WELL, here’s a rum one. The man who helped to drag many of Britain’s dentists off the National Health Service — and into a wealthier life working privately — has a new mission: helping the NHS plug the gaps that the mishmash of public and private is creating.
Confused? Not for long, if Mark Adams has his way. Adams is the new chief executive of the British arm of Netcare, the South African health group that wants to be the NHS’s biggest private partner over here. It already does operations for the NHS, and wants to run GP surgeries and — wait for it — NHS dentistry in areas where all the dentists have gone private, or just gone.
“I suppose you could say I am effectively making up for past sins,” grins Adams when I point out the irony. He used to run Denplan, the dental-insurance scheme that underwrote the shift of many dentists from public to private.
But that’s all behind him. Adams, 43, a posh Liverpudlian — born on the Wirrall — joined Netcare in January, after stints at Blue Arrow and AXA PPP Healthcare. Now he has new ambitions.
Last week, almost unnoticed in the furore over the NHS cash crisis, Netcare snapped up General Healthcare Group, one of Britain’s biggest private- hospital groups, in a £2.3 billion deal that immediately transforms it into a major player in the British health market.
Suddenly Adams has 49 hospitals to add to Netcare’s one in Manchester, and a host of specialists to liaise with, as well as some property and venture-capital partners who bankrolled the top-price deal (nearly £1m per bed). Might their priorities not be different to his? “It would have been difficult to fund the deal without them,” nods Adams, “but I have worked with venture capitalists before and, while they are more financially focused than those in a care organisation, they are not devoid of values. And we have 51%, so we have control.”
Podgy and serious, Adams talks in a low, fast monotone, sprinkling his arguments with numbers, the legacy of a life spent working in medical insurance, financial consultancy, recruitment and temporary staffing — one of Blue Arrow’s most successful arms, for instance, made its money providing locum doctors to the NHS.
Sitting in offices in London’s West End, where Netcare’s headquarters overspills into temporary accommodation, Adams knows his new job throws him right into the cauldron. Many are suspicious of the South African company’s motives here, especially at a time when health-service chiefs have lost control of their finances.
Adams brushes aside suggestions that firms such as Netcare are driving the NHS towards total privatisation. “Look, I’m a real fan of the NHS,” he says, “it’s one of the things Britain has done incredibly well since 1948, but any business model needs to look at how it reinvents itself.”
That reinvention should use the experience of health innovators such as Netcare, he argues, as the NHS abandons its old managed model and encourages private and public sector to compete as suppliers of care.
“In South Africa, we are more than just a successful commercial company, we are a values-driven organisation. We do A&E, primary, secondary and tertiary care, diagnostics, hospitals and after. We also do a huge amount of pro-bono work, with HIV outreach and cataract clinics in the townships.”
Yet Netcare, with a turnover of 6 billion rand (£544m) in South Africa, has had a less-than-perfect start here. Contracts to provide cataract operations in Oxfordshire led to primary care trusts paying for surgery that was never done. There simply weren’t enough patients to be operated on but, under the terms of the contract, the money had to be paid.
Adams puts it down to the inevitable teething problems of a new system. “The Oxfordshire commissioning was incorrect, they already had capacity, they didn’t need Netcare. But if you’re going to bring in doctors, nurses and facilities, you have to be guaranteed a certain amount of money.”
Since then, he says, Netcare has done extra work with other trusts to make up the difference, and he points to 97% patient-satisfaction scores with 39,000 operations done. “The last thing we want is to be paid for not doing something.”
Because that would damage Netcare’s ambition to be the NHS’s favourite service provider. “We want to bid for GP services and NHS dentistry,” says Adams, “and diagnostics and acute elective surgery.”
But wasn’t he one of the principal persuaders of dentists to leave the NHS? He shrugs. “Most dentists move not because they want to go private but because they cannot do the quality of work they want to do. In a Netcare NHS facility, with centralised administration and technology, we can create the environment that allows them to do work of quality and do okay economically.”
So why not privatise the whole NHS? “This isn’t about privatising the NHS,” he retorts, “we are not a Trojan horse undermining it. For me this is about sustaining the NHS and making it fit for the current century.”
And the NHS workforce, now bearing the brunt of the cash cuts? “The government is being brave,” he says. “Inviting the private sector in is a way of creating efficiencies without sacrificing quality. But it is creating change and change is always difficult for people.”
Behind the anxiety, Adams is a cogent, low-key persuader. He will have further advantages, too, as Netcare competes for NHS work. He can “off-shore” admin and other backroom work to South Africa. He also has South African-trained medical specialists to call on here.
