Much has been written about the failure of the BBC to properly inform the public of the nature of the coalition government’s NHS bill, now the Health and Social Care Act, passed by the Lords on 19 March 2012. Many felt the BBC had abandoned the NHS under Conservative pressure and it appears significant numbers lodged complaints. And quite rightly. Having spent a number of days researching BBC coverage of the NHS, the picture which emerges should be of deep concern for both the BBC and the public. For whatever reason – and there are a number – it appears the BBC made a concerted effort to follow the government line, censor critical facts, bury fundamental elements of the reforms and present opposition to the bill in an intentionally limited and shallow manner. Their requirement to report impartially appears to have been fundamentally breached.
To avoid receiving a stock BBC response – ‘we covered the issue thoroughly with 146 articles including both critics and those in favour’ – considerable time has been spent researching the BBC’s coverage from 1 May 2010, just before the Coalition took office, to 1 April 2012, shortly after the bill was passed. Due to the difficulties of searching within radio and broadcast material without substantial time and resources, the focus has been primarily, but not exclusively, the output of BBC Online, both news and analysis (blogs have been excluded, though their material appears similarly limited).
The findings below have been separated into nine sections: Legitimacy – the bill no one voted for, The unexplored role of the private healthcare industry, The donations the Beeb refused to believe, The stories that weren’t, The March black out, Lobbyists over experts, Giving power to GPs?, Why the BBC chose the government over the health service, and finally Conclusions.
1) Legitimacy – the bill no one voted for
In the run up to the 2010 general election, David Cameron frequently pledged that under a Conservative government there would be “no more top-down re-organisations” of the NHS. Detoxifying the Tory brand on the NHS was a key part of their electoral strategy and Cameron’s personal campaign. There was no talk of any grand revolution in the coalition agreement either, a document which again expressed an explicit commitment that there would be no more “top-down re-organisations”. Yet just weeks into the coalition government, former Health Minister Andrew Lansley announced a top-down reorganisation so large, NHS chief executive Sir David Nicholson described it as “visible from space”. Explaining the apparent deceit on the BBC’s This Week, Michael Portillo admitted “they didn’t believe they could win an election if they told you what they were going to do”.
Considering the enormity of reactions against the bill, from the public, the press and the medical profession, and considering the NHS is the most highly regarded institution in the country, it would be reasonable to expect the BBC to inform the public that it was being “reformed” without a democratic mandate. Indeed, it was being broken up in direct violation of explicit election commitments. How did the Beeb cover it?
The broken pledge of no more “Top down re-organisations” was mentioned in online articles (analysis and reporting) just six times in nearly two years: twice in 2010, three times in 2011 and just once in 2012 – the year of the bill’s climactic passing. Of those six, half appeared when quoting critics of the bill. Only three times did the BBC independently raise the broken agreement themselves – here, here and here.
Direct quotes aside, however, the issue of the bill’s questionable democratic mandate would surely be a common feature in the Beeb’s analysis? In news and analysis articles, the issue was in fact raised just twice in nearly two years, and only once directly on the NHS. Neither example is the BBC’s own analysis; it only ever appears in two quotes. It was cited directly here, on an obscure blog as part of a resignation speech. The only other mention was in a general article on critics of the coalition, with their broad “mandate” to govern questioned by both Rowan Williams and Andy Burnham - who mentioned the NHS within that context.
In an unprecedented move, a UK court effectively ruled on the bill’s lack of a democratic mandate, in its judgement on government attempts to withhold the infamous ‘risk register’. As Dr Eoin Clarke reported in full, the court’s judgement included the following comments:
“From the evidence it is clear that the NHS reforms were introduced in an exceptional way. There was no indication prior to the White Paper that such wide-ranging reforms were being considered. The White Paper was published without prior consultation. It was published within a very short period after the Coalition Government came into power… Even more significantly the Government decided to press ahead with some of the policies even before laying a Bill before Parliament.”
(Note - the transcript can still be read at GPOnline)
None of these comments were cited in any BBC article. This was the most audacious smash and grab raid on a national asset in memory. Illegitimacy was a critical component of opposition to the bill, repeated regularly and vociferously; the electorate had not even been given a chance to consent to the changes. BBC message boards alone have countless examples of such criticisms. Yet the BBC raised the issue of a democratic mandate themselves a total of zero times, in nearly two years.
2) The unexplored role of the private healthcare industry
One of the most glaring absences of BBC reporting concerns the role of private health and consultancy firms. Whether it’s their lobbying, their links to government, the role they will play in Lansley’s new health market or the profits they are set to make, the BBC seemed determined to airbrush them from the picture. Here are some examples of things the BBC could have explored (or even mentioned):
Monitor is the ‘independent’ body that will be tasked with certain controls in Lansley’s new health market, one of which will be promoting competition – or ‘preventing anti-competitive behaviour’ in Newspeak. Private companies coming into the new NHS market will be keen to get access, yet they will often be unable to compete with the NHS’ low costs and economies of scale. To ensure this “distortion” would be no barrier to entry, the Department of Health (DoH) was allegedly considering allowing private firms to simply charge more, as we reported at openDemocracy (the BBC did not cover the story). That such a problem had even been identified spoke volumes on the Coalition’s claims that its reforms would increase efficiency.
