Sometimes we publish pieces submitted by KONP members or supporters on topics that we think are important to draw to the attention of campaigners. This one is by Emet Sachin, who has investigated the issue of ‘gainshare’ contracts and how these are adversely affecting funding for Continuing Healthcare (CHC) to the detriment of patients and their families. Gainshare is a performance-based contract where a customer and a service provider agree to share a percentage of any financial gains or improvements achieved through the provider’s efforts and the customer’s implementation of recommendations.
One leading company working within the NHS is Liaison Financial Services. Its objective is to achieve cost savings for NHS healthcare organisations via internal ‘Workforce, Financial, and Care Divisions’; the Care Division focuses specifically on the optimisation of CHC costs. They set up a subsidiary company Liaison Care in 2022 filing brief ‘filleted’ accounts up to August 2024 as a ‘micro-entity’. This group of businesses have received £multi-million remuneration from Integrated Care Boards (ICB) as their share of cutting the value of, or cancelling, CHC packages to patients with complex health needs as this article explains. The Group Accounts documented substantial dividends, totalling £2,959,880 shared between four company directors.
Profiting from Sickness: An Investigation into NHS Continuing Healthcare and the Erosion of Clinical Integrity, by Emet Sachin
A friend’s distressing experience with his father’s CHC funding being withdrawn prompted me to undertake a detailed investigation using Freedom of Information (FOI) requests. This revealed a worrying picture, with ICBs increasingly outsourcing CHC assessments to for-profit private companies through ‘gainshare’ contracts. This practice undermines fundamental NHS principles and forms the central focus of this article.
The NHS operates on the basis of a key social contract: healthcare based purely on clinical need, provided free at the point of use. This core principle, a pillar of public trust in British healthcare, is critically important for NHS continuing healthcare. CHC is a fully funded care package for individuals with significant, ongoing health problems, especially those needing urgent End-of-Life Care, where timely and impartial provision is vital for dignity and quality of life.
CHC Principles and Distorted Purpose
Where an individual has a primary health need and is therefore eligible for NHS CHC, the NHS is responsible for commissioning a care package that meets the individual’s assessed health and associated social care needs. A CHC assessment determines eligibility for full NHS funding based purely on clinical need, without considering cost, as clearly stated in the National Framework for NHS Continuing Healthcare (revised July 2023). This standard protects vulnerable patients. Gainshare contracts are threatening this protection. Fast-track assessments exist for urgent cases, but even in these scenarios, financial incentives from gainshare contracts are distorting the assessment process, leading to delays and wrongful denial of funding. This commercial model fundamentally conflicts with the NHS ethos by incentivising providers to reduce or withhold essential care to reduce costs.
Conflict of Interest and Patient Harm
My investigation, prompted by a personal experience of a friend whose father’s care was cut, used FOI requests to multiple ICBs and unearthed evidence of direct conflict of interest. Gainshare contracts award a percentage of ‘savings’ back to the private company, and therefore create a perverse incentive to deny or reduce care, placing vulnerable patients at risk. I found cases where patients with terminal illnesses and degenerative diseases had their care packages drastically cut or withdrawn, leaving families to fight through appeals. In some tragic instances, patients have reportedly passed away before their appeals could be resolved.
Procurement and Governance Failures
The investigation revealed widespread failures in oversight and accountability within the NHS itself. For example, the Countess of Chester Hospital NHS Foundation Trust approved a key supplier, Liaison Financial Services, but repeatedly stated it did not hold crucial contract details like total value or pricing models. This lack of transparency and due diligence is a recurring theme, pointing to a systemic failure to protect patients from profit-driven harm.
Systemic Issues
FOI requests to various ICBs revealed a pattern of neglect, poor governance, and systemic failure, including:
- Incomplete Data Protection: Many legally required Data Protection Impact Assessments (DPIA) were either heavily redacted or incomplete, obscuring how sensitive patient data was being used by these private firms.
