Government used crisis to increase privatisation – NHS white paper will endorse

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Boris Johnson seeks to 'take back control of the NHS' - full scale alert

The leaked draft of the forthcoming government white paper on the NHS has been interpreted, notably by the Times and Hugh Pym at the BBC, as planning to 'scrap forced privatisation and competition within the NHS'. Nothing could be further from the truth. As the draft makes clear, 'there will continue to be an important role for voluntary and independent sector providers'.

What you've seen with Covid is what you'll get in future with this government

This is what we would expect from a government that has responded to the pandemic by large-scale contracting out of services that should be delivered by the NHS and public health services. Billions have been spent on contractors and management consultants delivering test and trace, billions more on the privatised supply chain and procurement of PPE, hundreds of millions committed to building new laboratory networks outside the NHS – and up to £10 billion due to be spent on private hospitals to clear NHS waiting lists over the next 4 years, while thousands of NHS beds are closed or kept empty.

This is not a government reducing the role of the private sector

The Government could end private contracts today without legislation - and could have done at any point since 2013 - by scrapping the regulations that were added to Section 75 of the Health and Social Care Act. Instead this Government is ready to vastly increase privatisation in the NHS. Nothing in the leaked draft suggests bringing existing contracted-out services back in-house. Unless outsourcing is ended, much of the fragmentation created by the 2012 Act remains as an impediment to genuinely integrated care.

The draft also specifically states that there will be no change in the rules on procurement of non-clinical services, including 'professional services', such as consultancy and digital systems.

DON'T BUY IT. Here's what we really said about the leaked doc suggesting Johnson planning to reverse privatisation in NHS. As KONP's John Lister says they've been using crisis to increase privatisation. This is why we urgently need a https://t.co/ubRgwS6A21 #PeoplesCovidInquiry pic.twitter.com/dmaxouPazI

— Keep Our NHS Public (@keepnhspublic) February 6, 2021

Integrated care systems beckon the private sharks which encircle the NHS

Campaigners have been warning that the establishment of 'Integrated Care Systems' (ICS) involves increased dependency on digital and data systems, which are largely provided by the private sector. A new ‘Health Systems Support Framework’ (HSSF) has been established by NHS England to fast-track contracting out up to £700m worth of services that will support the set-up and ongoing management of ICSs, with a pre-approved list of over 80 providers, almost all of them private sector and more than a quarter of them American companies. This will put corporates at the heart of ICS management, as well as decisions about outsourcing of both clinical and non-clinical services, including the control of NHS data and digital systems, management, health planning, referral controls and clinical care pathways. [More on HSSF management systems derived from US health insurance market and motivated by cost reduction rather than meeting patients' needs.]

Embedding private sector in NHS decision-making at ICS level

The white paper proposes legislation for the new ICSs as statutory structures. Towards the end of the leaked draft it even suggests that voluntary and private sector 'partners' could be included in new ICS Health and Care Partnership Boards - shaping policies and services in each area. This would be represent another insidious extension of private sector influence.

The Government is working to strengthen, not marginalise, the private sector

The proposal to scrap scrap competition rules is potentially a problem for the NHS. Doesn't it sound great and spin well! But when we see the numerous disastrous contracts for consultancy and PPE that have been awarded without competition by the Government during the pandemic, our alarm bells are clanging. Nor is there any limit on ICS bodies as commissioners or on NHS and Foundation trusts opting to put more services out to tender if they wish: indeed a growing range of 'framework contracts' make it increasingly swift and easy for them to do so, bringing in pre-approved private companies to do work previously done by NHS employees.

'Integration' - impeded by new 2-way split

The Government’s 'integrated care' proposals in the leaked draft are different from NHS England's proposal, not least in providing for TWO ICS boards in each area, one for NHS commissioning (NHS plus local govt) the other an 'ICS Health and Care Partnership' board, which could include anyone, but specifically could include private companies (disguised by the phrase 'voluntary and independent sector partners').

This second, subsidiary Board appears to have been introduced as a sop to the Local Government Association which has complained at the way local government has been marginalised in the secretive development of early ICSs. But this could pose massive risks to local authority social care - the proposed powers at this second tier of bureaucracy are not outlined.

This Partnership would be tasked with promoting partnership arrangements, and developing a plan to address the health, social care and public health needs of their system. Each ICS NHS Board and Local Authority would have to 'have regard to' this plan. The Council will be promoting collaboration and it would not impose arrangements that are binding on either party, given this would cut across existing LA and NHS accountabilities.

The subsidiary Partnership Board would be required to work in line with the overall ICS plan. If implemented, this would give the NHS a major role in decisions about social care and significantly weaken the role of local authorities in social care. [More at Social Care: relationship to ICSs.]

So even the ICS would not be integrated, and local government remains a subordinate bit-part player to make the set up look more local and less undemocratic.

Meanwhile the under-funding of NHS services and the chaos of the largely privatised social care sector continue, leaving little but the name and the rhetoric of ICSs to suggest this is about any real integration of health and care.

Reconfiguration

The new powers proposed to be returned to the Secretary of State would allow them to intervene 'at any point' during a process to close an A&E or maternity service or during any other reconfiguration, lacking any real knowledge, and dependent on the (often twisted) version of the facts they are fed by local health bosses - rather than being called in, for example, by an aggrieved local authority after the event.

It's hard to object to this on principle - we have supported the NHS Reinstatement Bill's central call to return powers to the SoS and argued they should not have been removed. And maybe this might have arisen from ministers being aware that, even as they rubber stamp half-baked plans (Shropshire, SW London, probably Leicestershire, etc), they are often being misinformed by NHS bureaucrats and problems arise for local Tory politicians. But with central control and the wrong ideology comes the reinforced responsibility for campaigners to stand firm and challenge every major decision. And one option is to find effective ways to develop pressure on this issue, e.g. to insist on ways for alternative local views to be directly presented to the SoS as the consultation on the proposed legislation takes place.

What now?

We have detailed our concerns about Government and NHS England plans for integrated care systems even before the appearance of the White Paper. We are at this very moment developing campaigning messages and materials - available very soon.

Watch the KONP Campaigns page below and our social media.

KONP Secretary and Editor of Health Campaigns Together, John Lister on the BBC 6am February 2021