News of a sort emerged last week that the Iranian Hospitalier’s circle of shadowy investors are to receive an annual bung for stitching up Hinchingbrooke Hospital. The first £2 million of any surplus will be top-sliced, and wired to Jersey, or perhaps some other island where the sun shines a lot. The sweetener came to light after the Health Service Journal unearthed a letter deposited in the House of Commons Library last November by Lord Howe. In it, Howe writes: ‘Under the contract with Circle at Hinchingbrooke NHS Trust, the first £2 million of any year’s surplus will go to the Franchisee, Circle, as it must cover its costs and earn a fee [emphasis added]’. Howe may call it a fee, but to Dr No it looks uncommonly like a kick-back. No wonder the thinking epidemiologist’s crumpet, Professor Allyson Pollock, is scandalised.
Previous attempts by Professor Pollock to gain further details of the contract have hit the brick wall of Section 43 of the Freedom of Information Act, which grants exemption from disclosure when the disclosure ‘would, or would be likely to, prejudice the commercial interests of any person (including the public authority holding it)’. The government noted the need to balance openness against commercial interests – but still refused full disclosure of the Hinchingbrooke contract details, opining that ‘there is also a strong case for non-disclosure as we believe that release would be likely to prejudice the commercial interests of the NHS and/or Circle’. Business interests can now, it appears, trump transparency and accountability in the provision of public services. Professor Pollock is right to be scandalised.
Yet all this is predictable. Over a year ago, Dr No referred to the Secret Nail in the NHS Coffin. The nail was the abolition of the Secretary of State for Health’s direct and personal responsibility for the provision of health services. Dr No suspected that this change – seen by many at the time as neither here not there, even obscure – was crucial to the Tory scheme to shred the NHS. By disconnecting the captain of the ship from the vessel nominally but now no longer actually under his command, the Health and Social Care Act has severed the highest link of responsibility and accountability; and, inevitably, this severance has caused a miasma of deflection of responsibility and denial of accountability to seep down through the organisation.
Hinchingbrooke Hospital’s brick and mortar haven’t been sold off, but a public contract for the provision of its services has been granted to a private franchisee. Such a state of affairs most definitely lies more on the private side of the road – a state of affairs we might consider in need of the utmost openness and accountability. Yet we now learn that key contract details are to be kept hidden behind a Cupressus leylandii hedge of commercial sensitivity. Dr No fears we will see a lot more deflection of responsibility and denial of accountability as ever more contracts are granted to all those so very willing cowboys now waiting in the woods, biding their time to ride out on to the prairies of the NHS.