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The Bangladeshi fire explains why Tony Blair's view of the NHS market is wrong
I am doing a Dan Hodges. But this time it is against his ideological pin-up Tony Blair, who knew the price of everything but the value of nothing. He was the future once, but now is not the time for clichés.
Tony Blair once said, ‘I don’t care who is providing my NHS services, as long as they are the most efficient’. He would, had his views been alive and relevant today, might equally have been applied to competitive tendering in the legal services sector. That sector too has also seen an ethos where profit rules; in a weird Darwinian ‘survival of the fitness’, human rights cases of massive social importance such as in housing or asylum are considered the lowest caste, compared to share acquisition of a multinational corporate. This is the attitude of anyone who would rather sell their own grandmother, than to look to a sustainable future.
“I don’t care who makes my T shirt as long as it’s the cheapest.” I would be very surprised if Primark and Matalan suffer a massive loss of trade as a result of public reaction to the collapsing sweatshop in Bangladesh. The similarity with the Texas fertiliser explosion is that there is no such thing as protection for workers by the Unions. Any country which has been trying to water down or to make workers’ rights non-existent, in the name of ‘industrial relations’, should think twice about whether they deserve to be called ‘a civilised country’. In this era of a maximum number of underemployed people with non-existent employment rights, and corporates making a killing weathering the recession, the public have to think: whose side is the government actually on?
ATOS are still achieving millions of profits, even though it is widely reported that administration of welfare benefits has caused immense mental distress as they have been do badly done; hence talk of why people cannot record their own assessment interviews as legal evidence, and the proportion of decisions made by ATOS which are overturned by the law courts on appeal. Add to that the staggering reports of people committing suicide because of their welfare benefits decisions (where it is incredibly difficult to prove causality); nonetheless, there is now a growing case of a link between mental illness and government policies of austerity in many jurisdictions.
Does it matter that the world has no morals but makes money? It does depend on your point-of-view, but will impact upon whether you feel that a leading sugary soft drinks multinational should be advising the current Obama administration on obesity. The building collapsing in Dhaka, and the subsequent fire, has brought out much disgust, which occasionally hits the mainstream media. But it all subsides again – attempts have been made to revisit history, so you will never find a clear account of the Bhopal explosion of the Union Carbide plant.
This issue of ‘corporate social responsibility’ has been advanced most prominently by Prof Michael Porter at Harvard, and emphasises that corporates living as responsible members of society is not simply a matter of marketing and PR but extremely important for society. Broadly speaking, proponents of corporate social responsibility have used four arguments to make their case: moral obligation, sustainability, license to operate, and reputation. “Reputation” is odd when applied to the current NHS, because, despite efforts by the King’s Fund and the current Tory-led government, attempts at making the NHS ‘consumerist’ have largely been overwhelmingly unsuccessful. Porter, in Harvard Business Review in October 2006, wrote: “In stigmatized (sic) industries, such as chemicals and energy, a company may instead pursue social responsibility initiatives as a form of insurance, in the hope that its reputation for social consciousness will temper public criticism in the event of a crisis. This rationale once again risks confusing public relations with social and business results.”
Legally, private limited companies have a duty for their directors to promote the ‘success’ of the company, i.e. profitability in the narrowest sense, under the Companies Act (1996). The idea of improved competition driving quality is strangled at birth by the fact that imperfect markets do nothing but encourage collusive behaviour in pricing, little choice in product, and massive profits for the shareholders. The concomitant ‘improvement’ in quality is barely noticeable. This has been the consistent outcome of all the privatisations in England, such as gas, water, electricity, and telecoms, where the consumer has suffered in an overpriced, fragmented service; Royal Mail will be next.
The Bangladeshi Fire is a human tragedy of unfathomable proportions, and is entirely driven by a consumerist culture where people appear do not care how the product arrives on the table, so long as it is there most ‘efficiently’. Of course, employment laws are there to protect the welfare of T-shirt makers, but this is what the Conservative government call ‘unnecessary red tape’ when applied in this country. The fire also poses serious questions about how we do business while Cameron pursues his ‘global race’. If Britain is not careful, it can easily outsource functions to abroad, and make as much of them as cheaply as possible. Diagnosis of dementia could be through an automated innovated server in Thailand, delivered by a multinational, with its head office in one of the Channel Islands to avoid tax maximally, to deliver healthy private equity profits. While it may not be the Unions that hold the country ‘to ransom’ any more, the power behind closed doors of private equity and bankers is not to be underestimated in the pursuit of profit.
Before going down the commodification of healthcare and the “Tony Blair dictum”, spend one moment thinking about exploding fertiliser plants in Texas or buildings collapsing in Bangladesh, as the lessons for business there could be salient for our increasingly privatised National Health Service (achieved entirely undemocratically.)
