Image: Erik Nordkamp
Maybe it was the hangover from Christmas or the focus on the impending junior doctors’ strike, but few people seemed to pick up on a quiet press release from King's College Hospital NHS Trust on January 4th, announcing that the managing director of big pharma company, Pfizer UK, had joined their board.
Erik Nordkamp will spend “up to three days a month” as a non-executive director advising on the strategic direction of one the most respected and high-profile NHS Trusts in the country, alongside his day job running the UK operations of one of the world’s most profitable and controversial drug companies.
The appointment will raise questions about potential conflict of interest issues at King's, and increasing pharmaceutical and private sector influence over the NHS.
Dr Jacky Davis from Keep our NHS Public criticised the appointment:
"It is not appropriate for the head of Pfizer UK to be appointed as a non-exec director at one of the country’s most prestigious trusts. Clearly his presence on the board is likely to influence its attitude to the relationship between the private sector and the NHS, and increase the influence of the pharmaceutical industry within the trust and the broader NHS.”
She called on King's NHS Trust to rethink their decision:
"This continues to blur the boundaries between public and private sector. The private sector constantly seeks to infiltrate the public sector to increase their influence - King's NHS Trust should not be facilitating this. Once the public and patients become aware, there is likely to be pressure to reverse this decision. Those who made it should listen to patients and recognise that public interest is not best served by this appointment."
Mr Nordkamp’s appointment comes in the wake of multiple, high profile cases of corporate greed and accusations of illegal price setting by Pfizer which have drawn public and political ire.
In August 2015 the Competition and Markets Authority alleged that Pfizer, and another drug company Flynn Pharma, breached competition law by unfairly jacking up the price of anti-epilepsy drugs by up to 2600% costing the NHS millions. The total annual bill to the NHS for the treatment rocketed from £2.3m in 2012 to more than £50m in 2013. Both companies deny wrongdoing and the case continues.
In November last year Pfizer, which had a global turnover of $45.7 billion in 2014, announced a controversial merger with Irish-based drug-maker Allergan, in a deal widely condemned as being principally designed to reduce its global tax bill. The tie-up allows Pfizer to move its HQ to Ireland to benefit from the Republic’s much lower corporate tax rate.
Pfizer was already in hot water in the UK over its tax dealings. In 2012 MPs slammed the company for paying no tax despite generating sales of £1.8bn here in 2011. Pfizer has said it has not illegally avoided tax in either case.
King’s College Hospital Trust have defended the move, responding to inquiries with a statement saying: “We are delighted Erik Nordkamp has joined King’s as a Non-Executive director. The role was publicly advertised, and Erik was appointed following a competitive short-listing and interview process involving the Trust Chair and Council of Governors, which comprises elected members of the public, patient and staff populations at King’s.
“All Non-Executive Directors are required to declare any interests pertaining to matters for discussion at the start of Board or Committee meetings. In the event a Non-Executive director declares an interest concerning an agenda item, they will be asked to abstain from the discussion.”
Despite these assurances, staff and patients will be wary about the influence the head of a pharmaceutical company will have on a Trust such as King's. With prices charged by drug companies for treatments increasing at rates way beyond any meagre increase in NHS budgets, pressure from companies for the NHS to reform how it operates and spend more on medicines is growing.
Pfizer is one of many companies to have had new medicines ruled as too expensive to be cost-effective for the NHS by the National Institute for Health and Care Excellence (NICE). Pfizer has been pressing for NICE’s rules to be changed to allow more expensive drugs to be prescribed by doctors, claiming the UK is falling behind in its standards of care, but also in how conducive an environment it is for the ‘life sciences’ industry.
There is increasing concern that this push – focused as much on economic arguments as health outcomes – will combine with other pressures on the NHS to force reforms to the fundamental structures and principals of the NHS. Simply put – Pfizer and other drug companies want people in the UK to spend more money on their medicines and the NHS as it is currently structured is a barrier to that happening.
King’s move comes amid a growing global debate around the high price of medicines, rationing of patient access and the ethics and effectiveness of the profit-driven innovation model which underpins the pharmaceutical industry. There's also a growing debate on the future of the NHS. Staff at Kings, or any other Trust with pharmaceutical leadership on their board, may find it difficult to maintain credible independence in any such discussion.
NHS Trust representative body, NHS Providers, has said it doesn’t hold any information on pharmaceutical company representation on the boards of its members, although an initial internet search reveals a number of examples of serving or recently retired pharmaceutical sector professionals sitting on NHS Trust boards across England.
Keep Our NHS Public's spokesman Alan Taman voiced campaigners’ serious concerns about the link between the appointment of private sector non-executive directors and the privatisation of the NHS,
“The current system of safeguards to stop unscrupulous non-execs wielding undue influence on trusts is not strong enough. The only way to stop this is to stop NHS privatisation.”
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