Today, the House of Lords debates the principles of the English Health and Care Bill. So I’d like to ask its noble Lords, before they assent to this stage of the bill, if they can explain what those principles actually are?

What is it that the bill, in a nutshell, actually does?

Explaining that effectively was beyond the health secretary, with the government’s own MPs reportedly baffled as to why it was undertaking a massive reorganisation of the NHS in the midst of a global pandemic.

The government tells us that the bill will support the NHS in tackling its backlog, including by promoting ‘integration’ with social care. But no plausible explanation of how the bill will achieve that is offered. The care system languishes, unfixed, privatised, means-tested, gate-kept, short-staffed, fragmented, unaccountable and underfunded. And it will continue to do so despite Boris Johnson’s promises and despite the controversial upcoming National Insurance levy and last week’s white paper. Demoralised NHS staff continue to leave the service and disgruntled patients reject the pandemic shift to a ‘digital-first’ NHS.

The government and its supporters also like to say the bill is ‘the NHS’s own plan’, indeed its ‘Long Term Plan’, and claim an electoral mandate on that basis. Former prime minister David Cameron’s NHS boss, Simon Stevens, who is making his maiden speech in the Lords today, helped draft these plans, it’s true. But the British Medical Association warned in October that the bill will “do more harm than good” and that the bill’s approach to reforming NHS competition “risks making it easier for private companies to win NHS contracts without proper scrutiny”.

There’s an awful lot of people telling us this bill definitely isn’t about privatisation, though. MPs told openDemocracy readers who contacted them that this was “inaccurate scaremongering”, a claim echoed by Spectator assistant editor Isabel Hardman in the i newspaper and the Institute of Economic Affairs’ Kristian Niemietz in The Telegraph.

And even sympathetic peers are now wary of the P-word. This bill “is not about privatisation”, one (Labour) peer told me bluntly last week, before I’d suggested it was.

But there’s a reason it’s very easy for people to confidently assert what the bill is not about, and rather harder for them to say accurately what it is about (apart from the unfair social care cap, which focused the minds of some ‘Red Wall’ Tory MPs).

Laws in disguise

And that reason is that – as Camilla Cavendish pointed out in a different context in the Financial Times last week – two new reports have claimed this government is evading effective parliamentary oversight and heading us towards “government by diktat”. We are in a situation, Cavendish said, in which “bills are often drafted only in outline”, important detail is left to secondary legislation, and – according to a House of Lords committee – “guidance” is used as a form of “‘disguised legislation’, with legal effect but no oversight”.

Cavendish acknowledges this trick isn’t altogether new. Indeed in 2012, Parliament was given an NHS bill that Cameron’s allies later admitted was “unintelligible gobbledegook”, and into which the really nasty bits were added later, through ministerial direction, ‘guidance’ and secondary legislation.

But even more than in 2012, this new bill allows shifts to care that will have major impacts on people’s health and lives to be introduced with a sweep of a ministerial pen, or an unaccountable decision of a bureaucrat or management consultant.

And as NHS experts Allyson Pollock and Peter Roderick point out in today’s Guardian, if you properly scrutinise the bill even in its skeletal, enabling form, an alarming picture emerges.

It’s one in which the power to decide what the NHS must offer is being taken out of the hands of Parliament and handed over to unaccountable and corporate-influenced boards.

The real principle of this bill is to make it far easier for the NHS to scale back what it delivers, one local decision at a time.

These boards will also be less regulated in terms of the qualifications of the frontline health staff their services must employ, what they must pay them, and how they hand out contracts to private firms, as the BMA, trade unions, some MPs and campaigners have noted.

More than one way to privatise healthcare

Much in the bill cements the current direction of travel, it’s true. And that direction is the wrong one.

Already, one in five people is now being forced to pay privately for the healthcare they need, according to openDemocracy’s recent survey of 7,000 readers, with our findings borne out by other polls.

So even if the NHS itself remains “free at the point of use”, as government MPs like to reassure us it will – we’ll nonetheless see more people forced to go private.

There’s more than one way to privatise healthcare – as the right-wing think tanks and their supporters know – and the government is prepared to distort figures and language to achieve it.

MPs use the language of ‘sustainability’ and post-COVID ‘recovery’ to obscure what they think is really sustainable – reducing the NHS, over time, to a minimalistic fall-back option for those who can afford nothing else. A health service scavenged from by a range of private firms selling ‘solutions’ and backed up by a range of self-pay and insurance options for those who have the cash to do so.

To the think tankers and their friends in private health and insurance, such a direction of travel is just as effective – and politically easier – than selling it off in one fell swoop and introducing cash tills at the doors of NHS hospitals.

Leading off for the government in today’s Lords debate is Lord Kamall, who was until recently, the research director of the right-wing Institute of Economic Affairs.

I expect Lord Kamall will talk eloquently about how this bill makes the NHS more sustainable, accountable, modern and efficient.

But peers who cannot actually explain what that means – what this bill will do, in principle – should not vote for it.