It will, however, require deft handling. There are the expectations of Netcare’s South African bosses, who are also eyeing eastern Europe, to be managed, plus those of the venture-capital partners. General Healthcare’s management has to be melded in as well — it’s clear that Adams faces considerable challenges.
That, according to former colleagues, should not deter him.
“Mark’s very down-to-earth, he’s got years of experience and he’s very good at generating new ideas,” says David Mezher, chief operating officer of PruHealth, a British-South African joint venture where Adams sat as non-executive director. Peter Owen, ex-PPP, now chairman of CFS Stellar, calls him “an excellent manager, very good at the relationship side with the NHS”.
Adams is unusually experienced in the public-private divide in British health. His father worked for the insurance arm of the British Medical Association, advising doctors and dentists. Adams himself joined the Medical and Professional Insurance Bureau straight from school.
He set up his own consultancy in the mid-1980s, helping dentists move into private practice. He sold it for £1m to Denplan, which he went on to head. That in turn was taken over by PPP Healthcare, which similarly promoted him. Adams is unusual in having leapt from small to big company leadership with little in between, and he retains a mistrust of hierarchical structures.
“Mark’s a natural diplomat,” says Mark Wood of the buyout firm Paternoster, who worked with him at PPP, “and he’s activity-driven but not in a thuggish or relentless way. He did a fantastic job at PPP, taking it from loss to profit in short order.”
Adams’s time at Blue Arrow was less rewarding. He left early last year, he says, because of a difference of philosophy — “I wanted to take it away from pile it high, sell it cheap.” Before joining Netcare he was working on a portfolio of health interests, including a spinal-injury management organisation and a staffing business that brings in east European healthcare workers.
Now he has catapulted back to the top of a fast-growing organisation. He has to find new headquarters for Netcare, probably near London Bridge — nothing too flash, he acknowledges, as the company is going to come under intense media scrutiny. He drives a Porsche, too, but you are not likely to see much of that. Adams knows that a private-sector boss flitting round the NHS in a flash sports-car is a stereotype too far.
Instead you may see more of him with his stolid bulldog, Maggie. Adams has married twice — he divorced before setting up his first consultancy — and cites his family, his dog, his wine collection, the odd round of golf and Everton football club as his abiding passions.
“I am worried that your photo is going to make me look a bit of a chav,” he sighs, fretting about the photographer’s elaborate set-up. Heaven forbid. But as Netcare becomes increasingly prominent, that could be the least of his problems.
Vital statistics
Born: January 25, 1963
Marital status: married twice, with three children
School: Ellesmere College, Shropshire
First job: trainee, Medical and Professional Insurance Bureau
Salary package: £250,000 plus bonus
Car: silver Porsche 911
Home: Aspley Guise, a village near Milton Keynes
Favourite book: The Throwback, by Tom Sharpe
Favourite music: The Beatles and Green Day
Favourite film: Pulp Fiction
Favourite gadget: iPod
Last holiday: Dubai
Mark Adams's working day
THE chief executive of Netcare UK wakes at his house in Aspley Guise, near Milton Keynes, at 6.30am. Mark Adams is on the train to London soon after 7am and at his desk in Hanover Square by 8.20.
“A lot of what I do at the moment is growing the team. We are going to grow rapidly over the next couple of years in partnership with the NHS.”
He also attends meetings with the health department and primary-care trusts. “I look at how the bidding processes and implementation projects are going, and spend a fair amount of time talking to our banks, backers and shareholders.” Lunch with contacts is usually at Pret A Manger or McDonald’s. “We don’t spend money unnecessarily. It’s not a journalists’ dream dining with Netcare.” He tries to be home by 9pm.
Downtime
MARK ADAMS spends his money on wine and following Everton. “Being born on the Wirrall I am not a true Scouser — they call us Woolybacks — but I am a true Blue, a fanatical Evertonian. One of my proudest moments was when my 11-year-old son, Matthew, was mascot for the day at Goodison Park for the Blackburn game this season. It was probably a bigger day for me than him. We won 1-0.”
Adams also has “a weakness” for fine wine. “I tend to buy it en primeur and lay it down. Yes, I have made a few small purchases this year. Cantenac Brown and St-Julien — couple of dozen of each.”
He plays golf at Woburn, near Milton Keynes, and drives a Porsche 911, but he describes the Porsche as “a sop to the male menopause”. He expects it will be traded in for a Volvo soon.
