As the Guardian reports this morning:
A private company, listed on the stock market, has been given the right to deliver a full range of hospital services for the first time in the history of the NHS, reigniting a debate about the use of business in the health sector.
Circle Healthcare, a John Lewis-style partnership valued at around £120m, will manage the debt-laden Hinchingbrooke hospital in Huntingdon, Cambridgeshire, from February after the government signed off on a decade-long contract on Wednesday.
But as the Bureau of Investigative Journalism reported in May:
[Circle's] accounts reveal a structure of fiendish complexity, with 49.9% of Circle’s shares held in the British Virgin Islands, and the remaining 50.1% in Jersey, although Circle says the Jersey arm “has recently been re-domiciled as a UK tax resident company”. The Jersey company’s accounts include six pages of related-party transactions.
UK tax resident does not mean UK incorporated, by the way.
As the Guardian also noted today:
However, Circle is viewed by ministers as a model "mutual" with 49% of its ownership in staff hands. It operates a scheme to allow more shares to be gained through a performance-related rewards system.
Well that may be a Tory view, but first of all this is not a mutual: it is 50.1% controlled by a private for profit company.
Second that 'mutual' bit is in the unaccountable, zero tax, regulation lite, British Virgin Islands where candidly anything can (and does) happen. Hardly 'John Lewis like', I suggest.
And third, I don't want staff in any hospital managing for profit. That means they do three things:
a) Cut corners where there is no cash incentive applied to doing things. Care does not have cash incentives attached, nor do many services for the elderly, for example. It's why we end up with consultants prescribing food and water which is otherwise not delivered;
b) Undertake too many procedures where there is a tariff payment - because this is how the hospital makes money - so look for an increase in operations in Huntingdon very soon;
c) Turns away cases where there is uncertainty and what is medically called 'multiple comorbidity' - or in other words the person is really sick, no one knows what is going on and it's not clear what needs to be done so no payment is likely to be generated but sure as heck the person needs looking after.
That's what will happen here.
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