It may be reassuring to those private providers to know that Monitor is run by some friendly faces. Of the five members of the board, two, including the Chair, David Bennett, are ex-McKinsey staff, the global consultants who make substantial profits advising both private firms and governments on outsourced public services, amongst other things. Another had previously worked for NM Rothschild, the famous merchant bank, leaving a minority of just two whose prior work was mainly within the NHS. Of the five members of the senior management team, the same David Bennett, formerly of McKinsey, is Chief Executive. He leads a team of five, dominated by staff from both McKinsey and KPMG – a global accountancy giant which again makes substantial profits from outsourced services.
None of which received any mention by the BBC.
The same David Bennett appeared in a major scoop by The Mail on Sunday, revealing that in his new Monitor role he had received hospitality from his old firm, McKinsey, worth over £6,000. McKinsey pampered a further two members of the Monitor management team, one of whom had previously worked for the consultants. More worrying still, the Mail’s Freedom of Information requests had shown:
“Many of the Bill’s proposals were drawn up by McKinsey and included in the legislation wholesale. One document says McKinsey has used its privileged access to ‘share information’ with its corporate clients – which include the world’s biggest private hospital firms – who are now set to bid for health service work.”
“The company is already benefiting from contracts worth undisclosed millions with GPs arising from the Bill. It has earned at least £13.8million from Government health policy since the Coalition took office – and the Bill opens up most of the current £106 billion NHS budget to the private sector, with much of it likely to go to McKinsey clients.”
Giving such a clear insight into the dark underbelly of the NHS bill, the article made a big impact. Except at the BBC. Their coverage of the scoop amounted to a single, brief mention at the bottom of this article. Devoting just 120 words to the story - over half of which was a government rebuttal - only the hospitality element was mentioned. McKinsey’s role in writing the bill and its commercial ties with those who would profit was not considered newsworthy. That the BBC appear to have found themselves to the right of the Mail on Sunday should be an issue of the most profound concern.
In a sign of things to come, Virgin lodged a complaint against the Yorkshire Primary Care Trust in March this year, accusing the Yorkshire NHS Trust of ‘predatory pricing’ – foregoing profits in the short term by selling services below cost (Note - this story can still be read at the BMJ). Struggling to compete, here was a private provider taking action against the NHS for charging too little, or in market terms, being ‘too efficient’. Private firms, as the incident showed, will not only struggle to compete with NHS costs but they will take legal action against the NHS when it happens. The story was not covered by the BBC.
On 14 May 2011, The Guardian reported the comments of Mark Britnell, a senior adviser to David Cameron and KPMG’s Global Head of Health. In a conference in New York the previous October, Britnell had described how the NHS would be turned into a “state insurance provider”, a “big opportunity” for the private sector; the NHS would be shown “no mercy”. Despite the story breaking on 14 May, the BBC did not mention the comments until 4 days later when they were mentioned in brief to explain a comment by Nick Clegg. It was not deemed a story in its own right, and it was never mentioned again.
On 2 March 2011, a Channel 4 scoop was published in the press showing the health bill could lead to GP practices being floated on the stock exchange. One private health firm, IHP, proposed setting up a private company to run the actual commissioning for GPs, an agreement that would see 20% of the company owned by the GPs themselves. Savings would be booked as profits and the company would be floated on the stock exchange within five years. Oliver Bernath, the founder of IHP, is another former member of McKinsey. This story received no coverage on the BBC at all, though once again it was reported in The Guardian, The Express, and The Daily Mail.
In March 2012, it was reported that in 22 of the new clinical commissioning groups (CCGs), the bodies tasked with purchasing services, “at least half and sometimes all of the GPs that dominate their boards have a personal financial interest in a private or other non-NHS provider” (False Economy, reported in The Guardian). A major concern of critics was the potential for medical decisions to be influenced by financial interests, yet the BBC decided against exploring these issues. To do so would require explaining something quite critical to the public: the people who will now commission healthcare, be they GPs or private firms, may have financial interests in the private firms providing that care.
Indeed, the role of the private sector was almost totally ignored by the BBC. Of all the major firms standing to profit from the “shake up” of the NHS, there doesn’t appear to be a single BBC article examining the crucial role they have played in lobbying for this bill, or the extent of profits they can expect to make as a result of its passing. Besides its bland overview of the bill, which often includes the phrase “and will open the health service to more competition from the private sector”, the BBC was unwilling to spell out exactly what was happening.
Consider this final Channel 4 scoop which the BBC failed to acknowledge:
“GPs say they have firm evidence now that the government is planning to privatise the National Health Service as part of its reforms… In a document seen by Channel 4 News, plans are laid out for how services will be bought for patients… Under the NHS reforms, GP practices will form consortia and they will manage about 60 per cent of England's NHS budget. But it has been acknowledged that some GPs will not want to - or be capable of - managing such huge enterprises.
