Intended for healthcare professionals

Views And Reviews Acute Perspective

David Oliver: The revolving door to the NHS lobby

BMJ 2019; 365 doi: (Published 03 April 2019) Cite this as: BMJ 2019;365:l1297
  1. David Oliver, consultant in geriatrics and acute general medicine
  1. Berkshire
  1. davidoliver372{at}
    Follow David on Twitter: @mancunianmedic

In January the chief digital officer for NHS England, Juliet Bauer, left to take up a role at a Swedish digital start-up company. The company, called Kry (Livi in the UK), has developed a video consultation app and has partnered with general practices in England.1

That same month the Financial Times reported that Bauer had written a national newspaper article extolling the virtues of Kry’s app without disclosing that the company had already hired her (the piece was eventually amended to clarify the matter).23 Meg Hillier, chair of the House of Commons Public Accounts Committee, described Bauer’s action in writing the article as “brazen” and “jaw-droppingly inappropriate.”3 Bauer was then “reminded” that she could not lobby government agencies for six months after leaving NHS England.4 Before her appointment to NHS Digital in 2016 she had worked as the Times’s director of product development and had also written of her personal commitment and motivation to join the NHS.5

The story is one of many illustrating the revolving door between the NHS and the private companies seeking to influence government policy or secure its business. Employees, lobbyists, and consultants secure advisory or leadership roles in government bodies and then move back to the private sector. Meanwhile, senior government officials and former ministers take their inside knowledge and contacts to organisations and sectors that do regular business with government.

I’ll pick just a few examples. Jim Easton moved from being Department of Health director for improvement and efficiency—at a time when legislation forced NHS tenders to be put out to “any qualified provider”—to being CEO of Care UK, “the largest provider of private NHS services.”6

Mark Britnell7 and Gary Belfield,8 who headed the health department’s grandly named “world class commissioning,” moved to roles at KPMG, which sells consultancy to the NHS. Andrew Lansley, former health secretary for England who introduced pro-market legislation,9 took up a role advising the drug company Roche, which was involved in a row with the NHS over cancer drug pricing.10 (Remember, this is the same Lansley who set up the controversial Cancer Drugs Fund11.)

While in opposition, the former prime minister David Cameron12 said that the “far-too-cosy relationship between politics, government, business and money” was “the next big scandal waiting to happen.” He also oversaw a “nudge” approach to public health rather than harder regulation. Kate Marley, one of his special advisers, then moved to lobbying for the tobacco giant Philip Morris.13 After he stood down Cameron was then himself banned for two years from approaching ministers or government officials on behalf of a US genomics company.14

A series of special health advisers at Number 10 have come from private healthcare or health consulting firms.1516 One of these, Paul Bate, came from consulting, moved to the Care Quality Commission, and now works for Babylon Health, whose model, despite some controversial claims, has been promoted by the current health secretary.17 Monitor, the former regulator of foundation trusts, was headed by a McKinsey consultant, David Bennett, on one of the highest salaries in the NHS. His dual status as chair and chief executive of Monitor from March 2011 to January 2014 was criticised by the Public Accounts Committee,18 and he has since returned to consulting. Monitor employed more management consultants from the big firms than staff with frontline NHS experience, and it signed contracts with the big four consultancies worth £32m (€37m; $42m).19

The revolving door has been described by Jennifer Mindell as an element of the “corporate capture” of public healthcare,20 a phenomenon that weakens government’s integrity, independence, and effectiveness.

I’m not suggesting that we need to ban such moves. But we surely have to be far more transparent than we are right now and to shine some very public light on the revolving door to the NHS lobby.