In an emergency, all of us expect to go to A&E and be seen, no matter who we are or where we’re from. In law, Clinical Commissioning Groups must ensure that emergency care is provided for every person present in the area. But it’s changing. In September, a badly burned Rochdale nurse went to A&E and was advised to go to Bury given the long delay in Rochdale. When she got there, staff told her “we don’t take patients from Rochdale”, due to a directive from the Northern Care Alliance. Lord Davies told this story when proposing an amendment to stop any provider from refusing treatment on the basis of which Integrated Care Board (ICB) the patient belonged to.
In response to the Rochdale nurse’s experience, government Minister Lord Kamall didn’t even mention emergency care. He said no provider could be expected to provide treatment for which they were not funded, and each ICB must be free to decide what treatment to commission, so it’s policy. Even in an emergency, funding flows will trump patient care.
The NHS is being broken into around 40 separate financial systems. Their budgets will be set with a new Payment Scheme. The cost of a treatment will depend on where it is given, who provides it, and who is being treated. And, providers including the private sector will be consulted on the prices to be paid. This means a postcode lottery rigged to suit private firms. If the Integrated Care Board is going over budget, NHS England can intervene to stop spending. With local budgets and a variable payment scheme, ICBs may ask why staff in their area are paid the same as other places with better budgets. They may impose local pay and conditions for NHS staff in their patch. That would destroy national agreements, and unions should be screaming about this threat.
So who profits from this?
Around 240 organisations, most of them private companies, are accredited by NHS England to develop Integrated Care Systems through the Health Systems Support Framework. Several dozen are US transnational corporations supplying the health insurance market. Operose, which controls dozens of GP surgeries, is wholly owned by US transnational Centene, a $100bn enterprise. Under the Framework, Operose is accredited for 22 topics, like population health management and payment reform. Its former boss Samantha Jones became Boris Johnson’s Expert Advisor for NHS Transformation and Social Care. She is now Permanent Secretary and Chief Operating Officer of 10 Downing Street.
A data-driven NHS
The Framework aims to transform the NHS into a digital and data-driven system, where clinicians rely on algorithms, remote monitoring, big data, and artificial intelligence. Labour peer Lord Hunt of Kings Heath tabled 7 amendments to the Bill promoting digital transformation. One requires all NHS organisations to spend at least 5% of their budget on digital transformation. Hunt also chairs the Advisory Board of Octopus Tenx Health, a health technology investment company. When Octopus took over, the Tenx Board included the husband of Samantha Jones. Tenx Health co-founder Joe Stringer stated at the start of lockdown that coronavirus could be the catalyst for the mass adoption of tech across the health system. He predicted venture capital funds would take it up.
Cronyism over care
Despite Government spin, the private sector is not barred from Integrated Care Boards. They can sit on committees and the provider collaboratives where private companies and NHS Trusts will come together to carry out the functions of the ICB using delegated budgets. New procurement regulations will allow ICBs to award contracts without competition. Just like the crony covid contracts were handed out, overpriced, some to firms with no relevant experience, or which failed to deliver.
Rushed through without due process
And, very worryingly, NHS England isn’t even waiting for Parliament to approve the Bill. As the Lords point out, Parliamentary process is not being followed. Before the Bill is even law, NHS England is issuing guidance, area Chief Executives are being appointed, Constitutions drafted, and management consultancies are already redesigning elective care.
Lord Hunt has said in reference to this:
“…it purports to go through a process from the start that says that this is how ICBs will be set up—but they have all been set up, the boundaries settled and the chairs nominated, without any proper public accountability process whatever.” 
Similarly, Baroness Thornton has asserted that there has been a ‘pre-emption of parliamentary process’, by this government over crucial and significant decisions which could affect the healthcare of us all:
“…it seems that the latest advice from the Government and NHS England confirms deadlines for appointments of leaders, chairs and boards, many of whom have been appointed, possibly involving the spending of public funds, long before the Bill has completed its passage through Parliament. Indeed, there are many other matters which are still subject to parliamentary process. This is pre-emption of parliamentary process.” 
The fact that the government are trying to push this legislation through under the radar speaks volumes about their prediction of criticism, and should ring alarm bells with all who care about the future of the NHS as a fully comprehensive and public service. Finally, Lord Scriven gives his assessment of the situation:
“We are living in a parallel universe. We are discussing the legislative framework for this new system while, out in the real world, the foundations and the bricks are being built. People are in place. Dates are being set. People are being told that they cannot be on boards. This Parliament has not decided. Under what legislative framework are these organisations working? They have no legitimate powers or approval from Parliament, yet they are being set up. People are being put in place. Chairs are being appointed. Councillors are being told that they cannot sit on ICBs. This Parliament has not decided that yet. Letters are going out from NHS England telling the system when it will start, and Parliament has not gone through the legislative process. This is not collaborative working at a local level, because many local authorities feel that they are not even in the car let alone in the driving seat; the car is leaving and they are being asked to join at a later date. This is not a good start for collaborative working. It has to stop. NHS England has to be reined in and told that, until there is a legislative framework, the system must stay still.” 
We should fight the Health and Care bill all the way. But if it does become law, Keep Our NHS Public want to see it repealed and the NHS restored as a universal, comprehensive service, publicly provided, publicly accountable, free at the point of need with decisions taken on clinical grounds, not on the ability to pay.
Greg Dropkin, researcher and member of Keep Our NHS Public