“This document sets out how commissioning support units can be set up. Richard Vautrey, deputy chair of the British Medical Association's (BMA) GP committee, said that the document was quite explicit in suggesting that the government was going to create a market for private companies to come in and take over these services…”
Privatisation was the critical basis of opposition to the bill yet the BBC consistently, almost religiously, failed to inform the public of why the bill represented a substantial privatisation of their National Health Service.
It is hard to overstate the scale or seriousness of the BBC’s inadequacies here, as it appears to be more than mere failure, but rather wilful failure.
3) The donations the Beeb refused to believe
In February this year, an NHS chief who criticised the bill claimed he had been “smeared” by Andrew Lansley’s department. Professor Ashton CBE, who had also been critical of New Labour’s health record, said that “someone on behalf of the Health Secretary called his local BBC radio station to allege that he could not speak objectively because he was a member of the Labour Party”, as The Independent reported (the story was ignored by the BBC). The article continues:
“A Conservative Party spokesman said: ‘The BBC has a responsibility to report news objectively. They should always inform their viewers if the person they are interviewing has political motives, and it is absolutely appropriate for us to request that they do so.’”
It’s a shame that neither the BBC nor the Conservatives showed any real commitment to this notion because if they had, the Health and Social Care bill might never have been passed.
Motivations, whether political or financial, should be disclosed and yet as far as the BBC was concerned, the Health and Social Care bill was simply an isolated policy decision by the Conservatives with the aim of “putting GPs in control”. Had the BBC been an independent news source aiming to give the public the best possible understanding of what was happening and the interests involved, here are some things they might have covered:
When citing Andrew Lansley, the Health Minister in charge of the NHS bill, it would have been proper to note that he received a £21,000 donation to his personal office from John Nash, then Chairman of Care UK, a health firm with substantial income from the NHS. Nash also founded Sovereign Capital which runs a number of private health firms.
When citing Conservative Party representatives, it would have been proper to note that since David Cameron became leader, the party had received over £750,000 in donations from firms and individuals in the healthcare industry – firms set to make significant profits from the new NHS market. Detailing these donations to both Lansley and the Conservatives, The Mirror’s investigation was widely quoted yet merited just 21 words from the BBC. They mentioned the donations just the once, as part of a ‘newspaper review’.
Going back to 2001, however, and the level of financial backing given to the Tories by health firms is even more astounding. Earlier this month, Dr Éoin Clarke provided a database showing 333 donations totalling £8.3million (Note - the database can still be viewed at Social Investigations). This received no coverage or mention from the BBC.
In May last year, Mr Lansley was again in the news when The Daily Mail reported on the business activities of his wife, Sally Low. ‘Low Associates’ was found to be boasting of its ability to help ‘make the link between the public and private sectors’. Labour MP Grahame Morris said it constituted a “clear conflict of interest” and suggested Lansley’s position was no longer tenable. The BBC never mentioned the story.
Even more alarming, however, were the direct financial interests of our MPs and Lords in the health industry. A substantial number from both Houses of Parliament held positions or financial stakes in the very firms waiting to cash in on the NHS break up. This was an absolutely critical story not just for our health service but for our democracy and entire representative system. Andrew Robertson at the Social Investigations blog compiled a list showing details of 140 Lords and 65 MPs with what he claimed were direct interests in private healthcare, including 1 in four Conservative Peers, 1 in 6 Labour Peers, 1 in 6 Crossbench Peers and 1 in 10 Liberal Democratic Peers. No attempt to explore these interests has ever been made by the BBC.
On 4 March 2012, just weeks before the bill was passed in the Lords, The Daily Mail reported that Lord Carter of Coles, the head of the NHS regulator, the Co-Operation and Competition Panel, had considerable interests in healthcare providers. As chair of American healthcare firm, McKesson, he was last year paid a staggering £799,000 from just one of his many healthcare linked positions. Though reported in both The Mail and The Guardian, it received no mention from the BBC.
A blogger, Skywalker1964, has posted a response they received from the BBC over the lack of reporting on such issues. It includes the following explanation:
“In addition to this coverage however, I note that you would like to see probing of the links you believe exist between Andrew Lansley’s office and the health care and pharma industries, and exploration of your concerns the bill represents “the destruction of the NHS.” (my bolds)
This borders on the surreal. For the BBC, uncomfortable facts on the NHS bill have become beliefs, yet the beliefs of government ministers and their backers in the health industry are reported as fact.
Having run numerous searches of the BBC site, no mention was found anywhere of the financial interests of either MPs or Lords in healthcare firms in relation to the NHS bill. Neither could any article be found exploring the donations to the Conservative party from the healthcare industry. These issues were an important element of opposition to the bill, as well as important to our democratic structures, yet the BBC operated an effective blackout.
