Thanks to Greg Dropkin for his summary of the failure of the final House of Lords’ attempt, on 26th April 2022, to stop some of the worst aspects of the contentious Health and Care Bill. This blog post is based on his report.
On Tuesday 26 April, the House of Lords met in order to decide how to respond to government decisions made by the Commons the day before, on these four issues:
- Workforce planning
- NHS Reconfiguration
- Modern Slavery
- Social Care Cost Cap
As things turned out, in the absence of substantial Labour opposition to the government positions, the House of Lords agreed to all four. This meant “ping-pong” was over.
The Bill has now received Royal Assent.
You can download Greg’s summary of how each issue was debated here:
Not with a bang but a whimper – What does it mean?
First, it means that almost none of the issues which we and KONP have highlighted were in the frame during the final arguments. These include:
- The Bill’s entire project to make the NHS compatible with the US Accountable Care model
- Emergency Care, never mentioned in the Bill, removing the existing requirement for Clinical Commissioning Groups to ensure its provision for everyone present in the area
- No definition of the group of patients for whom an Integrated Care Board is responsible
- The new Payment Scheme, with prices varying by area and by who receives the treatment or service and who provides it, and with the private sector consulted on the details. The Scheme will be used to set the budgets for Integrated Care Boards, to be enforced by NHS England
- The Secretary of State’s new power to deregulate health professions
- The Health Systems Support Framework, under which over 200 companies including several dozen US transnationals involved in the health insurance market, are accredited by NHS England to support the development of integrated care systems
- And all the issues previously considered by the Lords which fell by the wayside, such as ensuring in the text of the Bill that patients and carers would be protected before hospital discharge.
In the Commons, Margaret Greenwood was a lone voice attempting to remind MPs of some of the wider underlying issues as in her speech on 30 March.…Karin Smyth’s speech on 25 April shows that much of the Bill was satisfactory to the Labour Front Bench, and Shadow Health Secretary Wes Streeting did not speak in this (final) debate.
Second, there are now major dangers for patients and staff in the Bill as passed. Here are three:
- In an emergency, we all expect to go to A&E and be seen. Under current law, Clinical Commissioning Groups must ensure that emergency care is provided for everyone present in their area, but this Bill does not even mention emergency care. This will trigger disputes as to who pays, and may even lead to patients being denied emergency care. That would violate medical and nursing ethics and the NHS Constitution, whose first principle is headed “The NHS provides a comprehensive service, available to all.”
- The NHS cannot recruit and retain a stable workforce without good pay and safe working conditions, but the Bill threatens these too. The NHS is being broken into around 40 separate local financial systems. Budgets will be set using a new Payment Scheme whose prices vary around the country according to who is being treated, and who provides the treatment or service. Private companies will be consulted on the Scheme. With highly variable budgets tightly controlled by NHS England, Integrated Care Boards will be under pressure to reduce costs by using fewer or less qualified staff, or even introducing local pay.
- The Bill will open the door for private companies such as those accredited through the Health Systems Support Framework, to win contracts with Integrated Care Boards, influencing decisions on what care is provided, by whom, and for whom. It will be entirely up to the ICB Chair to decide whether an appointment to the Board, or its committees or sub-committees, “could reasonably be regarded as undermining the independence of the health service”. This subjective judgement without specific verifiable criteria, does not actually exclude private sector representatives from sitting on the ICB or its committees or sub-committees, which will have delegated powers and budgets.