- Lack of Due Diligence: Contracts were signed with ‘Liaison Care’ before the company was legally incorporated, so the contract was actually with a financial services company (Liaison Financial Services), not a care provider. At least one ICB admitted to not performing due diligence before awarding a contract.
- Inadequate Consent and Consultation: Vulnerable patients were given as little as one week to provide informed consent for data sharing, and there was no patient or public consultation before these outsourcing decisions were made.
Specific ICB Examples
Some specific examples illustrate these systemic issues:
- NHS Nottingham and Nottinghamshire ICB: This ICB paid Liaison Financial Services at least £1,890,642, which correlated with 33.8% of claimed savings from 308 reviews. An internal review later confirmed a ‘gainshare’ agreement despite initial denials.
- NHS Norfolk and Waveney ICB: This ICB had significant governance gaps, including a Chief Nurse who signed a contract while also being the overall CHC budget manager, a clear conflict of interest. They had a ‘gainshare’ arrangement with Liaison Financial Services for 325 reviews, totaling at least £1.1 million.
- NHS Lincolnshire ICB: This ICB admitted to having no due diligence or risk assessments before awarding a contract to Liaison Financial Services and incorrectly reported that Liaison Care was CQC-registered. They spent at least £1,274,000 with the company for care reductions.
External Validation and Political Response
The issues identified in this investigation are not isolated incidents but part of a wider, national problem. A BBC News article on 29 August 2025 details how South Cumbria MP, Tim Farron, has urged the Government to intervene after cuts to NHS care, specifically noting the involvement of the private company Liaison Care.
An FOI request from Farron’s office to the Lancashire and South Cumbria ICB (and shared with the BBC) revealed that 94 people had their eligibility for CHC reduced or removed since Liaison Care was brought in, a figure five times higher than in a similar prior period. A report in The Westmorland Gazette further substantiates these findings, highlighting how a similar FOI request revealed a 420% increase in the number of people who have had their CHC eligibility reduced or removed by NHS assessors since Liaison Care was hired. This evidence directly supports the core finding of my investigation that these contractual arrangements lead to a significant increase in care cuts. These decisions, driven by financial targets, result in immense stress for vulnerable patients and their families, forcing them to spend their time fighting appeals against flawed decisions rather than maximising quality of life and forging good memories.
Problematic Invoicing Practices
Evidence provided from FOI requests shows that one company uses a detailed, scenario-based approach to billing. For instance, when an individual’s care needs change and their package decreases, the company invoices for the cost difference between the old and new packages of care. This continues for 12 months from the first invoice date. The company also has procedures for when an individual passes away, with invoicing stopping only at the end of the quarter in which the individual died. This practice indicates a financial model that prioritises income over patient care and is clearly a misuse of taxpayer money.
Implications and Urgent Concerns
These comprehensive findings collectively expose a widespread and deeply concerning issue where financial incentives are fundamentally driving care decisions, thereby profoundly undermining the public service ethos of the NHS. The alarming invoicing practices – charging for care not delivered or for deceased patients – further highlight how an overriding focus on monetary gain is systematically eroding clinical integrity.
Complete transparency is not merely desirable but an absolute prerequisite if genuine efficiency savings are to be credibly distinguished from harmful, cost-driven reductions in care. There is an urgent need to ensure that all contracts uphold stringent clinical standards, and, most critically, to protect vulnerable patients from profit-driven care reduction.
Failing to address these documented issues poses an existential risk to the NHS’s core mission, leaving its most vulnerable patients susceptible to the severe consequences of cost-cutting disguised as efficiency. Ultimately, this commercial model is fundamentally at odds with the NHS’s founding principles and creates an unacceptable conflict of interest where financial targets are prioritised over human need. This is not genuine care; rather, it is a profound system failure masquerading as efficiency, and the public has an inherent right to full disclosure and accountability.
Emet Sachin
Disgraceful. Has this been shared with the media, can it be?