Thanks to the 216 MPs who voted (sadly unsuccessfully) to annul Statutory Instrument on Integrated Care Provider regulations

On Monday 18th March MPs debated Early Day Motion #2103. This Motion was sponsored by Jeremy Corbyn, the Shadow Health Secretary Jonathan Ashworth and other opposition MPs. It sought to annul Statutory Instrument 2019 No.248, The Amendments Relating to the Provision of Integrated Care Regulations 2019.

The record of the debate is online here.The record of the vote is online here. The breakdown of the “aye” votes by party is: 4 Conservative, 1 DUP, 1 Green Party, 205 Labour Party. LibDems don’t seem to have voted either for or against. What’s that about?

999 Call for the NHS are sending the following thanks to all 216 MPs who voted to annul the Statutory Instrument – combined with a warning about the risks to patients and staff of Integrated Care Systems and their key building blocks, the new Primary Care Networks. If you’d like to thank your MP – and pass on this warning – you can find their contact details here. And you can download this MP letter here (.doc file) and change it as you please.

Dear MP

Thank you for voting for EDM #2103, in the attempt to annul SI 2019 No 248. As well as thanks, we would like to offer a warning about the damage that Integrated Care Systems and their key building blocks, the new Primary Care Networks, are already inflicting on patients and staff.

We knew the arithmetic of MPs’ party membership meant it was very unlikely that this Prayer Motion would be passed. But it was crucial for MPs to stand up for the principle that such important legislative changes should be introduced by primary legislation. Not quietly introduced, without proper MPs’ scrutiny and debate, in secondary legislation that undoubtedly means it is possible for a private company or joint venture to hold an Integrated Care Provider contract.

As far as we can see, nothing in the proposed primary legislation would undo that possibility.

Although NHS England proposes primary legislation that would repeal s75 of the 2012 Health and Social Care Act and remove NHS commissioners and providers from the scope of the Public Contracts Regulations, it seems that the quango still intends to retain the possibility of competitive tendering. Implementing the NHS Long Term Plan – Proposals for possible changes to legislation 2.11 says,

“There should be a continued place for the use of competitive procurement, either by NHS commissioners or integrated care providers…”

And 2.15 says,

“The new regime would allow NHS commissioners to choose either to award a contract directly to an NHS provider or to undertake a procurement process…”

We welcome MPs’ opposition to SI 2019 No 248 on the clear grounds that that such important legislative changes should be introduced by primary legislation – particularly since the secondary legislation allows the Integrated Care Provider contract to be held by a private company or joint venture.

But we are puzzled by the Shadow Health Secretary’s second reason for opposing the Statutory Instrument, namely that:

“…the proposal to incorporate GP practices into ICPs appears to cut across the idea of GPs beginning to work in wider networks covering 30,000 to 50,000 patients, retaining their GP contracts but sharing common resources. That was highlighted as a direction of travel to be celebrated by the Prime Minister when launching the long-term plan.
GP practices can already network and collaborate without this new contract.”

With all due respect, we feel this is a misreading of the situation. We can’t see how Integrated Care Providers cut across the primary care networks. Rather, as far as we can tell, the new GP Network contract that requires GPs to work in wider networks covering 30K-50K patients, is identical to NHS England’s “virtual” Integrated Care Provider contract – just rebranded under another name.

(The draft Integrated Care Provider contract that NHS England consulted on last year came in 3 versions – fully integrated, partially integrated and virtual. The differences are about the position of GP services in relation to the contract.)

(The Multispeciality Community Provider contract is one variant of the draft Integrated Care Provider contract)

The key point for us is that – whether or not GPs are employed by Integrated Care Providers – both Primary Care Networks and Integrated Care Providers do the same things. They provide a care model, obviously based on the USA’s Accountable Care Organisations, that is designed to “manage demand” for NHS and social care services. And to deliver this care model, they employ a cost-cutting, less skilled “modern workforce”, also copied from USA Accountable Care Organisations.

This care model has many problematic features for patients and staff. We believe it is not appropriate for the NHS, as a universal health service intended to socialise risk and provide a comprehensive range of treatments based on patients’ clinical needs – not financial considerations.

The Integrated Care model is based on cuts and downgrades to District General Hospitals, closure of Community Hospitals’ beds and the shift of hospital services into large scale primary and community care services.

This has serious negative effects on patients, as distances to hospitals and GP “hubs” increase. It worsens health inequalities, since it disproportionately affects patients on low incomes who can’t afford the extra travel for themselves and their families.

The new Integrated Care model restricts patients’ access to GPs – who will mostly only see high-cost patients with complex conditions. Less qualified staff, including physician associates, will see everyone else. This will make it almost impossible for patients to exercise their right under the 1948 NHS Act, to continuity of care with a named GP.

The new Integrated Care models also push much of the work of health and social care onto patients themselves, their families, friends and voluntary sector organisations (the so-called “left shift”). This is hailed as an end to the “dependency” model of healthcare – a worrying echo of the neo-conservative demonisation of people in receipt of benefits.

Integrated Care Systems introduce large scale behaviour change schemes targeted at patients suffering from, or deemed to be at risk of, modern epidemics such as obesity, diabetes, anxiety, depression, heart and respiratory problems – regardless that these are largely determined by social, economic and environmental injustices and deregulated corporations.

Through wearable technology, there will be a lot of remote digital monitoring of people’s participation in self care and self management. We think there are pretty horrendous privacy and civil liberties implications (briefly discussed by Shoshana Zuboff in her Surveillance Capitalism book). We are alarmed that this could be the slippery slope towards conditionality of NHS care, as patients are divided into deserving and undeserving ill.

Given the problematic nature of the integrated care model that the government and its quango NHS England are imposing on the NHS, we would welcome clarification about whether or not you support this.

Thank you again for voting for EDM #2103.


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