The UK government’s Health and Care Bill represents a major threat to the future of the NHS.

It will fundamentally change it from a national public service, delivered by public sector workers, to around 42 local, integrated care ‘systems’, each based on a business model. The implications for patients and staff are extremely serious.

If enacted, the bill will worsen a postcode lottery as each system will be required to develop a plan to meet the health needs of the local population, deciding which treatments to prioritise and which not to prioritise in their given areas.

I believe it will lead to increased rationing of services, too, as the Integrated Care Boards (ICBs) running the care systems will have far stricter financial limits each year, and once they have spent the money they have been allocated, patients may have to wait longer or go without treatment. That is a frightening prospect.

As it currently stands, the bill allows for big business to sit on both ICBs and their constituent Integrated Care Partnerships (ICPs), with private companies influencing decisions about what health and social care is available in an area, despite the fact that those very same companies will, in all likelihood, be seeking contracts to deliver health and care in that same area. Conflicts of interest are inevitable.

Health minister Edward Argar told MPs last month that the government will amend the bill to prevent “individuals with significant interests in private healthcare” from sitting on ICBs. This is a weak response; it should be a fundamental principle that decisions about the planning of services and expenditure of public money are made by public servants. What’s more, such an amendment to ICBs would not apply to ICPs, the minister made clear – and so would still leave the complex array of sub-committees, placed-based partnerships and provider collaboratives open to the influence of private companies.

Recipe for cronyism

The bill would also remove the procurement of healthcare services for the purpose of the health service from the scope of the Public Contracts Regulations 2015. As a result, contracts could be handed out to the private sector without the stringent arrangements one would expect in the awarding of public money. This is a recipe for cronyism.

Under the government’s plans, vulnerable people would be discharged from hospital before crucial social care needs assessments have been done, putting patients at risk and leaving families to pick up the pieces.

As of May this year, four million patients had been discharged in this way under temporary measures in the Coronavirus Act of March 2020, yet the government doesn’t even know how many of those were readmitted within 30 days.

The government has said that an independent evaluation of the implementation of the hospital discharge policy would report in the autumn; it’s a matter of very real concern that the government decided to push ahead with the policy without properly understanding the clinical outcomes.

There are major implications for NHS staff too. The bill allows for NHS professions to be removed from regulation and this has the potential to impact on the status and, over time, level of expertise of the people who work in the NHS.

The bill would revoke the national tariff and replace it with a new NHS payment scheme. Thirty-six parliamentarians recently wrote to the minister for health arguing that this will, in effect, give private healthcare companies the opportunity to undercut NHS providers and that we will see healthcare that should be provided by the NHS increasingly being delivered by the private sector.

If that happens, NHS staff may find themselves forced out of jobs that are currently on Agenda for Change rates of pay, the NHS Pension Scheme and other terms and conditions, with only private sector jobs with potentially lesser pay and conditions available for them to apply for if they wish to continue working in the health sector. One only has to consider the dire pay and terms and conditions of many people working in the care sector to see just how important national collective bargaining is to NHS employees.

We are still in a pandemic; 5.7 million people in England are waiting for hospital treatment and chronic staff shortages are leading to extremely high levels of stress for health and care workers. Yet the bill offers nothing to address any of these issues. Instead, it offers the NHS gift-wrapped to big business and smoothes the way for the erosion of pay, pensions and other conditions of service for over a million NHS staff.

The Health and Care Bill tears apart the vision of a comprehensive universal National Health Service that is valued so highly by us all. It must be defeated.