While the National Health Service is still coping with Covid patients and itself struggling with staff shortages and sickness, the Johnson government has launched a major reorganisation of the service that would remove its legal duty to arrange the hospital care people need. It also consolidates the Treasury at the heart of health decisions. The government’s bill, which passed its second reading in parliament on Wednesday, has been characterized as allowing a corporate takeover of the NHS; but it would be more accurate to say that it breaks the social bond of the last 75 years in which the government takes responsibility for the health of the public.
The NHS is the last remaining institution that embodies the 1945 Labour government’s legacy of social reform. So it is appalling that parliamentary Labour has not made more noise about the issue – and Labour MPs have even amplified Tory disinformation about the legislation. Karin Smyth, a former NHS manager and the Labour MP for Bristol South, considers the Tory measures offer an opportunity “to give the NHS renewed life to truly achieve its objective of high-quality healthcare, free at the point of use.” She says: “I do not share the fears of some colleagues that the bill is another attempt to privatise the NHS, nor that it is part of a plan to run down the NHS so that it can be sold off. What I fear most is a missed opportunity to reinvigorate the NHS and secure outcomes of care at the centre of the NHS and social care system.”
Hopes that the new law will lead to an improvement in patient outcomes are belied by the absence of funding and staffing details in the legislation. Local clinical commissioning groups in England would be replaced with 42 new regional integrated care systems (ICSes), whose boards would allow private healthcare providers to sit on them. They will commission NHS and local government services, and would be authorised to hand out contracts without them going out to tender.
It has been left to extra-parliamentary bodies such as Keep our NHS Public, We Own It, EveryDoctor, Public Matters, and other campaigners to raise the alarm about the substance of the bill now being foisted on the public. Nick Davidson, a member of Haringey Keep Our NHS Public, points out in LabourHub that although the law is being portrayed as a way of taking back control of the NHS from the “unaccountable, undemocratic, quasi-governmental body, NHS England”, in reality the new regional ICS boards that replace it will be even more unaccountable and their decisions can be overridden at any time by the government. Although it removes the obligation to put NHS contracts out to tender, spun by the Department of Health as a measure to reduce bureaucracy, “some 200 private companies will be accredited, through a body known as the Health Systems Support Framework, to provide services to the NHS. These companies will be given direct access to the health service.”
The central issue of funding reveals the core of the changes that are being planned. The money available to each ICS will be capped at an annual amount, based on a government-decided target. “The question is who determines the targets and how realistic is the capping. In the past, health authorities have been able to roll over deficits and seek bailouts. Capped budgets will remove this flexibility and inevitably lead to further rationing.” According to Keep Our NHS Public, the restrictions on their allotted funding means they will have to make cuts to services including closing hospitals and reducing patients’ access to the care they need. “Depending on the decisions each ICS makes there will be a postcode lottery of what services patients can expect to get – there will no longer be a national entitlement to a full range of services.”
It will be the Treasury that maintains tight control of the funds. The lawyer Peter Roderick and public health doctor Allyson Pollock have delivered a devastating analysis of the law’s implications. “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.” Pollock and Roderick point out that the bill scraps the idea of universal healthcare and replaces it with a “core responsibility” for “groups of people”. This would be similar to employer-sponsored HMO groups in the US, a system dependent on excluding people with expensive medical conditions.
According to the Guardian, the BMA’s deputy chair, Dr David Wrigley, said: “We are concerned that private health providers like Virgin Care could be given seats on the boards of ICSes and therefore potentially be involved in deciding who gets what contracts.” But Virgin Care is small fry compared to the well-funded US-based health corporations which are aggressively seeking opportunities for profit in the British health market, and which will take advantage of the legislation to capture this market. These include the likes of Centene, a US insurance and Medicaid conglomerate, already the largest provider of GP services in England and with a stake in an outsourced hospital surgery firm, Circle Health. Along with the buyout of GP’s practices, there will be no defence against rapacious drug pricing. Since funds for ICSes will be restricted, expensive drugs will have to be paid for by the patients themselves. Those who cannot afford private health insurance will be left to their own devices.
The government is vulnerable because of the public support for the NHS as a guarantee of healthcare as of right, and is carefully obscuring the true implications of its reorganization with ambiguous language and cautious disclaimers. Just as the Tories have isolated themselves with their hostility to taking the knee in football, they face the risk of positioning themselves even further out of line with public opinion by breaking the social pledge to provide universal healthcare. But the opportunity this provides for Labour is being ignored by its leadership. The party is distributing “Faith to fight for our NHS” badges – but has no concrete plan to stop the government’s legislation, and won’t even commit to support the nurses’ demand for a 12.5% pay increase.
The government’s U-turns over free school meals and lockdowns show that it is sensitive to public pressure, despite its majority. The public must be made aware of the extent to which the new Tory law dismantles the principle of healthcare free at the point of use. A poll commissioned by We Own It last year found that 76 per cent of the public want to see the NHS reinstated as a fully public service against just 15 per cent who wanted to see continued involvement of private companies. The left should support all organisations campaigning against the legislation, such as the national Day of Action launched by We Own It and Just Treatment for this Saturday, July 17.