ourNHS: Analysis

Forget the spin – new English NHS bill is all about cutting our right to healthcare

Far from reversing the disastrous 2012 reforms, this new bill makes it even easier to axe and privatise services – that’s the real COVID ‘recovery plan’

caroline m.jpg
Caroline Molloy
13 July 2021, 4.30pm
Sajid Javid, unmasked
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Tayfun Salci/ZUMA Wire/Alamy Live News. All rights reserved

We all know the NHS has a huge backlog. As things stand, it will struggle to meet its legal obligations to provide us with the healthcare we need for the years ahead.

The government faces a simple choice. It can either support the NHS to meet those obligations – ideally in a way that improves its long-term sustainability. Or it can reduce those obligations – reduce our rights to access healthcare.

New English health secretary Sajid Javid claims that his goal is to “build a better NHS and bust the backlog”. But experts who’ve pored over the detail of the new Health and Care Bill, published last week and due for its second reading in Parliament tomorrow, have spotted alarming signs that the bill will follow the latter strategy.

That it will “bust the backlog” by further reducing the government’s obligations to secure NHS care for us all – and our ability to get that care.

It’s a direction of travel the government has been on for some time. But this bill goes far further – even, according to the lawyer Peter Roderick and public health doctor Allyson Pollock, removing the current legal duty to arrange the hospital care people need, from surgery and consultant care to physiotherapy.

Such a possibility may sound hard to countenance. But the warning comes from the team that was the first to explain why the 2012 NHS reforms were a poorly understood disaster – as then Prime Minister David Cameron himself later admitted. Pollock was also the most prominent early voice to warn that Private Finance Initiative (PFI) hospital schemes were an enormously overpriced way of building NHS capacity, as pretty much everyone now admits.

The bill enables a power grab by the Treasury, the money men, the private sector and their lobbyists

Other leading health campaigners and experts – including Keep Our NHS Public, We Own It, Public Matters, John Lister, and David Rowland of the Centre for Health and Public Interest – have all raised the alarm that the substance of the recent white paper and now the bill, dumped on an exhausted NHS, an exhausted Parliament and exhausted population, appears to be being driven by principles opposite to those that are being spun. They are also entirely against the wishes of the public, who remain strongly wedded to a universal, comprehensive and publicly delivered NHS.

Power grab by the money men

The problems with the bill cannot be waved aside as minor details, to be sorted out in committees as it makes its way through Westminster.

Far from being a power grab by the health secretary as some media reports assert, the bill enables a power grab by the Treasury, the money men, the private sector and their lobbyists – one which will have terrible implications for ordinary people’s access to healthcare and the future of their local hospitals and other NHS services.

The bill and its accompanying measures impose an iron grip on costs, at least in terms of cash for local NHS services, whilst dramatically watering down the public’s rights in terms of what healthcare we will have a right to receive, where, when, and from whom, in the future.

Alongside the alarming drafting on rights to hospital care, the performance targets imposed by the bill scrap the 18-week target for waiting times, mentioning only a target of 52 weeks, for example.

Pollock and Roderick also point out that it scraps the “responsibility” the government has to arrange healthcare for each of us in England and replaces it with a – seemingly undefined, but presumably more restricted – “core responsibility” for uncertain “groups of people”. It also gives the health secretary the power to water down the requirement for staff to be properly trained and qualified.

The bill also makes it far easier for whatever government money flows into the NHS to flow straight back out again to private firms, and allows private corporations to play a huge part in shaping virtually every aspect of our healthcare.

Much of the crucial detail is left out of the bill. It instead empowers the health secretary to fill in the gaps without returning to Parliament.

And it allows him to appoint the local chairs of the new local health boards – so-called Integrated Health Boards – and allows them, in turn, to grant seats on those boards to representatives of private health and care companies.

These boards are given latitude to decide what healthcare local groups of people will and won’t receive in future, what services are kept open, which are shut or scaled back or ‘digitalised’.

The firms that could take seats on them include the likes of Centene, a US insurance and Medicaid giant rapidly expanding in England’s NHS, now the largest provider of GP services in England and with a stake in an outsourced hospital surgery firm, Circle Health. Boris Johnson recently appointed the head of Centene’s UK operation, Samathana Jones, as his senior health advisor.

Then there are firms like Babylon, which supplies digital NHS GP and 111 services across London and beyond, and is now part-owned by both Centene and controversial US tech giant Palantir. Or the private-equity-owned giants that already provide the large part of England’s mental health and care homes, and whose lobbying for inclusion on these boards looks set to bear fruit.

The bill even explicitly gives private firms a say in deciding how much they should be paid

Or Virgin – which since 2012 has won contracts for huge chunks of community health services, and already has a seat on at least one ‘shadow’ version of these new boards as a result.

A race to the bottom in which patients are the losers

As well as helping shape what services an area gets, the bill also tears up the existing rules about procurement. If it becomes law, it will be far easier for private firms to get their hands on new contracts, and hold onto existing ones, regardless of past performance or social and labour standards.

The bill even explicitly gives private firms a say in deciding how much they should be paid for the contracts they have won, and thus how risks and rewards are shared between the public and private sector – and allows richer providers and areas to pay more to lure NHS staff away at the expense of a brain drain elsewhere.

In short, the bill is a disaster waiting to happen. As David Rowland, writing in the BMJ, points out: “As long as the NHS relies on private companies to deliver NHS services it will require a highly effective form of market regulation to protect it against the well-documented tendency of for-profit healthcare companies the world over to fix prices, generate illegitimate income through fraud, engage in collusive and monopolistic behaviour, and win public sector contracts through cronyism.”

As Rowland says, “Simply shifting the policy goal of the NHS from competition to collaboration will not mitigate these risks.”

In other words, you can ask the private sector to collaborate all you like. But you’re simply not on a level playing field if you surrender your right to properly regulate, in the way this bill does.

The bill also – despite carefully worded denials – does nothing to restrict the government’s ability to sidestep NHS structures entirely and hand vast health-related contracts to its outsourcing, tech, data, consultancy and finance friends. £37bn for Test and Trace, anyone? The bill fails to put this new infrastructure on a statutory footing, health data privacy campaigners MedConfidential point out.

When Javid claims the bill will “embed the lessons learned from the pandemic”, it seems the biggest lesson the government has learned is that if you move when people are reeling, disoriented and grieving, you can get away with cronyism and with demolishing accountability, privacy and rights to comprehensive and publicly delivered services.

And it contains enough to raise alarm that the long-term vision is a future in which the NHS provides underfunded, fragmentary and second-rate, US-Medicaid-style care to the poor, old and sick, whilst a plethora of private companies pick up ever fatter contracts to diagnose, operate on and care for the rest of us.

NHS local executives and the think tanks (and journalists) with whom they orbit appear to be hoping that these freedoms will primarily benefit NHS hospitals and clinics, if a little bother about the health secretary’s powers can be sorted out. But that issue is a distraction to the seismic changes in this bill. And if they fail to speak out strongly, they are closing their eyes to the reality – made explicit in accompanying policy papers – that these freedoms will, as things stand, fall equally to the private sector, which is being enabled to exploit them far more ruthlessly in a deepening ‘austerity’ climate. The result? A race to the bottom in which patients are the losers.

Even those groups that have cautiously welcomed some of the proposals – the Royal College of Physicians amongst them – said that this bill should be nowhere near Parliament until some of the huge outstanding questions, notably around social care and the public health and prevention organisations, are answered.

The public don’t want this – and they will not forgive MPs who fail to learn from mistakes.

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