – from a range of qualified and high quality providers.  We have access to broad range of local intelligence which tells us about the services and standards that the public  require  from  the services we will be commissioning and we will use this to make sure that we focus on areas which are important locally.  We are working on a number of areas to improve this choice:

  • Working with NHS, the independent sector and primary care providers to strengthen access and improve quality for example; CCG clinical leaders on Contract Management Boards for both CHFT (Calderdale and Huddersfield Foundation Trust) and SWYPFT (South West Yorkshire Partnership Foundation Trust), and Quality Boards for both CHFT and SWYPFT …
  • Building on the ‘market place’ event for third sector providers, held in the summer, where organisations  promoted their services and met the CCG Board, we will be rolling out further initiatives over the next year.  Work with third sector will be further strengthened as part of the development of the Communications and Engagement Strategy which will be published in April 2012 …” (p. 57-58)

There are several reasons why we should worry about companies such as BMI and Spire taking over NHS services:

  • Excessive payments during the lobbying process – for example, the Morning Star reported in early 2010 that former Labour Secretary of State for Health Patricia Hewitt was paid £500 an hour as a senior adviser to investment firm Cinven. Cinven bought all of BUPA’s private hospitals and its hospital company Spire Healthcare had already siphoned off NHS treatments such as obesity in Yorkshire along with knee and hip replacements in the Midlands.
  • Cherry picking profitable work leaving what’s left of the NHS to carry out the remainder – an article in Health Service Journal in February 2009 analysed the inter-relationship between the NHS and private healthcare providers. Where the NHS books private sector treatments for patients, this work is usually priced according to a NHS defined tariff. This tariff is less financially attractive for private firms than other types of work.
    “Many are only interested in taking it on when they have spare capacity. Most will be choosy about what procedures they offer at tariff. Nuffield Health medical director Andrew Jones says: ‘It is just technically not possible to do an anterior cruciate ligament at tariff price.’ BMI Healthcare also says the full cost of delivery is not reflected in the tariff.
    “Spire Healthcare has seen its volume of NHS work rise to more than 40,000 procedures a year, around 15% of its income. But commercial director Richard Jones insists this NHS funded work is supplementary to its main income from private work. The company is ‘perfectly capable’ of doing some work at tariff, but it depends on its nature and timing. ‘We are selective in what we do… we would not do some specialties at tariff.’ ”

  • High costs and risk involved in commissioning. – Open Democracy 31 May 2012 reported that General Healthcare Group (the largest private hospital group in the UK through its ownership of BMI Healthcare) is, according to the Finanical Times, “teetering on the brink” again due to the huge debt load incurred when it was taken over by a consortium of investors in 2006.

    Spire is looking to sell, and then lease back, a third of its hospitals to reduce its debt as parent company Cinven looks for a major payday by floating the company on the stock market.

    “The government talks about the NHS’s lack of efficiency and the need to make money go further. But with companies like Spire involved, money is disappearing to satisfy the demands of financiers. Add on the profits and dividends that go to owners and shareholders, and that’s a huge amount of money gone that could have been spent on public healthcare.”

  • Tax avoidance records of these companies – Also according to Open Democracy 31 May 2012,
    “Spire’s taxable UK profits are used to pay interest on a loan it has taken from a Luxembourg-based subsidiary of Cinven, its private equity owner. The money then goes from Luxembourg back to Cinven as dividends. Spire’s 2011 accounts show this scam has only increased in size, with £72m going straight to Cinven, compared to £64m the previous year, wiping out its UK tax bill.

    “It is not just tax avoidance that is draining UK healthcare. Spire’s accounts also show it is paying 8% interest on the £1.2bn debt Cinven has taken out to finance the business. So £100m goes straight to the banks that loaned the money.”

  • Pressure on patients to go private – according to Pulse in December 2011, patients are increasingly being driven to pay for private healthcare because of tough restrictions being placed on GP referrals and cuts in the availability of some procedures on the NHS.

    Major private healthcare companies reported a surge in the number of ‘self-pay’ procedures, as patients who do not have medical insurance choose to go private to avoid blocks placed on GP referrals.

    Spire Healthcare, which runs 37 private hospitals across the UK, saw a 10% year-on-year increase in the number of self-pay ‘clinically necessary procedures’ it carried out in October.

    BMI Healthcare said it has seen a ‘continued and steady’ increase in the number of self-pay procedures.

    Dr Clare Gerada, Royal College of General Practitioners chair, warned there was a risk patients would increasingly see the NHS as providing ‘sub-optimum’ healthcare: ‘GPs are being restricted in what and who they can refer, you have referral management systems putting barriers between the GP, patient and specialist, a limited budget for commissioning and the squeeze in hospitals. If people want to go privately that’s fine, but I don’t want a health service that is sub-optimum compared with what you can get privately.’


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