Do Unions really oppose the Health and Care Bill?

The Social Partnership Forum’s “Transition Partnership Group” is supporting the organisational change to statutory Integrated Care Boards that the Health and Care Bill legislates for.

How many members know that their union has signed up to what appears to be tacit acceptance of NHS England/Government NHS policy as well as a clear commitment to work in partnership? 

The “Social Partnership Forum” is the health unions’ partnership with NHS England and the government 

It involves a signed partnership agreement between Government, NHS England, NHS Employers and Unions including the BMA, GMB, Unite and Unison. 

Social Partnership Forum partners

The Social Partnership Forum was set up in 2006 by the hugely unpopular Health Secretary Patricia Hewitt (now Chair of Norfolk and Waveney Integrated Care System), in response to the Unions’  embarrassing exposure of her when she was trying to privatise community services. (The Social Partnership Forum spins this rather differently in their History section. )

Locally, Kirklees Primary Care Trust used New Labour’s Transforming Community Services scheme to force through the divestment of its community health provider arm to Locala, a contentious community interest company the Primary Care Trust set up before its abolition by the 2012 Health and Social Care Act.  Kirklees Primary Care Trust refused to ballot staff about the transfer.

The Unions went on to sign an Agreement with NHS England and the government in 2012. The Agreement was updated in 2016 (the year of the junior doctor contract). In the agreement, all parties agreed to “confidentiality” and “agreed external positions”. 

The 2016 Agreement essentially committed the health unions to assisting policy implementation of a new public/private NHS Integrated Care System. Through NHS England’s 2014-19 Five Year Forward View, and then through the NHS Long Term Plan 2019-24, the NHS has been dismantled into 42 non-statutory Integrated Care Systems.

Initially manifesting as Sustainability and Transformation Plans, these Integrated Care Systems are based on the USA’s limited Medicare/Medicaid system that provides limited publicly-funded health insurance for people who are too poor or old to get private health insurance.

The Health and Care Bill 2021 is designed to lock this system in place. It passed its second reading in the House of Commons on July 14th and will enter the Committee Stage from 7 Sept until 2 November.

To “support system change”, in  April 2021 the Social Partnership Forum created a new “ICS Transition Partnership Group” co-chaired by NHS England and Unison.    Through this partnership approach with the Government and its quango NHS England/Improvement,  the Unions appear to be helping to smooth the way for the Health and Care Bill:

“The ICS Transition Partnership Group (TPG), a subgroup of the national SPF, was established in April 2021, to enable partners to get involved in the organisational change arising from the establishment of statutory ICSs. The group includes representation from NHS England and NHS Improvement (NHSEI), Department of Health and Social Care (DHSC), NHS Employers, ICSs/clinical commissioning groups, commissioning support units and NHS trade unions. The aim of the group is to support staff during the organisational change, by minimising uncertainty and limiting employment changes, working to the principles of simple, local and evolution.”

Its Terms of Reference, created in June 2021, has these “deliverables”: 

“Work together to ensure all national guidance and process with workforce implications is supportive of the delivery of the transition in line with the core principles and intended approach. 

“Support a smooth transition and minimise disruption.” 

By 19 August 2021,  the Transition Partnership Group (TPG) had developed an Integrated Care System Human Resources Framework for the transition of staff into Integrated Care Boards. Alan Lofthouse (Unison) and Tom Simons (NHSEI) have published a joint statement in support of the HR Framework.

The Transition Partnership Group has  also  published guidance on provider collaboratives.  The guidance builds on the Integrated Care System design framework, and sets out the importance of provider collaboratives and place-based partnerships, highlights the benefits of working at scale, and outlines expectations for systems and providers.

Doesn’t look much like health service Trade Unions’ opposition to the Health and Care Bill.

So what does the British Medical Association Council’s vote against the Bill amount to?

The British Medical Association have identified Parliamentary amendments that they will be calling for and says without them they will be unable to give any future support for the Bill.

But the Health and Care Bill is beyond amendment

Tinkering with it will not create a Bill that meets the needs of the NHS for the 21st Century.

The Bill must be stopped by MPs.

NHS and social care legislation must be deferred until a Bill can be drafted that will enable:

  • world class health care for all,
  • a publicly-provided national health service, adequately funded and free at the point of need,
  • providing comprehensive treatments based on the patient’s best interest, decided together with clinicians not on the basis of financial calculations,
  • with national NHS staff pay and conditions and professions regulated independently of government politics.

On July 14th, the day MPs voted through the second reading of the Health and Care Bill, Sharon Graham said on Facebook that the “Bill is a Trojan horse for more privatisation, cronyism, austerity and a licence for politicians to run down and sell off the NHS.” And that she “will ensure Unite leads a serious & effective campaign to oppose this disgraceful bill.”

Locally, Unite Community – Lancashire branch, with support from British Nuclear Fuels Ltd Unite branch, has initiated a collective campaign with NHS campaign groups to lobby the 11 Lancs Tory MPs who all voted the Health & Care Bill through on its second reading, to vote against the Bill at its next stage and to oppose the Integrated Care Systems into which the NHS has been remodelled.

You can find out more about the Lancashire Don’t Blow It! Kill the Health and Care Bill campaign here .

Update January 2022.

As the House of Lords debates Health and Care Bill amendments during its Committee stage, Stewart Player’s Yorkshire Bylines piece ‘Consensus and betrayal: the health bill and the unions‘ concludes,

“[A]ll Forum participants have known exactly how to add to the confusion, arguing at once to reject and strengthen the bill. And, as may be expected, the unions’ ‘offensive’ against the bill has been scaled up as the legislation passes through the House of Lords, secure in the knowledge that it will have no impact whatsoever. In fact, unions’ support for the NHS is now primarily rhetorical, and bears remarkable similarities with the actions and alignments of organised labour in the US, which has been a main culprit in the repeated defeats of proposals for universal healthcare, and the retention of private insurance, within that country.

“At the very least, all the union leaders involved owe their members, and the public alike, some clarification as to their real position with regards to the bill.”


  1. The wretched Hewitt has been responsible for so much harm.

    To quote Wikipedia: “In January 2008, Hewitt was appointed special consultant to the world’s largest chemists, Alliance Boots. Such an appointment was controversial given Hewitt’s former role as Health Minister, resulting in objections to her appointment by members of a Parliamentary committee.

    Hewitt also become the special adviser to private equity company Cinven, which paid £1.4billion for Bupa’s UK hospitals.

    Hewitt joined the BT Group board as a non-executive director on 24 March 2008 and retired from the position in 2015 after six years as a director and five as senior independent director and chair of the remuneration committee.

    In July 2009, Patricia Hewitt joined the UK India Business Council as its chair and was reappointed to the role in 2014. She stepped down from this role in 2017.

    In July 2017, Patricia Hewitt was appointed the chair of the NHS Sustainability and Transformation Plan (STP) Oversight Board for Norfolk and Waveney.

    Liked by 1 person

  2. nor is the agreement to forward the long-term plan ‘tacit’ as it is explicit in its description of how it will support the transition from the current system / model to the American counterpart.

    What the health unions signed up to in the government Social Partnership Forum (2016 updated agreement in 2019)…
    To support the effective partnership working in system transformation, including changes arising from new care models, integrated care and the Sustainability and Transformation Plans (STPs).

    Liked by 1 person

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