The future of public services has never been more uncertain, with politicians seeking to balance critical investment with the need to tackle the £178bn budget deficit.
In such a climate, then, what are the advantages for the public purse of the NHS paying a profit-making entity, Asteral, to source and maintain equipment on its behalf and to train NHS staff to operate it?
“We want to take away the headache for them so they can concentrate on running the hospital,” says Antoinette Keane, head of legal and company secretary at Asteral.
Of course, she would say that. But then, unlike other providers in the managed equipment services (MES) sector, such as Siemens and General Electric, Asteral is vendor-independent, meaning it can source equipment from a variety of manufacturers to come up with the best deal.
“Regardless of who gets in [following] the general election, there will be budget cuts. We can help by advising on having one piece of kit that has dual or triple functionality – it’s important being vendor-independent. Our contracts are fully flexible to allow them to review equipment every 12 months if necessary. We very much see it as a partnering relationship.”
The NHS is the company’s sole client. This is partly philosophical – a number of senior Asteral staff hail from the public body. But it is also strategic and relates to the NHS’s size and the potential for Asteral to add value through technical expertise.
Working with a single client may be part of the reason for Asteral’s risk-averseness.
“We manage risk to make sure there’s no litigation,” says Keane. “The biggest risk is negligence, but we follow NHS rules and policies. We keep meticulous records, have good clinical governance rules, mange all sites – we have people onsite all over the country – and have clinical specialists.”
Keane was the first lawyer at Asteral, having been an associate at Lovells for the previous three years. There was no central legal function when she joined – individual business lines instructed their own lawyers, burning up lots of cash in the process.
“One of the first things I did,” says Keane, “was to renegotiate astronomical fees with one of these firms on work that had already been done. Obviously it’s a lot harder than negotiating parameters from the outset.”
She works with Ashurst, LG, Lovells, Morgan Cole and Pinsent Masons, but decided against setting up a panel so that all instructions have to go through her. She admits having encountered a bit of ”resistance” to this, but her employers cannot be too unhappy after legal spend was cut by around half.
Keane tends to outsource M&A work (“it’s very labour-intensive; the firms have the resource and time”), together with “bespoke, specialist advice” on public procurement and employment matters, for example.
“I like to go to big names for bespoke advice – it’s always about the individual, not the firm. One of the reasons I instruct Ashurst is because I followed [project finance partner] Jason Radford, who moved from Lovells,” she explains. Radford is also her former boss.
The organisation has significant contracts with Greater Peterborough hospitals. This represents a £203m deal that is the “first-ever fully integrated, vendor-independent PFI contract”, she proudly asserts. The company also works with hospitals in Whittington and Leicester.
Because some of the work that Asteral wins is project finance-related it is obliged to use Department of Health documentation – the blandly named ‘Standard form 3’ (SF3). But Keane notes that this approach is fraught with problems.
“It’s written for a build project, it’s not appropriate for MES,” she states. “[With project finance build projects] risk decreases over time, but with MES this follows the lifecycle of the machine. In-house we’ve recently developed a new Asteral standard form contract. It more accurately reflects what an MES is and takes the best from SF3.”
The contract, which Keane and the two lawyers she manages spent around six months working on, was “very exciting”, she admits, before pausing and asking: “Does that make me sound boring?”
But you do not have to be a drafting anorak to appreciate the efficiency and clarity conveyed by the Asteral contract. Whereas most standard form contracts can run into more than 1,000 pages, Keane condensed it into a compact 77 pages.
By reducing bureacracy to allow the NHS to focus on its core tasks with an approach such as that, Keane is likely to win healthy admiration from her client and its patients alike.
Name: Antoinette Keane
Title: Head of legal and company secretary
Number of employees: 70
Legal capability: Three
Legal spend: £200,000-£300,000
Main external law firms: Ashurst, LG, Lovells, Morgan Cole,Pinsent Masons
Antoinette Keane’s CV
1994-97: LLB (Hons), University of Leicester
1999-2000: LPC, Nottingham Law School
2001-03: Trainee solicitor, CMS Cameron McKenna
2003-04: Associate, Tite & Lewis
2004-07: Associate and senior associate, Lovells
2007-present: Head of legal and company secretary, Asteral