4) The stories that weren’t
Reading through a number of important news items concerning the NHS bill and the interests involved, a considerable number of what might be described as ‘negative’ news stories did not appear to be covered by the BBC at all. If BBC output was being screened by Mr Lansley himself it would have been hard to notice the difference. Many omissions appear consistent with the BBC’s approach of minimising the role of the private sector. Here is a collection of stories that weren’t (perhaps the BBC considered them only “beliefs”):
False Economy reported that despite considerable reassurances on the issue, it appeared Monitor would not in fact prevent “cherry picking” in its rules on selection criteria, stipulating only that they are ‘transparent’ and ‘published’. Cherry picking was a prime concern of opponents of the bill who argued the private sector would dump the more costly and complex cases back on the NHS whilst ‘skimming the cream’. It was a key part of the controversy. While the BBC covered cherry picking, they ignored Monitor’s decision not to have rules guarding against it, as reported here on False Economy.
Liberal Conspiracy reported that, “The University Hospital of North Staffordshire (UNSH) has been criticised after it was discovered it started charging A&E patients for any drugs they needed. Health campaigners say the charges breach the NHS founding principle which says that care is free at the point of delivery and are set to seek a ruling on the legality from the Ombudsman.” This was not reported by the BBC.
A privately run NHS clinic in Hackney refused treatment to a 76 year old man who was later diagnosed with potentially deadly meningitis. Care UK (with financial links to Andrew Lansley) run the centre but refused to treat him as they had already fulfilled their ‘quota’: a sign of what lies ahead for our health service. It was covered here, in the Hackney Gazette but not at the BBC.
On 1 March 2012, just weeks before the bill was passed, the BMA issued a devastating denunciation of the plans, describing them as "irreversibly damaging to the NHS", and “complex, incoherent and not fit for purpose, and almost impossible to implement successfully, given widespread opposition across the NHS workforce". Reported in The Guardian, The Express and The Telegraph. But not at the BBC.
Hinchingbrooke hospital, the first taken over by a private company, caused widespread news coverage. The failing hospital had significant debts which its new operator, Circle Health, insisted would be paid off without sacrificing quality of care. Later, however, a document leaked to The Observer showed the firm admitting its expansion into the NHS “could affect its ability to provide a consistent level of service to its patients”. Reported in the Guardian, but not at the BBC.
In September 2011, The Guardian reported “the first tangible evidence that foreign multinationals will be able to run state-owned acute services, a market worth £8bn”, when it emerged that a German firm was in negotiations to take over hospitals. Again, here was a major story on the privatisation of English health services, yet it was ignored by the BBC.
In June 2011, a senior Lib Dem, John Pugh, expressed concerns over the neutrality of Sir Stephen Bubb, who led the Future Forum’s guidance on competition. Hand picked by the government, the Future Forum advised on the bill during the ‘listening exercise’. Bubb, it was reported, “leads the Adventure Capital Fund, which provides finance for "third-sector" organisations for a return on its investments”. Reported in The Observer, but not the BBC.
Prof Steve Field, the senior doctor chosen by the government to lead the Future Forum panel advising on the bill, described the plans as “destabilising” and warning they could “destroy key services”. Reported in The Guardian, but in the BBC’s coverage these highly damning quotes from a hand-picked government adviser were omitted and the overall tone of the report was significantly softened.
In The Observer, it was reported in March 2011 that Lansley’s Department of Health had withheld polling data showing record NHS satisfaction levels for six months. At the time, the Coalition was insisting poor NHS performance was a key reason for their ‘reforms’. The poll data was reported by the BBC when it was released in March but the fact the government had buried it for six months was not discussed.
In January 2011, the National Audit Office issued a warning on the potential consequences of the health bill, suggesting short term costs could rise and quality of services could fall, as reported in The Guardian.
None of the above merited any mention from the BBC. An unwillingness to report negative NHS items was also noticed by Dr Eoin Clarke, who published this list of a further 10 stories the BBC failed to cover. Importantly, the omitted stories are not a random selection; most relate to the strength of opposition to the bill and the role of private firms in reforming the health service.
5) The March blackout
Many complaints have already been filed with the BBC over their coverage of the bill through the month of March 2012, the climax of the bill and its passing in the Lords on 19 March. Numerous such complaints have been documented online, with one claiming the BBC have refused an FoI request asking how many complaints they have received over their NHS coverage. Much of the following issues relate to broadcast and radio coverage, elements that I have largely excluded from this analysis due to the difficulties of tracking coverage retrospectively. In doing so, they illuminate failings of the BBC’s coverage well beyond their online content.
Blogger Deevy Bishop filed one such complaint. She notes the absence of any reporting of a petition brought to the House of Lords by Lord Owen on 19 March 2012, the day the bill was finally passed in the Lords. The petition included 486,000 signatures calling for the bill to be delayed until after the Risk Register’s long-sought publication. Bishop’s complaint also noted the general lack of coverage in the month of March leading up to the passing of the bill. In the BBC’s response they acknowledge the bill featured on the flagship Today programme only once before the bill was passed. That was broadcast on 10 March, nine days before the bill’s passing. As Bishop says,
“So, if I have understood this right, during March, the Today programme covered the story once, in an early two-minute slot, before the bill was passed. Other items that morning included four minutes on a French theme park based on Napoleon, six minutes on international bagpipe day and eight minutes on Jubilee celebrations.”
