The concerns of campaigners that the proposals in the NHS White Paper to give statutory powers to “Integrated Care Systems” would lead to private companies sitting on ICS Boards have been proved justified.

Virgin Care’s local managing director Julia Clarke is already listed as a member of the Partnership Board, the unitary Board which currently runs the ICS covering Bath and North East Somerset, Swindon and Wiltshire (BSW).

But a look at the Board Papers for a meeting on May 28 reveals that the Virgin boss is not only occupying a seat, but actively intervening to protect the company’s interests. Minutes of the March meeting reported a discussion on the extent to which private sector “partners” would be required to be financially transparent towards the other providers within the ICS “for purposes of planning the independent/private sector’s NHS related or NHS commissioned work.” They noted Virgin’s reluctance to share any information with the public:

“Virgin Care were prepared to consider greater transparency where the contract with BaNES and BSW was concerned, but had reservations about sharing information in public.” (page 6)

In response to this the NHS “partners” tamely rolled over, agreeing to action by Chief Financial Officers to “further discuss how the ‘open book’ approach could be applied to private / independent providers while protecting those providers’ corporate and commercial interests” – in other words how to ensure ‘open books’ were not opened at all, and ICS contracts remain tightly guarded secrets withheld from the local public.

As this article was completed, the HSJ has revealed that BSW has been asking private providers to contribute £10,000 per year as a “voluntary” contribution towards the ICS running costs – a move questioned even by the private hospitals’ body the Independent Healthcare Providers Network, whose CEO David Hare told the HSJ it was:

“Deeply problematic on so many levels. Just one – what happens in the event of a procurement and the winner has paid and a loser hasn’t. Inducement? Reminder to me that lots more work is needed on ICS governance.”

Nor is it reassuring to find that the Palliative and End of Life Oversight Group includes no less than TWO Virgin nominees, alongside two representatives of Medvivo, the private company supplying out of hours GP services and urgent care, which is also to be brought on to the ICS Partnership Board.

The ICS leaders’ eagerness to embrace private providers can also be seen on page 29 under Transformation Priorities for BSW, which includes “maximise use of independent sector, working in partnership to target capacity at longest waiters in system”.

The White Paper leaves room for private companies to be incorporated into ICS Partnership Boards, but also into the main decision-making NHS Boards. Indeed the BSW Minutes from March enthusiastically noted that: “the lack of detail in the White Paper re governance arrangements at system and place levels indicated a level of freedom of design which should be exploited.”

If the vague proposals wind up entrenching private companies on decision-making boards while excluding any representation for the public or NHS staff, it’s clear that even meeting in public (as BSW does) would not ensure transparency or accountability.

* Meanwhile the National Union of Journalists at its online conference on May 21-22 has become the first TUC union to warn that ICSs represent a ‘double threat to accountability’ and call for any statutory ICS bodies to exclude private sector organisations and be compelled to meet in public and publish board papers. The NUJ motion also opposes plans to scrap long-standing powers of local government to block controversial changes and refer them to the Secretary of State and the Independent Reconfiguration Panel, and call for councils’ scrutiny powers to be retained at the most local level.

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