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Health and care bill: What threat does it pose to the NHS?

Critics argue the bill will pave the way for the NHS to be replaced by a profit-driven, American-style system.

The Health and Care Bill has passed the final hurdle in the House of Commons, and will now head to the Lords. 

Here’s why unions, doctors, nurses, MPs and celebrities are campaigning against it. 

What is the health and care bill?

The health and care bill focuses on restructuring parts of the NHS in England to create a ‘truly integrated’ healthcare system that involves less central bureaucracy. 

It proposes to establish 42 independently run Integrated Care Systems (ICSs) that cover the whole of England, made up of GP surgeries, community and mental health trusts, hospitals and other primary care services, with local authorities and other care providers.

These ICSs would be run independently by boards made up of NHS trust representative, finance, nursing and medical directors, as well as private companies. 

While there are currently 42 ICSs in England, the health and care bill proposes to establish ICSs as statutory bodies, meaning they would have the power to authorise legislation. 

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That means these ICSs would be responsible for commissioning and delivering services to patients within their geographical area, rather than one central NHS body, which has been the system since the founding of the NHS in 1948. 

The bill also increases powers for the health secretary to intervene on the configuration of services.

At present, controversial changes to NHS services can be referred to the government. But under the proposed Bill, the Health Secretary would be able to intervene in minor local plans at any time.

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Why has Sajid Javid proposed the bill?

The health secretary inherited the bill from his predecessor, Matt Hancock, when he took over in June.

Three days after being appointed, Javid urged the prime minister to delay the reforms planned by his predecessor because “significant areas of contention” had yet to be resolved, The Times reported.

Boris Johnson overruled Javid, though, and insisted that he press ahead with the “huge” NHS reorganisation.

“The fundamental aim of this legislation is to put into statute the requests the NHS made of government in 2019, while making a number of other changes to support improvement across the health and care system,” wrote Javid to the Health and Social Care Committee ahead of its second reading in July.

Javid added that the bill would “empower local health and care leaders to pursue new and innovative ways of delivering for people and communities.

Who is opposing the health and care bill?

Union Unite is one of the loudest and fiercest critics of the proposed bill, voicing concerns about its impact on services, accountability, funding, professional standards, privatisation, safety, and terms and conditions. 

“The government’s new Health and Care Bill is a Trojan horse for more cuts and cronyism and is a licence for politicians to run down and sell off our NHS,” said Jacalyn Williams, Unite’s national officer for health.

“Attempting to drive this through while we are still in the middle of a pandemic and without a care for patients, or staff already stretched beyond their limits, is a disgrace. 

Doctor-led campaign organisation EveryDoctor points out that up to 11 per cent of the NHS’s budget already goes to private companies. 

“This Bill will embed private companies in the NHS in England, and give them the power to decide who gets what treatment when. No one should be profiting from public healthcare, it’s as black and white as that,” the organisation said. 

Multiple Labour MPs have also thrown their weight behind the campaign to #ScrapNHSBill, including Rebecca Long-Bailey, John McDonnell and Barry Gardiner. 

Bell Ribeiro-Addy has labeled the bill “an attempt to carve up more of our NHS for privatisation and pave the way for more dodgy contracts.”

Dubbing the bill “the corporate takeover bill,” Labour MP for Norwich South, Clive Lewis wrote in The Independent; “these reforms will usher in a huge transfer of decision-making power to private companies and democratically unaccountable third parties through innocuous sounding “Integrated Care Systems”, which will not guarantee my constituent’s right to access the healthcare they need, when they need it.

Will the bill privatise the NHS?

The bill will bring about a “complete break up of the NHS as we know it,” a Unite spokesperson told The Big Issue, by breaking up the single, central and public NHS into 42 parts. 

These 42 parts will have space for private companies to sit on their boards, who will then be able to influence the running of ICS – including who receives contracts, the services it provides and at what cost. 