Particularly surprising is the BBC coverage of 19 March, the climax of the bill as it was finally voted through by the Lords. I can find no record of any news report or analysis from BBC Online regarding the bill on 19 March. Besides the live streams on Democracy Live, the climax of one of the most controversial bills in recent history merited not a single article. With the bill safely passed, however, the next day saw a stream of seven articles: here, here, here, here, here, here and here.
In a piece by Dr Eoin Clarke, he notes a number of other curious omissions by the BBC. At the Royal Free Hospital in Hampstead, for instance, Andrew Lansley was heckled by angry medical staff, as both The Daily Mail and Sky News reported, but not the BBC. Again, opposition to the bill appears to have been censored.
Cai Wingfield published a comprehensive account of what happened to a small and peaceful NHS protest in central London on 17 March, two days before the bill passed. This was a group composed of many middle aged and elderly people, a march for the NHS. As the pictures demonstrate, this appeared to be a distinctly unthreatening and good natured march. It was responded to with riot police, who kettled the protesters, broke them up, pushed them around and generally intimidated them. British citizens can no longer march for their health service without being attacked by riot police in central London (the account is well worth reading). This raises firstly the issue of why the police appear able to deploy kettles as a first rather than last resort, but more importantly, why did the BBC fail to make any mention whatsoever of this protest or the police response? For the coalition pushing through this enormously unpopular bill, it certainly spared some blushes.
In an excellent piece by Media Lens, entitled The End Of The NHS: Buried By The BBC, they note that:
“On the very day the bill passed into law, the tag line across the bottom of BBC news broadcasts said ‘Bill which gives power to GPs passes’. The assessment could have come from a government press release, spin that has been rejected by an overwhelming majority of GPs. The BBC has also repeatedly failed to cover public protests, including one outside the Department of Health which stopped the traffic in Whitehall for an hour.”
Along with many other bloggers, they note numerous Twitter messages of dismay over the effective news blackout at the BBC whilst the bill was being passed. Author Marcus Chown lists four events he claims were not reported by the BBC:
- Unreported ‘Drop the NHS bill’ protest on Mothers’ Day in Parliament Square, London.
- Unreported doctors’ ‘Drop the NHS bill’ protest.
- Unreported ‘Drop the NHS bill’ sit-down protest that blocked traffic for an hour in Whitehall, London.
- Unreported ‘Drop the NHS bill’ candle-lit vigil, St Thomas’ Hospital, London.
Another activist identifies some recurring patterns of bias in the BBC’s reporting of the bill:
“When the BBC have reported on the bill they have been sparse with their explanations of its implications or the reasons why so many - including most medical professionals - have objected to it. They have tended to limit their comments to those of the type “Some people say it's privatisation” without explaining why or exploring the issue.” (my emphasis)
This is entirely in line with what I have found while analysing the BBC’s coverage. As Media Lens ask, why could the BBC never offer some real reporting on the bill, like this news report from Russia Today? Closer to home, this John Snow interview on Channel 4 and the analysis given below it are simply on another level when compared to BBC coverage.
It appears that throughout March, and particularly the day of the bill’s passing, the BBC made a deliberate effort to censor news surrounding the bill and particularly efforts to oppose it. They may have refused to disclose how many such complaints they received, but the BBC must account for the woeful quality of their coverage and what appears to be deliberate censorship.
6) Lobbyists over experts
Had the BBC shown any commitment to neutral reporting, the commercial links they would have exposed could have led to major improvements in their treatment of sources. On the subject of transparency the BBC repeatedly cited sources inaccurately and failed to make clear their political or financial interests; they allowed commercial lobbying to be reported as informed opinion.
One frequently cited source was the NHS Partners Network, described as ‘representing health firms’. They were cited uncritically and casually as providing a credible source of information. They are in practice a commercial lobbying organisation, representing many of the firms standing to make billions from the health reforms (a fact the BBC never addresses). Their members include some of the largest health firms in the world, such as Care UK, Assura Group, Bupa, Circle, General Health Group, Pfizer, Ramsay Health Care and United Health UK. One article reads:
“In fact, the NHS Partners Network, which represents the firms which already see NHS patients, predicts there will not be any significant rise in private sector involvement for at least five years.”
This is implausible at best; there has already been an increase in contracts and services handed out to the private sector – that is, members of the NHS Partners Network, and it is already apparent large chunks of the NHS will have been privatised well before 2017. Many negotiations are already underway, and the first hospital, Hinchingbrooke, has already been handed to a private firm, Circle (a member of NHS Partners Network). For a comprehensive record of the privatisations underway see Dr Éoin Clarke’s blog, The Green Benches.
In the following article, the BBC states:
“The NHS Partners Network, which represents health firms, said it was a myth that the NHS was to be privatised. Just 3.5% of NHS operations are done by private firms currently - and the network said that was unlikely to even double over the next decade.”
Again, highly dubious spin is treated as a credible news source. The story is no different with H5, an alliance that lobbies on behalf of the five largest private hospital providers. Their CEO, Matt James, was allowed to publish an entire article at BBC Online lobbying for the reforms – reforms H5 will make substantial profits from.
