Steve Score, Leicester NHS campaigner
The future of the NHS hangs in the balance. Nearly five million people are waiting for treatment. Covid has pushed our health services to the limit, but years of underfunding meant it was already in crisis before the pandemic. Waiting lists were already rising, as were the huge staff shortages.
But rather than addressing these problems as a priority, the government is proposing more drastic reorganisation of the NHS.
In February, plans were leaked and then published in a white paper. Inaccurate headlines suggested the government was planning to reverse previous privatisation and to properly integrate health and social care.
This was wrong. The white paper did not propose reversing privatisation nor deal with the crisis in social care. The government would divide the NHS in England into separate areas runs by boards called ‘integrated care systems’ (ICS). NHS England is already three-quarters of the way through its plan to create 42 ICS in advance of legislation to empower them.
The market mechanism first introduced under Thatcher, including its split between ‘purchasers’ and ‘providers’, will remain.
A new health and care bill is expected to be published shortly, having been flagged up in the Queen’s speech in May. But that was vague on the detail. If the bill includes much of what was in the white paper, it will be a further threat to the NHS and must be opposed.
What confused the press was the suggestion in the white paper that the compulsory competitive tendering rules would be scrapped. However, it does not mean privatisation being abolished – just that companies would no longer have to compete! Throughout the pandemic the government handed out private contracts worth billions for test and trace, PPE, and to private hospitals. These have been without competition or transparency, and with a heavy element of cronyism – and that’s the model they want to continue.
NHS England has already created an approved list of private companies to fast-track the outsourcing of contracts. ICS with commissioning powers will be able to include private companies on their boards. So not only can private profiteers continue to carve out bits of the NHS, they can also now be part of running it!
In fact, companies like Virgin are already being invited onto the existing fledgling ICS, like the one in Bath, Swindon, and Wiltshire. Of course, these bodies will not be democratic, with members being appointed not elected.
It is also proposed to remove the current requirement for the government’s plans for the NHS to be debated annually in parliament.
Local councils, which would have their scrutiny over the NHS weakened in the white paper, are one of the ‘partners’ who will have representatives on the boards. But the current power of local authority Health Scrutiny Committees to refer bad local NHS decisions to the secretary of state would be removed.
On some occasions, local campaigners in the past have succeeded in getting decisions to close services reversed by putting pressure on councillors.
In fact, rather than simplifying the structure of the NHS, the plans create two tiers of ICS in every area – one with the real commissioning powers and the other (also including private companies) which appears to be intended to act like the already existing ‘health and wellbeing’ boards.
Each ICS will have its own separate budget – bringing pressures to make cuts resulting from underfunding, and increasing the potential for regional inequalities in service. It also raises concerns about whether it would be used to weaken NHS workers’ current national pay bargaining powers by replacing them with local bargaining.
All of this is of course not clear until the government publishes its bill. But one aspect that was mentioned in the Queen’s Speech was to “innovate and embrace technology” and that “patients will receive more tailored and preventative care.” Bland statements in isolation.
But the intention is to continue a process, begun with the pandemic as an excuse, of fewer face-to-face appointments with specialised staff, replacing them with more digital services, which will cause difficulties for those not able to access computers or smartphones.
In addition, there is the danger of faster discharge from hospital, but without the back up in community services.
Campaign groups such as Health Campaigns Together and Keep Our NHS Public are opposing this bill. Despite quotes from Labour’s Shadow Health Secretary, Jon Ashworth, saying that the white paper proposals meant “little accountability to the public, allowing contracts to be handed out to private interests with no challenge”, Labour has shown no real fight against these proposals. If Labour was a real opposition, Starmer would be hammering it in every speech!
Trade unions and campaigners will have to take up the battle to save the NHS. Stop and reverse privatisation, fully fund the NHS and pay the workers the 15% they need!