Private representatives including business owners, will be able to sit on these boards and influence the decisions made over services and care available to patients.

Unite fears that some boards might decide not to offer certain procedures or treatments labelling them as not cost effective. These boards could operate like commercial entities, maximising budgets over patients’ health.

This could create a postcode lottery that sees people in different parts of England get faster access to medical help than people in other areas. 

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While it is unclear what the funding streams will be for the ICSs, the union fears that instead of sharing one national budget among the NHS trusts, as is the current model, the model proposed by the health and care bill will create local pots of money, exacerbating regional inequalities. 

And finally, Unite warns that dividing up power to 42 different ICS could lead to different pay for NHS workers across the country, with a nurse in a more wealthy area earning more than a nurse in a poorer one.

What’s it got to do with the America healthcare system?

Opponents of the bill are warning that it will pave the way for the English NHS to be replaced by a profit-driven American-style system, which would incentivise private health providers to cut and deny care to increase profits.

“It’s modelled on the US healthcare system,” claims Unite, meaning that it makes more likely a situation which could see patients encouraged to go private for services that their local NHS body doesn’t offer, and then receiving a bill in the post. 

Actor and broadcaster Stephen Fry has lent his support to the yournhsneedsyou.com campaign, by drawing on his own experience of the American healthcare system.

“I’ve seen what a nightmare healthcare is – if you can call it that – in America. A real nightmare! And the idea of that infecting our NHS is like the idea of a new pandemic, frankly,” he said. 

“Research shows that American corporations are already embedding themselves in our NHS. And this is a really dangerous, and a very, very worrying turn of events.”

What amendments are being called for?

Unite is calling for the bill to be scrapped entirely, but others are seeking amendments.

More than 60 health and social care organisations including the British Medial Association and Royal College of Nursing,  are supporting an amendment, tabled by former health secretary Jeremy Hunt – now chair ofthe Health and Social Care Committee – which calls for the bill to address the staffing shortages crippling the NHS.

In a letter published by The Times, the group is calling for the bill to improve the way the NHS plans how many staff the health and care systems will need in the long term.

“There can be no doubt that the staffing crisis is the single biggest challenge facing our health and care services. Despite this, the proposals for workforce planning in the bill fall woefully short of providing any long-term solutions,” the letter reads. 

Staff shortages have affected almost all sectors of the NHS, causing severe delays in treatment including ambulances facing queues of up to 14 hours outside hospitals.

How did MPs vote?

The Health and Care Bill passed its third reading in the House of Commons despite the privatisation concerns and an amendment from Jeremy Hunt that would have introduced better workforce planning for care in England. 

The bill passed by 294 votes to 244, with a total of 18 Conservative MPs rebelling in support of Hunt’s amendment.

Campaigners shared their dismay on Twitter, vowing to continue to oppose the bill as it enters the House of Lords. 

EveryDoctor responded to the vote saying it would “build a digital map to mobilise communities in a movement to halt and reverse NHS privatisation.”

“This was just a battle. There has been a war on the NHS right from its inception; there have always been people looking to profit from healthcare. We want to win the war; and that requires a movement. So we’re building one,” said Dr Julia Patterson, chief exec of EveryDoctor.

The rejection of Hunt’s amendment on workplace staffing was met with “disappointment and disbelief” by the nearly 60 health and care organisations who tabled it.

“A broad coalition of professional, political and public support has been overlooked by a government still unwilling to solve the staffing crisis in the NHS and care system,” said Patricia Marquis, director of the Royal College of Nursing in England. 

“When vacancy levels are so high, the move is short-sighted at best and wilfully reckless at worst.”

There are around 100,000 NHS staffing vacancies advertised in England, reports The Mirror.

Hours after the amendment was rejected, parliament’s Health and Social Care Committee made up of cross-party MPS launched an inquiry into the NHS staffing crisis. It will look at why staff are leaving and what can be done to attract new doctors and nurses.

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