The Tories have a string of broken promises on the NHS. But now, they’ve made a promise we think they intend to keep. It will break the founding principles of our NHS and will bring healthcare into line with a global market, dominated by US corporations.
The Tories have pledged to incorporate the Long Term Plan for Integrated Care Systems, as drawn up by NHS England, into legislation within three months if they are re-elected (see Conservative Manifesto, page 9).
We oppose the Long Term Plan for five reasons:
1) The Long Term Plan adopts the plans of global health corporations, and aims to control costs by reducing access to healthcare and cutting the quality and cost of public health services: The Long Term Plan is the successor to the Five Year Forward View for the NHS, directly based on reports by the World Economic Forum, involving global healthcare corporations including US giants McKinsey & Company, UnitedHealth, and Kaiser Permanente.
2) The Plan moves away from a national service based on sharing the cost of ill-health: The key idea of the NHS is that the cost of healthcare should be shared out across the country, funded by general taxation, so that medical care does not depend on postcode or personal circumstance. The Long Term Plan shifts the risk to a local “integrated care system” (ICS), responsible for the health and resources of a defined population, with a fixed local budget so that poor health in each “population” - Merseyside, Newcastle, Hackney... - is now their problem.
3) The Plan aims to develop separate delivery systems, accountable for their own tightly controlled budgets: Integrated Care Systems are intended to evolve into Integrated Care Providers. These are simply new names for “Accountable Care Systems” and “Accountable Care Organisations” as they are known in the US. In an ICP, one organisation will hold the overall contract, decide what care will and will not be provided by the NHS, and subcontract the work to others, including private companies. The NHS is too big to sell in one job lot, but an ICP might have an annual budget of around £2bn, and the central contract could be awarded to a private company, or the ICP itself might eventually be sold.
4) The Plan relies on private companies to develop Integrated Care Systems: NHS England has already designated 83 organisations to provide support services to develop Integrated Care Systems. Of these, 76 are private companies, of which 23 are US based, including Centene, Cerner, Deloitte, GE Healthcare, IBM, McKinsey, and Optum, the UK arm of UnitedHealth. Optum proclaims “We are uniquely positioned to help with 15 years of experience in health system support. Combined with more than 20 years in integrated health systems in the US, we can provide the tools and expertise to help you manage risk, establish partnerships and engage patients in care.”
5) The Plan will mean healthcare is a commodity subject to trade deals: In the US, health is a commodity, people who lack insurance can die without emergency treatment and medical bills can cause bankruptcy. As the Tories prepare for a trade deal with Trump, and US negotiators intend to raise the prices the NHS pays for drugs, we want to protect the NHS from the global health market.
We reject the Long Term Plan – which may come very soon – to disintegrate the NHS into local systems where care is rationed at the whim of those who hold the contracts.
Keep Our NHS Public is opposed to these plans and campaigned along with We Own It to raise awareness of the privatisation threat in the draft ICP contract. We supported the two judicial reviews against ICPs. A Keep Our NHS Public petition against the NHS being included in a US UK trade deal has reached nearly a million signatures and we are working with We Own It, Global Justice Now and several other organisations to ask MPs to sign up to an agreement to protect the NHS from a trade deal by bringing it back into public ownership.