Based on an article by Justin Madders, MP for Ellesmere Port and Neston, leading for Labour on the Bill Committee
A pandemic, a burnt out workforce, record waiting times – pressure in every part of the system. The NHS is stretched to its absolute limit and beyond, yet against this background the Government have put forward the Health and Care Bill which represents yet another reorganisation of the NHS that fails to tackle the underlying causes of the challenges both health and social care face.
In simple terms, the Bill removes competitive tendering for clinical services (but not all NHS funded services); it replaces Clinical Commissioning Groups with bigger ICBs (which are expected to delegate to ‘place-based’ units of some sort); it replaces market structures with heavy top down management by a much enhanced NHS England. The big winners as always are the large acute trusts.
The Bill may end the waste and cost of pointless tendering introduced under Andrew Lansley, but it does not end privatisation even of clinical services.
The claims about the Bill favouring integration of services are largely rhetorical and clearly even the Government don’t believe they will be delivered as they have already begun to trail another White paper on integration.
Most worrying was the inadequate response to the issue of workforce planning. The provision was universally criticised – but has still so far remained.
During consideration in the Commons Public Bill Committee, numerous amendments were proposed but none were carried. (a total of 161 amendments to the Bill, 14 from Margaret Greenwood MP and 147 from Justin Madders)
Tory MPs voted down our efforts to ensure representation on NHS decision-making boards for mental health, social care, public health, staff and patients, and safeguard near-patient services from further outsourcing.
They also blocked our attempts to remove controversial powers for the Secretary of State to intervene in local service reconfigurations from the Bill.
Instead, there were many assurances and promises of further discussions and thought.
Some Government amendments are expected before the Bill goes to the next stage and concerns remain, especially about the possibility for private sector interests to influence commissioning of NHS funded services by having a role on ICBs, and for contracts with the private sector to be agreed without any proper oversight.
The new organisations are weak on clinical leadership and on staff, public and patient involvement. Who decides what is no clearer.
There is also the focus on acute care and the big Trusts – potentially leaving primary care, mental health, community care, social care, public health outside the key decision-making bodies.
The argument often advanced for rejecting Labour amendments that may have dealt with some of the concerns was that local systems should have ‘flexibility’ to shape services, but this argument was totally undermined by the provisions in the Bill giving many further powers for the Secretary of State and for top down intervention.
The Bill is about reorganising the NHS, not about improving care or the integration of care – and not about improving wellbeing or tackling unacceptable inequalities. It is a huge missed opportunity.
The structures in the Bill which are already largely in place may not last long, do not do enough to fix the mess made by the Tories’ previous reorganisation, and are frankly a distraction at a time when the NHS is facing the biggest crisis it has had in its proud history.
Staff and patients deserve better than this.
- Health and Care Bill fight will go on in the Lords
Health Minister Edward Argar tabled 14 amendments, the most significant of which reinstated deleted wording from the 2006 Act specifying that NHS services must include secondary care and ophthalmic services. However Argar’s promised amendment to exclude private health companies from gaining seats on ICBs has still not been tabled.Nor has any explicit guarantee of local access to emergency care, as it appears in the current legislation, been reinserted into the Bill, leaving questions over the access and entitlement to emergency care especially for refugees and migrant workers.Opposition parties in the Lords, where there is greater scope for votes to be won, will continue to fight for amendments on key issues including the lack of any local accountability, and seeking to define the NHS itself as the default provider both of clinical and of non-clinical services like cleaning, catering and porters.There are also likely to be proposals to require a business case to justify any contract in excess of a certain amount being outsourced to a private contractor, and imposing strict conditions.
UNISON has been supporting opposition efforts to amend the bill on the basis that the Government will pass something and so outright opposition would be ineffective. It less opens the door to privatisation as fails to close it. As it stands however, the Bill has most of its many initial deep flaws, and more organisations are drawing the conclusion that the limited repeal of the 2012 Lansley Act is not enough to justify anything but opposition at 3rd reading. UNISON needs an informed debate our future approach to it if nothing else changes.
