The trick is invisible privatisation. In 2011, Tory advisor Mark Britnell told the equity firm Apax that the NHS will no longer be “a state deliverer.” A year later, the Tory-Liberal government’s Health and Social Care Act led to what the BMJ calls “a big increase in the number of contracts being awarded to private firms.” Spending on private providers leapt from 2.8 percent in 2007 to 7.3 by 2017.
Both foreign and domestic asset firms are getting in on the action.
Asset companies and revolving doors
Asset firms invest other companies’ current assets: cash, debt securities, deposit treasury bills, and liquid equities. Collectively, they manage $22 trillion worldwide. The biggest include US firms BlackRock (managing $6.8 trillion), the Vanguard Group ($5.6tr), and JPMorgan Chase ($1.9tr). British companies providing asset management services include Aviva (managing £289bn), Legal & General (£1tr), and Royal London (£117bn).
A revolving door system means that some NHS executives bring their experience to asset firms and vice versa. Royal London’s Independent Non-Executive Director, Ian Dilks, is also Chair of NHS Resolution. Kevin Ayles, head of Human Resources at Record Currency Management ($64bn), used to work at Ashford and St. Peter’s NHS Trust. The Man Group’s (£1bn) portfolio manager, Jean-Robin Peters, was appointed to the Oak Cancer Care Appeal; a £70m campaign for a global treatment and research centre at Royal Marsden NHS Foundation Trust, Brompton.
These cases illustrate the use of charities and publicly-funded R&D as potential profits for companies and investors.
Charities and hi-tech: “The patient as consumer”
Thanks to the privatisation of charity via “social impact bonds”, asset firms “partner with” (read: invest in) voluntary groups that provide services to underfunded NHS sectors. For instance, Legal & General (L&G) “provided funding” to the advice charity Legacare, which works with the NHS and Macmillan to help terminally ill people. L&G also invested in the Royal Voluntary Service charity, whose Homes from Hospitals scheme reduced readmissions for the elderly by 80 percent.
Facing budget cuts and increased waiting times, people increasingly rely on health advice online. The charity www.healthtalk.org states: “We are delighted to be working with … [L&G] to raise awareness [of our campaign].” L&G along with Accelerated Digital Adventures also invested £8.5m in the carer-matching website Care Sourcer, which describes itself as seeking to save NHS England from the so-called bed-blocking crisis; i.e., patients staying in hospitals longer than supposedly necessary. “Care Sourcer can be used by private individuals, GPs, social workers, or anyone else who needs to find care for an older person.” Instead of funding social care, the Tories rely on these and other companies.
The nexus between hi-tech, cutbacks, and privatisation is deepening. Newton Investment Management oversees £27.3bn for its trillion-dollar parent, BNY Mellon. It describes the use of the tax-avoiding firm Uber by the company Cera as “help[ing] NHS patients receive timely care at home.” It also describes the partnership between the tax avoiding Amazon and the US firm HealthTap as “the gradual consumerisation of health care.” Royal London acquired holdings in Medica, “which supplies teleradiology services to the NHS” as part of its overall private rented sector portfolio. Newton Investment Management notes the “growing awareness” among companies “of the patient as a consumer.”
Drug companies and private insurance
After the Tories created quasi-privatised NHS Trusts in the 1990s, drug companies saw an opportunity to profit. For instance, GlaxoSmithKline (GSK) is working with the Frimley NHS Foundation Trust to learn about asthma in children as research for future drugs. The Financial Times says that NHS Trusts in the North of England have been used as “a template for radical changes, both in how patients are treated and how quickly new drugs are adopted by cash-strapped health providers.” In one experiment, GSK invested £80m in real-time, real-world clinical research into respiratory diseases. Other companies piloting the scheme include the Anglo-Swedish firm, AstraZeneca.
The US asset giant BlackRock has holdings in both AstraZeneca and GSK. Via its iShares World Health Care Index, it also owns part of Bristol-Myers Squibb, which is working with the Velindre NHS Trust to learn about cancer. BlackRock has a stake in the British firm Prudential, which sells NHS insurance: “In addition to your NHS pension scheme, Additional Voluntary Contributions (AVCs) could … help your retirement pot go further.” Restructuring sick pay insurance is another method of privatisation. Legal & General sells Income Protection Benefits to NHS doctors, nurses, and surgeons.
Hospitals and retirement villages: “Healthcare assets”
Under the Tories, the private company Primary Health Properties (PHP) bought and built land for 306 clinical practices, particularly GP surgeries. By 2017, PHP was sitting on £1.3bn-worth of property assets. PHP stated that the NHS is “looking to move services away from hospitals into local community based primary care accommodation. There GPs can … develop new models of care that will generate cost efficiencies.”
The asset and insurance giant Aviva refinanced a £75m facility so that PHP could build 31 medical centres by 2028 (Boris Johnson’s “40 new hospitals,” anyone?). Harry Hyman, managing director of PHP, praised: “the acquisition of well-priced, modern primary healthcare assets.”
Inspired Villages are retirement or “Later Living” properties designed to maximise pensioners’ health via community-based living, onsite chefs, and resident carers. The villages are a subtle way of de-funding NHS services by providing care at home; if you can afford to live there. Legal & General bought Renaissance Villages for £51m with the aim of integrating it into their Inspired Villages portfolio of 700 homes. L&G’s CEO Nigel Wilson said: “Later Living offers industrial scale reductions in health and care costs to the elderly through prevention and avoidance.”
Stopping the selloff
Labour published leaked US-UK trade negotiation documents concerning the NHS, which mainstream media instantly dismissed as a “distraction,” “no smoking gun,” and even part of a Russian disinformation operation.
Once the Tories had won their huge majority in the general election, meaning that no one can stop them, US interests in the NHS could be freely acknowledged. Confederation of British Industry chief, Carolyn Fairbairn, recently said: American negotiators “don’t really understand why we care so much about the NHS.” Fairbairn’s remarks followed reports that nurses will soon be trained to perform “minor” surgery on patients in the absence of traditional surgeons. Royal College of Surgeon training for nurses was recently piloted at NHS England Trusts.
With a new leader soon to be elected, the opposition Labour Party has an opportunity to expose Tory stealth privatisation and design policies to reverse the cuts and subtle forms of financialisation, like asset companies profiting from retirement homes and US investors making money from British drug companies trialling their products on NHS patients.