Confidentiality and disclosure: ATOS, GP extractor scheme and benefits claims
The Government has outsourced duties for awarding benefits claims to ATOS. It has also outsourced the handling of “big data” from NHS GPs to ATOS. Medicine and law maintain that safeguarding against conflicts of interests is essential for preserving integrity of the professions (for a comparative approach, see here). The Solicitors Regulation Authority (SRA) for example have produced full guidance in chapter 3 on this matter in their Code of Conduct. However, chapter 4 on confidentiality and disclosure also provide important information, particularly in relation to the mandatory requirement O 4.4 for “information barriers” to safeguard against breach of confidentiality (click on the picture to see an enlarged view).
These are currently the details of contracts awarded for the GP Extraction Service (“GPES”). ATOS are very open about their “GP Extraction Service” (details here).
Peter Oborne from the Telegraph, and many others, have warned against the portrayal of “benefit cheats” being misleading (see for example his article here, Nonetheless, professional monitoring and surveillance services, for example “George Osborne must correct his claims about benefit fraud. And his portrayal of the poor as mean-minded and cheating” Specialist private investigator firms such as Boothroyds do exist, which have some focus on benefits claimants. This has been a war waged in the popular media, for example on the BBC website and one from ITN news about a “crippled man winning a motorcycle race”:
The issue here is whether the patient has given “implied consent” for the “lawful transfer” of data from NHS to outside agencies. I have previously written about this issue under the present legislation. ATOS have previously denied that they operate any targets regarding benefits. Quoted in an article by Amelia Gentleman in the Guardian, an ATOS Healthcare spokesperson said: “It is simply and absolutely untrue that there are targets for the number of people to be assessed as fit-to-work; neither set by the Department for Work and Pensions nor Atos Healthcare. Every person we see is assessed individually with a focus on the facts of their own case.” The GMC will be mindful that their code of conduct, “Good medical practice”, cites conflicts of interest specifically in paras. 74-76:
Margaret McCartney has previously elicited from the GMC, the regulatory body for doctors, that “The first duty of all doctors is ‘to make the care of your patient your first concern’. But that is not the only duty doctors must observe. Being open and honest and acting with integrity is also an essential part of medical professionalism.” The full response is here. Indeed, the GMC make it further clear that dishonesty in writing reports cannot be justified by reference to the first duty of doctors. Further advice on disclosing information for employment, insurance and similar purposes can be found in this document.
The legal issue which is most crucial to this is whether there is a legal argument that the importance of disclosure outweighs the importance of confidentiality, and this is an issue for the professional regulatory bodies concerned governing the behaviour of all agents in the situation above. There is a good arguable case that ATOS should have effective information barriers in place. It is unlikely that patients when they have consented for their data to be held by GPs are aware that data can be so easily transferred to outside organisations. This is further complicated by the finding from Nature and Science within the last fortnight that it may be possible to identify the identity of individuals from “anonymised” data.
The response should not be one of “moral panic“, arguably. However, this is the sort of the letter that could produce a legal, regulatory and ethical nightmare:
ATOS and Frankie Boyle have the same business models: making money out of the misery of the disabled
If an entrepreneur from the Dragons Den, with the help of some pals in the City in hedge funds, wished to pile millions of capital into a disability welfare benefits suicide helpline, and wished to float it on the AIM (the London Stock Exchange part aimed for promising startups), you would have to worry about their ethics of their business plan. You might, anyway, or you might simply not care. If it started making millions of pounds through advertising from big pharma companies selling antidepressants, and then hived off its savings and tax paid at Guernsey, you might worry, or maybe not. This article is nothing to do with that, but I simply wished to introduce the notion of ‘business ethics’, a compulsory part of all MBAs courses currently here in the UK.
ATOS was awarded the contract by Labour in 2008, reportedly worth £112m annually to the IT services giant. It occupies unique strategic positioning in being the only corporate enabled by the Government to get disabled people off the benefits register: whilst not on the comedy circuit, it makes money simply at the expense of disabled people, impacting on them massive misery as widely reported. It has interestingly been reported that the controversial disability benefits contract between Paralympics sponsor Atos and the Government is too weak to ensure value for money for taxpayers, the spending watchdog has found. The National Audit Office criticised Iain Duncan Smith’s Department of Work and Pensions for setting performance targets too low, failing to adequately fine ATOS for poor performance and not properly checking the accuracy of performance data that ATOS submitted.