Another organisation cited uncritically was 2020Health, who the BBC described simply as ‘a health think tank’, when they ran a whole article on a 2020Health report on the NHS. Julia Manning, chief executive of 2020Health, also appeared twice on BBC radio to discuss the health service. But who are 2020Health? As SpinWatch points out:
“2020Health Chairman, Tom Sackville – a former Conservative minister – is CEO of the International Federation of Health Plans, which represents one hundred private health insurance companies in 31 countries… Its advisory council, however, is heavily weighted towards large, for profit companies. It includes a former director of pharmaceutical giant Astrazenca, the managing director of bankers N M Rothschild, the past President of the National Pharmaceutical Association, medical director of the Nuffield private hospital group, and CEO of Independent Healthcare Advisory Services, which represents the private healthcare sector.”
There were also multiple sources used from the organisation Reform, described as “a think tank” without any critical examination of their links or funders. Reform were cited uncritically in this article on the NHS bill, and their staff, usually Nick Seddon, were also invited onto BBC radio to discuss the bill on five separate occasions: four times on the Today programme, and once on Iconoclasts. Before joining Reform, Seddon was Head of Communications at Circle, the first private company to take over an NHS hospital, the Hinchingbrooke. As OurKingdom reported:
“Reform’s corporate partners represent some of the most powerful companies in the country, including the likes of Citigroup, KPMG, GlaxoSmithKline and Serco… Not only are [KPMG] already included in government policy-making, but they employ two members of the House of Lords… In fact, nine of the companies who are listed as corporate partners of Reform employ members of the House of Lords on their payroll.”
The firms just so happen to be some of the prime beneficiaries of the NHS bill. Reform’s website boasts that:
“[Corporate partners] find that a close collaboration with Reform helps them to achieve their own objectives, as well as bringing them into a new and high level network.”
Yet the BBC chose Reform as a suitable source of opinion on the NHS bill on six separate occasions, never once making clear to the public whose interests Reform represents. In one instance, the BBC even got a quote from Reform on the “good value for taxpayers” of some PFI hospitals – it would be very interesting to know which ones; perhaps those run by Reform’s funders.
In fairness to the BBC, after conducting days worth of research, finally an example turned up of a group who were introduced with full disclosure on who was backing them:
“The emergence of the RCGP letter comes on the day False Economy, the TUC-backed research group, claimed to have gathered evidence showing doctors, nurses and practice managers are having to spend time away from their day jobs to set up clinical commissioning groups.”
Representing 7 million members, the TUC is the largest democratic body in the country. Its sinister front organisation, False Economy published evidence that the changes were taking up considerable GP time, as much as four days a week. It’s interesting to consider the likelihood of the bill’s passing if the BBC had used this approach to sources consistently:
‘Andrew Lansley, the Care UK backed Health Minister, today unveiled plans to open up the NHS to private firms…’
‘The Conservative party, who have received over £8million in donations from healthcare firms, announced changes to the NHS which will allow ‘greater private sector involvement’…’
‘The think tank Reform, funded by KPMG, GSK and Serco, today backed government plans which will open up the NHS to private firms… such as KPMG, GSK and Serco.’
Sadly, however, the meticulous and highly regarded False Economy is the only source to receive such attention.
But what about the sources the BBC didn’t use? It may have surprised many to see that a number of notable experts on the health service and privatisations never appeared in BBC coverage at all. Highly regarded and authoritative opponents of the bill never appeared, including Allyson Pollock, professor of public health research and policy at Queen Mary, and Professor Colin Leys, author of The Plot Against the NHS. When asked about the issue, Leys told me:
“Throughout the passage of the Bill through parliament I listened fairly faithfully to Today and watched BBC television and never once heard any of the Bill's genuinely expert critics, such as Professors Allyson Pollock, Martin McKee, Wendy Savage and John Lister, or practising doctors such as Jacky Davis, Kailash Chand and Clive Peedell, or researchers specialising on the NHS such as Lucy Reynolds.”
Appearing on the Today programme to debate the changes on 1 February 2012, for instance, were Shirley Williams (a Liberal Democrat peer, Williams reluctantly voted in favour of the bill), Steve Field (pro bill), Nick Seddon of Reform (pro bill), and Chris Ham (pro bill). It’s a strange notion of balance; one that appears to contradict the BBC’s requirement on impartiality.
Not only did the BBC make generous room for comment from those with financial interests in the bill’s passing – interests the BBC failed to properly disclose – but it seemed reluctant to report the views of some of the most qualified and widely cited critics in the country. It seems every effort was made to put forward the strongest case for the bill, but sadly not for the case against.
7) Giving power to GPs?
To go back briefly to a complaint lodged against the BBC, part of which read:
“On the very day the bill passed into law, the tag line across the bottom of BBC news broadcasts said ‘Bill which gives power to GPs passes’.”
