Announcements that the Government and NHS England have proposals for NHS legislation that will “rein in” privatisation are misleading and beside the point.
The proposed NHS Integrated Care Bill is to enable the fragmentation of the NHS into Accountable Care Organisations – which the government has rebranded as Integrated Care Providers.
It will not save the NHS from big business – rather, it props the door wide open for it.
The undersigned NHS campaigns demand that Parliament:
- blocks the government’s US accountable care legislation
- doesn’t enable it by trying to amend it, as the Libdems did with the Health and Social Care Act
- passes an updated version of the NHS Reinstatement Bill, that clearly abandons the current neo-liberal, neo-conservative model of integrated health and social care, and extends to social care the NHS core principle of comprehensive health care that is free at the point of access for all, on the basis of clinical need as agreed between patient and clinician – in the changed context of today’s society
If the government’s proposed legislation comes to the table, all opposition MPs – as well as those Conservatives who respect the majority public view that the NHS should be nationalised and run by the public sector – should be under no doubt that they need to block it.
Deregulating markets in the NHS
The government’s proposed NHS Integrated Care Bill would scrap Section 75 of the 2012 Health and Social Care Act. This is taken to require competitive procurement of local NHS services. The Bill would also remove NHS commissioning from the remit of the Public Contracts Regulations 2015.
But this doesn’t begin to scratch the surface of the problem of NHS marketisation and privatisation.
The proposed legislation leaves intact contracts and their procurement, which we do not think should be the basis of providing NHS services.
Tellingly, Andrew Taylor, former director of the NHS Cooperation and Competition Panel, is on record as saying that the government’s proposals are about deregulating markets in the NHS, that they in no way remove them, and that
“no one has realistically talked about removing the private sector. ”
An updated NHS Reinstatement Bill is the primary legislation that Parliament needs to pass
The Health and Social Care Act 2012 should be repealed in its entirety, along with all other NHS marketising and privatising legislation and regulation as identified in a Consequential Provisions Bill to accompany the NHS Reinstatement Bill.
This Bill was drafted by a leading public health professor and a barrister.
Unlike the government’s proposed NHS Integrated Care Bill, the NHS Reinstatement Bill starts from the premise that the NHS is concerned with health and social care provision and should not be subject to market forces either internal or external.
The NHS Reinstatement Bill would restore the duty of the Secretary of State to provide or secure the provision of a comprehensive, universal NHS that is free at the point of clinical need and fully publicly funded, owned, managed and provided by directly employed NHS staff.
Worryingly, the government’s proposed NHS legislation will enable the fragmentation of the NHS into Accountable Care Organisations – rebranded by the government as Integrated Care Providers.
This ambition is the focus of their NHS Long Term Plan.
The House of Commons Health and Social Care Committee has been at some pains to convince the public that “Integrated Care” would not lead to privatisation of the NHS.
In January 2019, an MP on the Committee invited Simon Stevens, the NHS England boss, to explain this to the public. The Health Secretary, Matt Hancock, cut in excitably:
“There’s no privatisation of the NHS on my watch. The Integrated Care Provider contracts will go to public sector bodies to deliver the NHS in public hands.”
But by creating a new type of NHS trust – the Integrated Care Provider Trust – the NHS Integrated Care Bill risks turning the NHS into a set of local private/public partnerships.
As lead provider of a huge range of health and social care services for its area, an NHS Integrated Care Provider Trust would subcontract many front line NHS, social care and public health services to numerous private and third sector companies and charities.
This effectively creates Integrated Care Providers as a very large pool of public money to be siphoned out of the NHS.
The government’s proposed legislation will not save the NHS from big business – rather, it props the door wide open for it.
Ending the Competition and Markets Authority role in the NHS
Promoting collaboration over competition is an often-quoted justification for the imposition of “integrated care” on the NHS.
The government’s NHS Integrated Care Bill would end the Competition and Markets Authority role in the NHS, in order to facilitate NHS hospital mergers.
But problems are created by so-called ‘economies of scale’ where – in an attempt to emulate industry – hospitals are merged into larger entities regardless of the variety of patients’ needs.
Historically, mergers have resulted in downgrades and centralisation that strips hospital services from whole areas and increases health inequalities.
Individual and local knowledge are lost and problems are dealt with according to protocols and pathways, not what is best for the patient. This has to change. The system must be designed around what the patient needs, not on business considerations.
MPs must make sure that the NHS Integrated Care Bill does not go ahead.
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