It should be feckless and reckless bankers who scrounged off a taxpayer bailout ultimately to avoid a total crash but also to enhance massively their personal bank balances. The “scrounger” rhetoric has nonetheless turned to the disabled. Iain Duncan Smith has decided to take on disability benefits and reform of the state pension– two issues which even Tony Blair shied away from. It is convenient to blame a tide of disability hatred on Frankie Boyle, but he did not cause disabilism, in the same way that Gordon Brown did not cause a global recession. In March 2012, the Home Office estimated that 65,000 disability hate crimes occur each year. And disability charities say it could be as high as 100,000. They have little doubt that the deteriorating situation is being driven by “benefit scrounger” abuse. The Department for Work and Pensions has been thus far accused of irresponsible rhetoric, in particular for its suggestion that three in four people claiming incapacity benefit are faking disabilities. It now estimates that only 0.3% of the incapacity benefit budget is overspent due to fraud. A DWP spokesman says it is “absolutely committed to supporting disabled people”, but he acknowledges that “we need to work together and do more to change negative attitudes”. Katharine Quarmby, author of Scapegoat: Why We Are Failing Disabled People, warns: “Unless the government decouples reducing benefits from hinting strongly that most disabled people are scroungers, then we’re going to see more attacks.”
Frankie Boyle has a ‘unique selling point’ on the comedy circuit in making disabled people feel miserable. The critical issue here is that he does not intend hate crimes or prejudice or discrimination through his jokes, but he does occupy a niche in his market with jokes such as “mong” in referring to individuals with Down’s Syndrome. It is of course deeply disturbing to people including my cousin, Sarah, with Down’s syndrome who’s about my age, in the late thirties, but with learning difficulties and a reduced life expectancy. She does not need to be exposed to this indignity (and luckily she isn’t as Frankie Boyle isn’t even relayed by cable to Dhaka, the capital City of Bangladesh). Helpfully on the Scope website, “disablism” is defined as the “discriminatory, oppressive or abusive behaviour arising from the belief that disabled people are inferior to others”. This definition has been used by Scope since 2004. This word has been used by the disability rights movement for many years. The website says that: “We have ‘racism’ and ‘sexism’; why not disablism?” As Scope says, “Unlike racism or sexism you won’t find the word disablism in the dictionary but it is all too real in our society.” This word has already been used by the think-tank Demos in its report,Disablism: how to tackle the last prejudice by Paul Miller, Sophia Parker and Sarah Gillinson (ISBN: 1 84180 124 0).
To shame ATOS further, not all corporates have decided to be so idiotic, albeit their reasons may be based on more rudimentary economics. Diageo is the leading premium spirits business in the world by volume, by net sales and by operating profit and is one of a small number of premium drinks companies that operate globally across spirits, beer and wine. Diageo indeed creates long term value for shareholders through its outstanding brands, its geographical breadth and the expertise of its people; in other words, it is highly profitable. Howeer, Diageo is committed to building a sustainable business across its value chain through its Sustainability & Responsibility’ strategy. Publicity for Diageo cites that: “The way in which Diageo promotes a positive role for alcohol in society; respects the natural resources, communities and people it relies on; and champions a culture of good governance and ethics are all important drivers of growth … Diageo seeks to be at the forefront of industry efforts to promote responsible drinking and works with other stakeholders to combat alcohol misuse.” Whether you believe or not, it would be very hard to conclude that, apart from sponsoring the Paralympics (which the vast majority of disabled citizens resent), ATOS has not promoted the value of disabled citizens in society. “We won’t be sponsors of the World Cup or the Olympics,” Diageo chief marketing officer Andy Fennell had told delegates at the Cannes Lions Festival previously. “It’s really expensive and hard to get a return.” Speaking to Marketing, he added: “Brands have to do [such sponsorships] on conviction. I’m sure some of them will get real benefit from being associated with the world’s most extraordinary sporting festival.”
For ATOS, in sponsoring the Paralympics, particularly in light of all this, this has all been extremely damaging in terms of bad PR. PR is definitely something all multinationals are petrified about (take, for example, BP after the ‘Deepwater Horizon’ fiasco). There has to be some standards, not least because corporate investors are not that stupid themselves. Would you allow the makers of thalidomide to sponsor the Paralympics? Only this morning, German-based Gruenenthal, which invented thalidomide has “insulted” those affected by the drug by issuing an “insincere” apology, according to campaigners. The drug, sold in the 1950s as a cure for morning sickness, was linked to birth defects and withdrawn in 1961. The company has issued its first apology in 50 years, but said the drug’s possible side-effects “could not be detected” before it was marketed. However, the UK’s Thalidomide Trust said any apology should also admit wrongdoing. Gruenenthal would never dare to wish to subject itself to such a farcical situation, one assumes, even in the mission of partial rehabilitation for previous corporate problems. It was not been that easy for ATOS to sponsor the Paralympics anyway. Corporations can legally become associated with the London 2012 Games in two ways: First, multinational firms may seek exclusive marketing rights through The Olympic Partner program (TOP). The other option is through agreements with the LOCOG, the local British organization. But plenty of non-sponsors will attempt to correlate their brand with the Games, which is widely known as ambush marketing—something the IOC and LOCOG take very seriously.
