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The Guardian view on Boots: sick staff, a healthcare business and the public purse The Guardian view on Boots: sick staff, a healthcare business and the public purse
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A week ago, the Guardian published a Long Read on Boots, a piece which has provoked an extraordinary reaction. A flood of letters from pharmacists that even now shows no sign of stopping. Strong concern voiced by medical professionals, from GPs to the Royal Pharmaceutical Society. And the watchdog compelled to step in, so that, remarkably, Britain’s biggest pharmacy now faces the prospect of a regulatory investigation. A week ago, the Guardian published a Long Read on Boots, a piece which has provoked an extraordinary reaction. A flood of letters from pharmacists that shows no sign of stopping. Strong concern voiced by medical professionals, from GPs to the Royal Pharmaceutical Society. And the watchdog compelled to step in, so that, remarkably, Britain’s biggest pharmacy now faces the prospect of a regulatory investigation.
Our investigation reported a series of allegations from Boots’ own staff, as well as independent experts. We uncovered evidence that a senior manager at the chain was pressuring employees to milk NHS schemes for cash. Pharmacists suggested that professional ethics were being sacrificed for the sake of profit, and spoke of working conditions that threatened patient safety. All this appeared to stem from the business model adopted by Boots after its £11bn private-equity buyout in 2007. To pay back billions in loans, and to make their required returns, the investors pursued a model of “stretch and extract”: stretching finances and staff to the limit – then extracting profits.Our investigation reported a series of allegations from Boots’ own staff, as well as independent experts. We uncovered evidence that a senior manager at the chain was pressuring employees to milk NHS schemes for cash. Pharmacists suggested that professional ethics were being sacrificed for the sake of profit, and spoke of working conditions that threatened patient safety. All this appeared to stem from the business model adopted by Boots after its £11bn private-equity buyout in 2007. To pay back billions in loans, and to make their required returns, the investors pursued a model of “stretch and extract”: stretching finances and staff to the limit – then extracting profits.
In the light of the reaction, several conclusions can be drawn. First, Boots has been too hasty to deny the allegations from its own staff. If the company wasn’t convinced by the evidence with which it was presented by this newspaper, it ought to have heeded the worrying results of the survey run by the Pharmacists’ Defence Association. The subsequent correspondence from the very people the article was about – near-unanimous in their agreement, and adding their own experiences – ought to stir any executive team into further investigation. Crude denialism will not wash.In the light of the reaction, several conclusions can be drawn. First, Boots has been too hasty to deny the allegations from its own staff. If the company wasn’t convinced by the evidence with which it was presented by this newspaper, it ought to have heeded the worrying results of the survey run by the Pharmacists’ Defence Association. The subsequent correspondence from the very people the article was about – near-unanimous in their agreement, and adding their own experiences – ought to stir any executive team into further investigation. Crude denialism will not wash.
Second, the pharmacists speaking out clearly feel let down by their employer, their regulator and their government. Our correspondents and interviewees often request anonymity, for fear of reprisals from Boots or other pharmacy chains. Employers’ whistle-blowing procedures are mistrusted – and some correspondents don’t put much stock in the General Pharmaceutical Council to tackle these issues either. Years ago, the NHS’s own research, as well as the Royal Pharmaceutical Society, warned of the potential for abuse of medicine-use reviews (MURs), at a cost both to sick patients and to the taxpayer. Yet pharmacists allege that even now there is widespread abuse of this scheme and others – at Boots and its major rivals. For the regulator not to investigate these claims now, and for the Department of Health not to begin its own probe, would betray indifference to a mass rip-off.Second, the pharmacists speaking out clearly feel let down by their employer, their regulator and their government. Our correspondents and interviewees often request anonymity, for fear of reprisals from Boots or other pharmacy chains. Employers’ whistle-blowing procedures are mistrusted – and some correspondents don’t put much stock in the General Pharmaceutical Council to tackle these issues either. Years ago, the NHS’s own research, as well as the Royal Pharmaceutical Society, warned of the potential for abuse of medicine-use reviews (MURs), at a cost both to sick patients and to the taxpayer. Yet pharmacists allege that even now there is widespread abuse of this scheme and others – at Boots and its major rivals. For the regulator not to investigate these claims now, and for the Department of Health not to begin its own probe, would betray indifference to a mass rip-off.
Finally, the story of Boots is at root about what happens when high finance preys on the high street, taking billions in public money yet legally avoiding taxes, and turning a 150-year-old British institution inside out to enrich a core of offshore investors. The damage done to hardworking professionals, to the public purse and indeed to public trust is huge. And yet Boots, whose private-equity owners cashed out in 2014, is not the only such case. The care-home industry is dominated by private equity, a high-borrowing, hard-charging business model fundamentally unsuited to that slow-growth sector. NHS contracts – for everything from plasma storage to hospital management – are being parcelled up and flogged off. That has already produced some disastrous results, as the staff and patients at Hinchingbrooke district general hospital can tell you.Finally, the story of Boots is at root about what happens when high finance preys on the high street, taking billions in public money yet legally avoiding taxes, and turning a 150-year-old British institution inside out to enrich a core of offshore investors. The damage done to hardworking professionals, to the public purse and indeed to public trust is huge. And yet Boots, whose private-equity owners cashed out in 2014, is not the only such case. The care-home industry is dominated by private equity, a high-borrowing, hard-charging business model fundamentally unsuited to that slow-growth sector. NHS contracts – for everything from plasma storage to hospital management – are being parcelled up and flogged off. That has already produced some disastrous results, as the staff and patients at Hinchingbrooke district general hospital can tell you.
This isn’t about “public good, private bad”. Independent pharmacists are also private but don’t attract the same sort of accusations as the chains. Politicians (including within Jeremy Corbyn’s Labour) and the public need to assert certain principles. Who owns a company matters. Corporations working in this country and enjoying its infrastructure and well-educated workforce have obligations that go beyond paying the legal minimum in tax. And democracies are entitled to impose limits on what the rich extract from the rest.This isn’t about “public good, private bad”. Independent pharmacists are also private but don’t attract the same sort of accusations as the chains. Politicians (including within Jeremy Corbyn’s Labour) and the public need to assert certain principles. Who owns a company matters. Corporations working in this country and enjoying its infrastructure and well-educated workforce have obligations that go beyond paying the legal minimum in tax. And democracies are entitled to impose limits on what the rich extract from the rest.