The continued Covid pandemic, now again on the rise, the record summer demand for emergency ambulance services and emergency admissions to hospital, the ever-growing waiting list for elective treatment, mounting pressures on mental health services, and chronic staff shortages – these are just some of the problems faced by the NHS in 2021 going forward. But the government’s new Health and Care Bill does nothing to address any of them, and could even drive some demoralised staff to leave.
The Bill brings no extra funding for services, and no additional investment to tackle the mounting backlog of maintenance that has now risen above £9 billion. Instead, it is yet another major top-down reorganisation of the NHS, less than ten years after the last one. It will hugely disrupt and divert the energies and resources of local NHS bosses for at least the next two years, and cost many millions in redundancy and consultancy services.
Far from ‘integrating’ services, as claimed by the February White Paper that preceded it, the Bill as it stands could make disintegration easier, enabling private companies to pick up NHS contracts with minimal scrutiny or regulation.
While trade unions and campaigners wanted to get rid of the 2012 Health and Social Care Act and end competitive tendering in the NHS, we wanted the NHS to become the default provider of services. However, the Bill scraps only the 2012 regulations requiring NHS services to be put out to competitive tender, without establishing any clear new regulatory structure. This leaves scope for even more contracts to be awarded without competition to Tory cronies and donors, as we have seen on PPE and other contracts during the pandemic.
It also leaves local people with less influence than ever over their health services. It replaces local Clinical Commissioning Groups with just 42 regional level ‘Integrated Care Boards’ (ICBs), covering populations of up to 3.2 million, giving less local voice or involvement on the NHS than any time in the last 50 years.
Sweeping new powers for Secretary of State Sajid Javid would also give him control at all levels. Each Board will be led by a chair appointed by Javid; they cannot be removed without his agreement, and would appoint the chief executive and have a decisive voice on other Board appointments. On recent form, a rampant expansion of cronyism into the new bodies seems inevitable.
Local authorities in each ICB area have to choose just one representative between them on the Board, as NHS do trusts: but the private sector could wind up with a stronger voice. The GP representation on any ICB could potentially be a GP working for Centene, Virgin, or another corporate provider that has bought up GP practices.
And beyond the minimum five Board members, ‘local areas will have the flexibility to determine any further representation’, which could well mean private companies. Already one of the early shadow ICBs (Bath, Swindon and Wiltshire) has given a Board seat to Virgin, raising the question of how many private companies and management consultants will be represented when the 42 ICBs and their committees are given statutory powers by the Bill.
In all, the Bill gives 138 new powers to the Health Secretary, not least to intervene as he wishes into local plans to reconfigure services—over the heads of local communities, effectively marginalising the local authorities which currently have the responsibility to stand up for the interests of local people—and powers to refer controversial changes to the Secretary of State.
The Bill requires ministers to be informed of every proposed service change, so they can decide whether to formally ‘call them in’, and the Secretary of State would have powers to intervene anywhere at any stage, either to block local plans or indeed to demand (‘be the catalyst for’) a reconfiguration – possibly closing, merging, or downsizing local hospitals and services. The extent to which there would be any local control is left to his discretion.
To make matters even worse, each ICB will have a single, tightly limited pot of funding, and will be under pressure to cut services to fit the budget.
The Bill would also repeal the section of the Care Act 2014 which requires local authorities to carry out social care needs assessments before a patient is discharged from hospital. Given the lack of adequate community health and social care services in many areas, and the lack of funds to expand them, this so-called ‘discharge to assess’ could amount to a charter to dump patients without proper support.
It’s clear the Bill would not expand, improve, or integrate the NHS or social care, but reduce local accountability and offer new openings for private firms to decide policy and pick up contracts. It would be a step backwards rather than a step forward to reinstate the NHS as a public service, publicly provided, and publicly accountable to local people. For that reason, it must be opposed.