Frankie Boyle recently described Saudi athletes as ‘mainly thieves’ and said Britain’s best high jumper was ‘Taliban-assisted‘. Even this may have been a step too far, but will not see Frankie Boyle in the High Court (ATOS meanwhile lost recently a judicial review at the High Court in the case of work-related benefits). Over 400 protesters from Disabled People Against the Cuts and U.K. Uncut protested on Friday outside Paralympic sponsor Atos’ headquarters and the Department for Work and Pensions in London. The company, Atos, is a sponsor of the Paralympic Games and runs “fit for work” assessment tests on behalf of the U.K. government, for people on disability allowances. Protesters say that these tests are both “damaging and distressing” and have led to suicides.
Several protesters got into the DWP building and a further two in wheelchairs chained themselves to the doors, according to UK Uncut, which has been staging the protests together with Disabled People Against Cuts. “We are doing this to highlight that Atos, a sponsor for the Paralympic Games, is receiving £100 million from the Government in the hope they will assess people with disabilities and get them off benefits,” said Molly Solomons, a spokeswoman for UK Uncut. “This is due to a political and ideological choice which harms disabled and sick people, not an economic necessity.” Among those involved in the protest were Tara Flood, a former swimmer who won seven Paralympic medals, including a gold at Barcelona in 1992, who has herself recieved a letter notifying her that she will be assessed about whether she is allowed to keep her disability living allowance. The Medical Protection Society and the British Medical Association have now both demanded that the tests be halted immediately. It is believed that Atos staff are being pressured into unfairly declaring people “fit for work” so that they can fulfill targets set by the U.K. government, which is aiming to cut around 20% from the welfare bill in the country. Twelve doctors employed by the firm that is paid £100m a year to assess people claiming disability benefit are under investigation by the General Medical Council over allegations of improper conduct. Certainly, whilst ATOS has the backing of the Government, an important political source of backing, the regulatory threat that its staff could be disciplined by the GMC is a formidable one, impacting on its perceived ability to perform substantially its contractual obligations to a minimum standard.
The ATOS disaster is well described elsewhere. People have suffered all manner of attacks – from anxiety to heart – during the process and the testing has proven unreliable according to the latest figures from HM Courts and Tribunals service. Following a Freedom of Information request, the mental health charity Mind have released appeal figures for the period April to October 2011. They make for alarming reading. They reveal that over the six months, almost half of the people who appealed against their ruling won their cases. That’s 37,100 who had previously, quite wrongly, been found fit for work. This success rate increased to 67 per cent when people were represented by, say, a lawyer or a benefits adviser. The “benefit scrounger” dialogue does, however, sit rather nicely with the skit of Frankie Boyle in the context of the recent surge of “hate crime”; neither the Government or Boyle officially would wish to concede this of course. There were 1,942 recorded incidents of disability hate crime in England and Wales in 2011, an increase of more than 25% on the total for 2010 and the highest since this data was first recorded in April 2010. Data obtained under the Freedom of Information Act shows the number of recorded incidents grew by 60% between 2009 and 2011. While almost 2,000 reports were made to the police last year, the Crown Prosecution Service (CPS) made just 523 convictions for disability hate crime over the same period.
In summary, Frankie Boyle and ATOS both collude in making money out of disabled citizens’ misery, and their profitability is directly linked to their success in positioning themselves in uniquely taking the piss out of disabled people or getting people off the register, inter alia, respectively. Frankie Boyle’s skit may be threatened by Channel 4 “pulling the plug”. If it were up to market forces alone, the Boyle product (Boyle, tied in with publicity, marketing, DVDs, CDs, etc.) might have been very profitable for a long time to come, but the poor performance of ATOS is equally precarious albeit on a different timescale. The potential threat to the profitability of ATOS is more interesting, however. For the timebeing, the ATOS profitability seems pretty healthy: ATOS saw profits grow 2% in the first half of 2012 to €102m (£80m) compared to the first half of 2011. It is most unlikely that disabled citizens would take a legal claim en masse to ATOS for wrong decisions made about their benefits, not least because this Government has implemented a plan of shutting down legal aid and law centres as far as possible. In addition, there is a time lag in factors affecting corporate profitability due to ‘external events’ – for example, News International is not looking forward particularly to the outcome of the Leveson Inquiry? Now there’s another industry that stands to make much money out of the misery of the disabled……
The author is most grateful for contributions made by J.B. and A.B. in relation to an earlier version of this blogpost.
