ONE of the things about NHS privatisation is that it is deliberately really complicated.

Sometimes the government just hands over bits of the publicly owned NHS to private firms.

This always causes uproar. So it also creates very complicated structures that ultimately force privatisation, but it does it in such a complicated, jargony way, with lots of reorganisations and internal markets and the like, that it hopes no-one notices.

This story has a bit of that. So I’ll do the simple bit first.

The Tories put Simon Stevens in charge of NHS England, which runs the NHS and pushes privatisation.
Stevens previously worked for a US private health corporation called UnitedHealth. Before that he worked for Tony Blair, helping privatise the NHS.

Stevens’s NHS England has handed over a new, big NHS contract to his old firm, UnitedHealth.

Simultaneously UnitedHealth is being prosecuted by the US Department of Justice for cheating the limited US public health service out of cash — by deliberately putting non-dying people in hospices, because they are more profitable than dying people.

Now for the complicated details. NHS England has handed over contracts to private firms to act as “buyers” for the NHS. It’s called the Commissioner Support Lead Provider Framework.

First, health secretary Andrew Lansley broke up the NHS into lots of individual “commissioners” each buying NHS services.

Instead of one arm of the NHS helping out the other, each small part of the NHS will buy in operations and care and procedures separately.

This is supposed to create more “efficiency” through a “market,” but in reality it means private companies can sell procedures to the NHS.

It also creates huge transaction costs — the cost of managers buying and managing all the new private services.

Then in an extra twist, the actual job of being a “purchaser” for the new, fragmented, marketised NHS will actually go to private companies.

Stevens’s NHS England has “approved” a list of companies that can be hired by different bits of the NHS to help it buy stuff.

Handing NHS purchasing to private companies is both a privatisation in itself and drives further privatisation.

The companies in the “framework” will be more likely to buy in more private services than the old NHS managers they replace.

The companies on Stevens’s “provider framework” include Mouchel (a company best known for maintaining motorways), Capita (a firm often called Crapita for its history of privatisation failures) and a company called Optum.

They all will get an as yet unspecified share of a contract worth from £3 billion to 5bn.

Optum is actually a brand name for UnitedHealth, Stevens’s old employer. It is also being prosecuted for fraud.

Optum runs hospice services in Colorado, supposedly for terminally ill patients.

Last August the United States Department of Justice backed a lawsuit against Optum launched by two whistleblowers who accused the firm of defrauding public funds.

The two, both nurses who had risen to management positions with Optum, said the firm had, in the words of the lawsuit, “defrauded the United States through the submission, or causing the submission of false or fraudulent claims to Medicare for ineligible hospice patients and/or by their failure to report past overpayments for ineligible patients and to reimburse Medicare for these overpayments.”

Optum was filling hospices with patients who were not dying because they were cheaper to look after so the firm could make more cash from the US’s very limited public health system, Medicare.

Optum “targeted for admission ineligible elderly patients with conditions like debility, dementia, Alzheimer’s and cardiac or pulmonary irregularities that, while serious, were not likely to lead to the death of the patient within six months, thus allowing the defendants to keep these types of patients on their hospice census for more than six months, if not several years.”

The lawsuit says Optum did this with a system of bullying and reward.

It “created an incentive for staff to admit and retain ineligible patients” by hiring “inexperienced staff” who did not understand what made patients eligible for hospice care.

Instead of proper training they were offered “monetary bonuses” to keep patient numbers up.
Optum also “threatened staff with reductions in hours or terminations” if patient numbers on its “census” went down.

This included a monthly scorecard and “a monthly berating from his or her superiors if the census goals were not met.”

The firm undermined doctors’ judgements and “pressured or caused salaried and contracted physicians to improperly certify and recertify ineligible patients and/or to fail to live discharge ineligible patients.”

Nearly half its 1,200 hospice patients lived for over six months. Optum denies the charges, but its parent, UnitedHealth, has a history of fraud.

Back in 2002, when the firm started muscling in on the NHS, I examined its record for the Observer, and found a string of cases where UnitedHealth was fined in the US after charges it had cheated on bills presented to Medicare.
Looking over the preceding two years, I identified over $7 million of fines for corporate misbehaviour.

Then in 2004 United Healthcare agreed to pay $3.5m to the US Department of Justice to settle allegations of fraud on Medicare.

So a firm being prosecuted for cheating on healthcare, with a history of multimillion-dollar fines for cheating on healthcare is being put in charge of our NHS.

Last week I described how John McTernan, newly appointed chief of staff to Labour’s Scottish leader Jim Murphy, went to the last Conservative conference to tell Tories how much he admired Margaret Thatcher and privatisation.

I’ve had some further thoughts of Comrade McTernan — previously an aide to Tony Blair  — brought to my attention.

In August 2014 McTernan wrote a column for the Times which opens: “Privatisation: what is it good for? Everything.

That’s what I feel like shouting at the TV and radio when I hear Andy Burnham, the shadow health secretary, pontificating about the supposedly dire effects of competition in the NHS.”

The article is a complete argument for NHS privatisation. McTernan says Burnham “is fighting the wrong battle.”

Labour’s top Scottish official says: “It is hard to find any coherence in Labour opposition to private contracts.”

McTernan thinks that cuts and privatisation will fix everything.

He wrote: “Labour is committed to £20 billion of cuts if elected. The NHS needs the savings that privatisation creates.”

McTernan presumably still holds these views. Scottish Labour seems to hold an urge to destroy itself.

Follow Solomon Hughes on Twitter @SolHughesWriter.