Despite the concerns of many NHS staff, official bodies and health campaigners, the Health and Care Bill became an act of parliament on 28th April, two days after voting in the Commons and the House of Lords ended. The final Parliamentary argument turned on just two votes.
Why the Health and Care Act is a threat
Patients and staff now face major dangers, including:
Possible denial of emergency care: In an emergency, we all expect to go to A&E and be seen. Under current law, Clinical Commissioning Groups must ensure that emergency care is provided for everyone present in their area, but the new Act does not mention emergency care. This will trigger disputes as to who pays, and may even lead to patients being denied emergency care. That would violate medical and nursing ethics and the NHS Constitution, whose first principle is headed “The NHS provides a comprehensive service, available to all.”
A worsening of the staffing crisis: The NHS cannot recruit and retain a stable workforce without good pay and safe working conditions. The NHS is now being broken into around 40 separate local financial systems. Budgets will be set using a new Payment Scheme whose prices vary around the country according to who is being treated, and who provides the treatment or service. Private companies will be consulted on the Scheme. With highly variable budgets tightly controlled by NHS England, Integrated Care Boards will be under pressure to reduce costs by using fewer or less qualified staff, or even introducing local pay.
Increased privatisation: The Bill will open the door for private companies such as those accredited through the Health Systems Support Framework, to win contracts with Integrated Care Boards, influencing decisions on what care is provided, by whom, and for whom. Only the ICB Chair can decide whether an appointment to the Board, or its committees or sub-committees with delegated powers and budgets, “could reasonably be regarded as undermining the independence of the health service”. This subjective judgement without specific verifiable criteria, does not actually exclude private sector representatives from making decisions.
Still no workforce plan
Despite all the evidence of a massive shortfall in health and care staff, the Government claimed their Workforce strategy was fit for purpose. Until the final vote, the Lords had insisted:
- the Secretary of State should come to Parliament every 3 years describing the system in place for assessing and meeting the workforce needs of the health, social care and public health services in England
- independent assessments of existing and projected workforce over the next 5, 10, and 15 years; and of the numbers needed to meet projected needs
- NHS England and Health Education England to assist
- consulting health and care employers, providers, trade unions, Royal Colleges, universities and any other persons deemed necessary.
Even when the independent assessments were dropped, Labour’s amendment was defeated 169 – 204. Only 71 Labour peers voted for it, and no Conservatives. Baroness Cumberlege, who led the Lords opposition on Workforce planning on 5 April, did not vote.
The Government also won the vote over the controversial Social Care Cost Cap, dismissing demands that any costs incurred by the local authority would be included in assessments, and that Trailblazer pilot schemes must be evaluated, taking account of regional eligibility and the effect of the care cap on disabled adults, before Regulations could be made.
What does it mean?
Almost none of the issues which Keep Our NHS Public highlighted over the last two years were in the frame during Parliamentary debate:
- The Bill itself, making the NHS compatible with the US Accountable Care model
- No definition of the group of patients for whom an Integrated Care Board is responsible
- The new Payment Scheme, with prices varying by area and by who receives the treatment or service and who provides it, and with the private sector consulted on the details.
- The Secretary of State’s new power to deregulate health professions
- The Health Systems Support Framework, under which over 200 companies including several dozen US transnationals involved in the health insurance market, are accredited by NHS England to support the development of integrated care systems
Other issues were debated but failed to get into the final text, such as ensuring that patients and carers would be protected before hospital discharge. Parliament therefore succeeded in reframing the argument to miss out many key issues, and then focused on those amendments Labour wanted to fight for, but these were defeated.Margaret Greenwood was a lone voice reminding MPs of the Bill’s true scope. In general, Labour were overwhelmingly silent on the implications. On 25 April, Karin Smyth showed that much of the Bill was satisfactory to the Labour Front Bench. Shadow Health Secretary Wes Streeting was absent from the final debate.
What are our options?
We should mobilise locally for pressure on the ICB Chairs, coming from across the health and care sector, and take any chance we get to address health workers on the implications of the Act.
In the coming months, we should consider what options there are, in reality, to argue for a repeal of the Act and the renationalisation of the NHS.
Greg Dropkin is a researcher and a member of Keep Our NHS Public