Throughout the long and enormously controversial passage of the bill, which lasted nearly two years, the BBC adopted this phrase in an almost robotic manner. Scan through a handful of BBC articles and coverage on the bill and you will invariably find a summary of the bill very close to the following:
“The Health and Social Care Bill will allow GPs to get control of most of the NHS budget from 2013.”
“Under the proposals, family doctors will have more control over their budgets and there will be a greater role for the private sector.”
Critically, the one sentence overview of the bill insists it is about giving GPs ‘control’ of the health budget and treatment, and sometimes mentions in addition a ‘greater role for the private and voluntary sector’. This formulation has clearly been followed stringently and yet it makes such fundamental omissions as to be manifestly misleading. It is one thing to say this ‘could have come straight out of Conservative HQ’, but in this instance it probably did. It is indistinguishable from the government’s own presentation of the bill. I asked Professor Colin Leys, author of The Plot Against the NHS, whether he considered the BBC’s line to be accurate and balanced. He replied:
"The BBC routinely described the Bill as a reform to empower GPs - the government's description - rather than as turning the NHS into a market driven by shareholder interests, which was what the critics maintained - accurately, as is now becoming clear. The BBC's public service remit should surely have required it at least to present the Bill's purpose as contested."
To do so, however, would require widening the debate to an area the BBC repeatedly ignored: the role of the private sector in Lansley’s new health market, as well as the surrounding financial links between the health industry, the Lords, Mr Lansley himself and the Conservatives, who have received over £8m in donations from healthcare firms in the last 11 years.
What was very plain from an early stage in the bill was that private sector involvement would be considerable and fundamental. Not only do the reforms open the service to “any willing provider”, but since GPs are not accountants many will require the services of private firms to actually run their commissioning. NHS services are already passing to private providers at considerable speed.
There are a number of times the BBC quotes an opponent of the bill including only soundbites such as “warning of creeping privatisation”, or, “the bill is deeply unpopular”, or “faced strong criticism”. It is very difficult to find even a single example of the BBC explaining to the public why people felt this was being privatised, and by what mechanisms that privatisation might take place. The phrase “any willing provider” appears in just eleven articles in nearly two years and, strangely, the last time it was mentioned was June 2011, here. Within that coverage, the role of private firms appears incidental or a minor theme. Critics of the bill argued that it was the primary purpose of the reforms and that significant elements of the NHS would be opened to privatisation – as is now happening. This is not quite made clear by the BBC, to say the least. Combine that with the BBC’s refusal to properly report the following themes:
- - Financial links between Westminster and healthcare firms
- - The role of McKinsey in drafting the bill
- Services already being moved to the private sector
- The ‘Revolving door’ between Westminster, health firms, consultancy firms and NHS regulators.
- Financial interests of GPs in private healthcare firms
And the result is akin to describing the Iraq invasion as “a humanitarian intervention to protect human rights”. It just doesn’t come close to informing its audience of what is really happening, and why. For a bill that “empowers GPs”, it is telling that GPs overwhelmingly rejected the bill, while the private healthcare industry overwhelmingly supported it. Who does the BBC think has really been empowered?
At no point was an expert account of opposition to the changes found on the BBC site, yet could be freely found on other media sites and blogs. For instance, Allyson Pollock at the Guardian explained:
“Put simply, the legal effect of the bill is to abolish the statutory basis of a national health service by repealing duties to provide a comprehensive and universal service. The change is effected by creating clinical commissioning groups (CCGs) with an obligation to cover fewer services and responsibility for fewer patients and residents than primary care trusts (PCTs). Whereas PCTs act on behalf of the secretary of state, CCGs will exercise functions in place of him or her but without a clear primary legislative framework. The bottom line is that commissioners and providers in the new market will have freedom to select patients and services on financial grounds and to redefine eligibility for NHS care and in so doing introduce charges for care.”
Behind the bill’s friendly “family doctors” were a host of multinational health firms circling over the NHS, spending millions of pounds on lobbying and donations to help turn the NHS into a market from which they could profit. And that’s exactly what they have achieved. Putting aside the glaring democratic deficit of the bill, this was in fact the most fundamental and important criticism of the bill’s opponents – the majority of both the public and the health profession. A serious explanation must be given by the BBC for why they failed to explain the single biggest objection to the Health and Social Care bill, one of the most controversial bills in recent history.
8) Why the BBC chose the government over the NHS
There are a number of theories on why the BBC consistently refused to explain the NHS reforms in adequate terms or detail. For instance, a number of senior BBC staff have links with the healthcare industry. As Media Lens note, Dr Mike Lynch OBE, a member of the BBC’s executive board, has links to a number of firms in the health sector, including Apax Partners, “one of the leading global investors in the Healthcare sector”. BBC Chairman, Lord Patten, is on the board of Bridgepoint, a private equity firm with substantial healthcare interests. Bridgepoint also employed the Labour health secretary, Alan Milburn.
“One company acquired by Bridgepoint for £414 million in July 2010 is the residential care company Care UK”
That’s the same Care UK who donated £21,000 to the personal office of Andrew Lansley. On BBC links with government, David Cameron’s Director of Communications is in fact Craig Oliver, whose prior job was as a senior news editor at the BBC.
