A growing list of NHS leaders have joined Matt Hancock, the Secretary of State for Health and Social Care, as components in the lobbying scandal that has engulfed the government over the past few weeks.
David Cameron, Lex Greensill, the founder of Greensill, and colleagues, lobbied Matt Hancock to adopt Greensill’s Earnd app, which would have allowed doctors, nurses and other personnel to be paid daily rather than monthly. The lobbying was successful and a contract was subsequently awarded without tender or an open process within the NHS.
The Sunday Times and various other media have revealed that David Cameron organised meetings between Lex Greensill and various top people in the NHS, including Mr Cameron bringing Greensill to a “private drink” with Matt Hancock in October 2019.
The Conservative peer, David Prior, chair of NHS England, a former Tory MP, health minister and Tory party deputy chair, also played a role in the lobbying for Greensill, organising a meeting between Lex Greensill, his colleague Bill Crothers, an ex-head of government procurement under Cameron, and Julian Kelly, NHS England’s chief financial officer, in July 2019. Sir Simon Stevens, NHS England CEO, was also reported to be at this meeting albeit for only around 15 minutes.
Lord Prior also helped to facilitate a meeting at which Lex Greensill was able to lobby Dido Harding, the Tory peer previously in charge of test & trace and now chair of NHS Improvement, the health service’s financial regulator.
Following the lobbying, Greensill launched a partnership with NHS Shared Business Services, jointly run by DHBSC, allowing up to 400,000 NHS staff to be paid daily. However, eventually only 450 staff were reported to have used the app and both Greensill and Earnd went into administration in March 2021.
The Times has also reported that David Cameron is facing new questions about whether he lobbied on behalf of the American healthcare company, Ilumina, for which he acts as a paid adviser. Ilumina was awarded a £123 million contract with the Department of Health, a week after Cameron appeared with Matt Hancock, at a genomics conference in September 2019. Both Cameron and Ilumina have denied any lobbying took place.
No safeguards
The awarding of the contract for the Earnd app to Greensill took place before the pandemic hit, when contracts had to be put out to competitive tendering in what was considered to be an open and transparent process. Yet, despite this Greensill was awarded the contract without any competitive tender process.
The pandemic led the government to put in place emergency regulations for contracts, which meant no open competitive tendering process. And over the past 13 months the government has awarded contracts worth around £20 billion without any competition.
It is now clear that billions of pounds worth of contracts were handed to companies with links to Conservative donors. This was highlighted back in November 2020, by the National Audit Office (NAO), which questioned the use of the emergency regulations citing a loss of public trust due to the lack of transparency and the use of the VIP channel as it was known, which gave companies with contacts in government, the lords, and the Conservative party a much greater chance of being awarded contracts.
Legal action is now underway by The Good Law Project over what it has described as “pork barrel” politics, a term from the US to refer to the act of exchanging favors to constituents or business persons for their political support such as re-election or campaign support.
Change ahead?
The government has made clear in the February 2021 white paper, however, that things will be changing in the area of contract awards in the NHS. It has plans to remove the much criticised competition rules, which allow commercial companies to bid for a vast array of NHS contracts and were a keystone of the Tory health reforms of 2012.
The tendering process proved wasteful and undermined NHS supply, but what will replace the current system? NHS England is consulting on a new system which provides “more flexible arrangements that better support the NHS ambition for greater integration and collaboration between NHS organisations and their partners, while reducing administrative bureaucracy”.
But does this mean less outsourcing and what happens to existing contracts? Less seems outsourcing is improbable, certainly in the short term, as the government shows no sign of fully protecting NHS services from privatisation, or putting in place a plan to raise NHS capacity so that it can handle demand and take back in-house the hundreds of contracts now in private hands.
The new NHS Whitepaper whilst planning to remove enforced competition leaves in place the market roles of provider and commissioner, and a number of healthcare firms actively expanding their interest through NHS contracts, undeterred by the approaching changes in the competition rules. It seems therefore that privatisation sits as a threat to a sustainable NHS.
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