The biggest issue facing the NHS is the money and the workforce, and going into that mix, we have these wholly-owned companies. They are a wheeze to gain income, but the consequences are deeply troubling. They drive further fragmentation of the NHS and, when collaboration should be growing, we instead see each trust going its own way.
If these changes for wholly-owned companies were driven by service improvement and the appetite of staff for change, the managers and boards of the trusts would be doing their jobs, which is to identify the need for improvement in these services and to speak to their staff about how to achieve it. However, in almost every case, the changes have been progressed in secret, with little or no staff engagement or consultation, and with no documents being made public. It is very hard to get the documents from these trusts. Worse still, we are now in an uncontrollable hiving off of NHS assets to these new companies, with no discernible safeguards to prevent the assets, or indeed the whole company, from being sold off to anyone else. They are one step away from being taken outside the NHS to any other provider.
In response to some of my written questions, I have discerned a bit of change in the Government on the NHS. I asked how many trusts have had to change the terms of their authorisation, which was a requirement in the Health and Social Care (Community Health and Standards) Act 2003, to protect the transferred assets. On 11 May, the Government said:
“There is no requirement to change the terms of authorisation when setting up a wholly owned subsidiary and therefore, the Department does not hold the information requested. If trusts hold community interest assets then these are considered public assets and cannot be sold unless subject to a Departmental/Secretary of State approval, however this is only a limited number of assets.
For other assets trusts should consider whether transactions are ‘reportable’ under the transactions guidance and therefore would be subject to a review if above the thresholds outlined.
NHS Improvement has committed to:
The proposed creation of subsidiary companies becoming a reportable transaction to NHS Improvement under the Transactions Guidance, irrespective of size; and”
NHS Improvement will be looking at “subsequent changes”.
While a tick-box exercise and oversight by NHS Improvement is welcome, that is closing the door after the horse has bolted. In answer to another question about continued onward sale, I was told that there would be restrictions where disposal would affect commissioner-requested services. The 2003 Act does not say that. Section 16 talks about NHS foundation trusts not disposing of protected property
“without the approval of the regulator”
and says that protected property is the
“property of the trust designated as protected in its authorisation.”
I think there has been a change in that period and I would like to understand why. If the Minister cannot answer that today, I am happy to write to him.
We have essentially no assurance as to how the transfer of these wholly-owned companies to any private bidder, one step on, can be stopped. How would local people ever know? How would the staff now? We cannot get any information from most of these trusts. They are not answering FOI requests and that is why this is essentially of such continued concern.
The first step to remedying this shambles would be to close the VAT loophole, which I do not have time to talk about today. Meanwhile, NHS Improvement should not be encouraging the recreation of a two-tier workforce, especially at a time of such overwhelming concern about the availability of a skilled workforce. This is ever more important with Brexit looming. NHSI is a Government body funded by the taxpayer and accountable through the Secretary of State to Parliament. That it is encouraging and permitting these deals, and doing so in secret, is a disgrace. It should not be allowed. As NHSI is subject to ministerial oversight, the Secretary of State needs to tell it to stop it.
6.29 pm