Media Lens quote an email sent by a BBC employee to Marcus Chown, which suggests the BBC had “pages and pages of text on the opposition to the bill” but simply didn’t run the material. It’s an important claim because it suggests a deliberate effort on the part of the BBC to distort their coverage of the bill and particularly the strength and nature of opposition to it, a theme supported by numerous elements of this report.
Like Media Lens, it is not the intention to suggest here that financial interests were a factor in the BBC’s reporting. What is far more plausible is that under pressure from the Conservatives, the BBC buckled, they hoped that appeasement on the NHS would protect the BBC from any further swings of the axe. For a number of years the Conservatives made very plain their desire to substantially reduce the scope and influence of the BBC. Cameron even described his cuts to the BBC as “delicious”. What has been plain from before the Coalition even took power is that the BBC were in Conservative crosshairs.
It’s important to note, also, the central role of the NHS bill in the Conservative’s wider vision, their public sector ‘revolution’, in which the entire state “except the military and judiciary” is to be opened to the private sector. At the forefront of the revolution is the NHS, the great “Marxist” behemoth, in the words of one Tory councillor. Break up the NHS and everything else falls; it is the totem of the post war social democratic settlement, the antithesis of market values. This Conservative-led Coalition is a one term project, and spurred on by Blair’s message to go as far as possible in the first term they are attempting to forge a new political settlement that will outlast their inevitable 2015 eviction. In Nicholas Timmins’ book on the bill, Never Again, Lansley is quoted as saying:
“So it all had to be put into legislation to nail it down, to ensure the next secretary of state could not just come along and change it without fresh legislation… What I set out to do was entrench a consistent and coherent structure of reforms [so that] things would not change just at the behest of a change of secretary of state, or even more a change of government” (Timmins, 2012, my emphasis)
Having taken such a huge and unpopular gamble with the NHS, the Conservatives would have done anything to ensure it went through. It is in this context perhaps that the BBC, to their profound shame, took their place kneeling at the Conservative foot.
It marks the culmination of the BBC’s slide into a far more traditional ‘state broadcaster’, an organisation afraid to challenge power and terrified of controversy. In its reporting of domestic affairs the BBC seems resigned to the role of a bland and compliant megaphone for established interests. Speaking to Media Lens, former BBC correspondent Tim Llewellyn explained the decline of the BBC following its treatment over Iraq:
“There is no backbone left in current affairs programmes; news operates on the principle that X says Y and Y says X and this adversarial knockabout is a substitute for real analysis and questioning.”
All considered, fear, compliance and a misguided vision of self-interest seem to have left the BBC incapable of challenging abuses of governance.
The BBC’s coverage of the NHS bill represents a profound failure to inform the public on an issue of the utmost importance. To summarise, it appears that:
- the BBC never questioned or explored the lack of democratic mandate for the changes to the NHS
- they consistently presented the bill using the government’s own highly contested description
- expert critics were not given the space and opportunity to highlight the true nature of their objections
- financial links between healthcare firms, the Conservatives and the House of Lords were never reported
- the significant role of the private sector in Lansley’s new health market was never explored
- fears over privatisation were occasionally stated but never explored or explained
- the role of private firms in commissioning care was not properly explained, if at all
- the role of private firms in creating the bill was never examined or reported
- sources with significant links to private healthcare were presented without a disclosure of their interests
- the BBC censored key stories, particularly as the bill reached its final stages. On 19 March 2012 when the bill was finally passed in the Lords, BBC Online published not a single article of news or analysis on the bill.
This research focuses mainly on the output of BBC Online, in its news and analysis. It is possible that their radio and broadcast coverage was significantly different but this seems unlikely considering the number and content of other complaints on their coverage. It is possible that the searches done for this research were not extensive enough and there may be considerable material in a range of formats refuting the criticisms made above – something I hope the BBC can shed light on. Furthermore, it is suggested here that the BBC refused an FoI request to release the number of complaints they have received over their NHS coverage.
If the above criticisms are found to have merit either in full or in part, however, then the BBC has some serious questions to answer. It is not in the government that the strength of the BBC lies – a parliamentary system captured by forces inherently opposed to its existence – but in the British public, the support of which it should rigorously protect. If it continues its slide into an elaborate extension of the Number 10 press office and loses its connection with the public it will find its friendships in Westminster to be short-lived.
To put these issues to rest, the BBC should:
- release full data on the complaints it has received over its NHS coverage, if it has not done so already
- formally address the concerns listed above
- make available to the public, journalists and academics a full account of their coverage across all mediums so that it can be properly analysed.
Considering the importance of both the NHS and the BBC as national institutions, it is crucial that these concerns are addressed.
If you enjoyed this exposé, openDemocracy has launched a new section - OurNHS, edited by Oliver Huitson, in collaboration with 38 Degrees, Keep Our NHS Public and many more. Donations to make OurNHS sustainable can be made from the home page, here.
*June 2013 update: in the majority of quotes from the Green Benches, notes have now been provided for alternative sources for the story where GB no longer provides them.
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