No place for the profit-motive in the NHS

A letter published in today’s Swindon Advertiser.

Andrew Milroy (Americans should stay away from the NHS) was certainly right about the US health companies. The health insurance system they have has been disastrous for the health of the country. The US health insurance industry devotes resources on preventing people with health insurance from having treatment, adding acute stress to illness. The largest source of personal bankruptcy in the USA is the cost of health care, for those ‘lucky’ enough to receive it. For those who don’t it’s often a death sentence.

However, Andrew is wrong when he says they can’t afford to come here. Sadly they are already here, bleeding the NHS of resources. UnitedHealthcare is a case in point. It’s part of UnitedHealth Group, the world’s ninth largest company by revenue.

In a recent development, decisions on whether patients receive care are being made by AI programmes which often cut off funding and send people home, even when health staff object. According to a US Senate report published last October, from 2020 to 2022, UnitedHealthcare more than doubled the rate at which care is denied at the same time as it introduced an algorithmic tool to manage claims.

Four years ago, UnitedHealth’s fully owned subsidiary Optum, bought NaviHealth, the firm behind the AI model “nH Predict”. The algorithm was designed to save money by predicting the date when patients would be ready for discharge, by comparing them to a database with 6 million care records.

UnitedHealth Group has repeatedly said that its algorithm is used as a mere guide. But former staff have claimed that it was used to set stringent targets and that deviating from the targets, for instance, by insisting that a patient actually needs to stay in hospital for longer, led to being disciplined.

An investigation by US healthcare website STAT, found horrific stories of the harm this caused. For instance, a stroke patient was allotted 20 days of rehab by the algorithm, when the average for severely impaired stroke patients is almost double that, A 78 year old blind man who needed care for a failing heart and kidneys, and then fell in the nursing home, was granted 16 days. An elderly man nearing his discharge date after knee surgery was told to learn how to “butt bump” up and down stairs.

It’s a matter of concern, then, that UnitedHealth Group, is deeply embedded in the NHS. Its subsidiary Optum is paid by almost every Integrated Care Board for medicines management, primary care patient records or both, after its £1.2bn buyout of IT firm EMIS (Egton Medical Information Systems) was approved by the Competition and Markets Authority in 2023.

Concerningly, UnitedHealth’s subsidiaries are in the running to win contracts to provide the same services for the NHS that they have been criticised for in the US. Here, Optum was accredited by NHS England to bid for contracts on that very subject – the “provision of systems and solutions to automate the orchestration of pathways of care (including utilisation of AI)”.

Whether American or British, private health companies are bleeding the NHS of resources. Profit is literally a waste of money since it is taken out of the system. The profit motive should be driven out of the NHS. It has no place in it.

Andrew says “Surely their mission is not just to make money!”. Unfortunately it is. The opioid crisis, which he mentions, has shown that companies continue to push their drugs even when they know they are killing people. Some 450,000 Americans have died of opioid overdoses related to Oxycontin alone.

One of the demands of Trump for a trade deal with Britain is the further opening up of the NHS to US corporations. The government should commit to saying a firm No and also to sending the likes of UnitedHealthcare packing.

Martin Wicks