Wednesday, December 18, 2013

NHS and transparency

A few months ago File on 4 put out something on NHS, privatisation and commercial confidentiality. I was all set to hear lots about FOI (which seems to be the main conduit for getting this information out of NHS organisations on what has been privatised). I was looking to hear about how the whole thing rests on a public interest test. I wanted an examination of how these public interest tests are carried out and how sure they are.

I was disappointed.

So, here are some stats from the ICO website when you look at decision notices:

s43 (all sectors):

complaints not upheld: 175 DNs
complaints partially upheld: 104 DNs
complaints upheld: 279 DNs

s43 (all healthcare bodies):

complaints not upheld: 14 DNs
complaints partially upheld: 6 DNs
complaints upheld: 15 DNs

This means, in general, if you complain to the ICO, you have nearly a 70 per cent chance of getting more info from the public authority.

If you complain about a healthcare organisation, you have a 60 per cent chance of getting more info from the organisation (the NHS sample is tiny, considering how many such organisations exist, so I am less comfortable with this calculation).

That there are only 35 DNs related to healthcare is shocking. Why the hell aren't people complaining when they get silly answers?

It is easier if I slag off now defunct public authorities. Look at: The refusal is genius:

"We believe that by releasing this information, it is likely to affect the
viability of dental practices and impact on the ability to effectively
provide dental treatment to NHS patients in Westminster. This information
is therefore exempt under s. 40 (2) and (3a), Personal Information and
s.43, Commercial Interests, of the Freedom of Information Act."

Awesome - somehow, dental practices (which are companies) suddenly have personal data - and there is that ridiculous argument - ability to provide services is somehow the basis of something being personal data. Then there is the s43, without any idea as whether it is 43(1) or 43(2) - probably the latter. There is no public interest test. There is no description of how this harm will take place. And, as far as WDTK is concerned, there is no record of a complaint.

That does not mean that commissioning is done with bad intentions.

I will now digress into a political nuance before coming back to the point - feel free to skip this para if you are only interested in FOI. Andrew Lansley is universally acknowledged as a bad communicator. That is probably why he was moved out of health and demoted to Leader of the House. But one message that even he managed to get across about his Health and Social Care Act HSCA) (which actually went through because of Earl Howe's extraordinary abilities in the Lords, which is where any real objections to the Act might have borne fruit, not withstanding Shirley Williams'  disgraceful betrayal of decades of decent public service by supporting the Bill), was that the new clinical commissioning groups (CCGs) would mean that medical practitioners would once again be in charge of commissioning healthcare. He actually managed to convince people of this fact. But, working for a series of Primary Care Trusts (which used to do the health commissioning before CCGs were formed on 1 April 2013), I quickly discovered that, aside from the finance staff, IT and comms, almost all of the people working in core healthcare commissioning teams were ex doctors or nurses. Indeed, I had an outstanding colleague who was paid 5 days a week as a senior manager and who worked several days a month (for far less money) as a nurse. Commissioning was not perfect, but by God, it was done by people who understood the needs of the frontline staff and the community.

Back to FOI: Although commissioning is not done with bad intentions (although, I now think that it is worse than before in the CCGs), there is little transparency about it. There may well be a cry about how so much is farmed out to private companies like Virgin and how there needs to be a change in the law to make them subject to FOI. I have banged on about this before, but I will say it again: the standard NHS contract means that if you send a FOI to Virgin Healthcare about its service in Surrey (worth about £500million), it is CONTRACTUALLY OBLIGED to forward the request onto the service commissioner (one of the Surrey CCGs) to handle. The contract then says that the provider (Virgin in this example) MUST HAND OVER ITS INFORMATION TO THE COMMISSIONER TO ENABLE THE FOI TO BE ANSWERED.

Does this happen, dear armchair auditor?

So, in summary, we are not making enough requests to the NHS, often the NHS is giving out rubbish replies (although probably no more often than other sectors) and people so not seem to access the information on private companies that they can clearly get.

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