Health and Social Care Bill

Local Labour Party members were out at the weekend collecting signatures on the petition about the Health and Social Care Bill now going through Parliament, with hundreds of people signing up. We were “signing in the rain” on Sunday! I expect we will be out next weekend too.

If you have not already done so, you can sign on line:

Quite a few people have emailed me, asking for more details about the Bill, so I hope you find the following of interest and assistance.

At the root of the Bill is the removal of a key protection of the 1946 Act,  that set up the NHS – that the Secretary of State for Health should be directly accountable for providing the health service. The Government’s plans will break up the NHS as a national public service and are fundamentally weakening the Health Secretary’s responsibilities. The Secretary of State will no longer have a duty to provide a health service to all: it will be devolved to an unaccountable National Commissioning Board (NCB). Nor will he have power to instruct the NCB, only a duty to respect its autonomy: no one can appeal to him against bad decisions.

Despite their protestations, the Government have not acted upon the recommendations of the independent group of NHS experts, the Future Forum. The Bill still contains the essential elements of the Conservative and Lib Dem Coalition long-term plan to set the NHS up as a full-scale market, based on the model of the privatised utilities. Under their plans,  a new economic regulator will enforce competition law on the NHS for the first time, and even have the power to fine hospitals 10% of their turnover for working together: what will that do for patient care?

Any doubts about the Coalition’s  intention to privatise were dispelled by the revelations of emails  reported in Sunday’s Observer newspaper (4/9/11) ,  that the Coalition Government since late last year have been  in active discussions to  pass over  the management of between 10 and  20 NHS hospitals to international private companies. The contracts will run into hundreds of millions of pounds. The emails show that private sector consultants McKinsey are acting as brokers between the department and “international players” that are bidding to run the NHS. The documents even lay out some of the conditions required by “international hospital provider groups” for running NHS hospitals. “International players can do an initiative if 500 million revenue is on the table.” They also need to have “a free hand on staff management”.  

 In her Guardian article last Saturday, (3/9/11)  Polly Toynbee summarised some of the worst parts of the Bill as follows:“

  • Local GP commissioners, renamed Clinical Care Groups (CCGs), must put a duty to ensure choice (competition) well above “having regard to” equality. They can be challenged by private companies that want to tender, opening the whole system up to EU competition law, so all the NHS is up for privatisation.
  • The bill allows wholesale outsourcing of commissioning to the likes of KPMG or United Healthcare if CCGs prefer not to do it: will these prefer the private sector?
  • The National Commissioning Board has no obligation to distribute funds fairly according to an agreed formula. With no democratic input, it can distribute funds as it likes. Already money is gradually being shifted from north to south: the postcode lottery will grow.
  • Hospitals have no cap on private beds. When financially squeezed, priority can go to paying off debts with foreign patients. This too opens the NHS to EU competition law.
  • Monitor, the regulator, has barely altered since the row: it now has a duty to prevent anti-competitive behaviour – which is another, possibly stronger, way of saying promote competition.”

I have seen the rather sparse reply from Hendon’s Tory MP to constituents who wrote to him through the 38 Degrees campaign, in which he states that “38 Degrees’s (sic) concerns are without foundation”.  It cannot be possible to believe that anyone who has actually read and studied the Bill and the 38 Degrees arguments and legal opinion could possibly have come to this conclusion. I can only assume that this is a Conservative Party standardised reply from an MP who was too busy on his jaunt to Belize to find time to read and study the Bill properly and compose a fully reasoned reply.

As Lib Dem peer Shirley William wrote, the opinion of the lawyer in the 38 Degrees campaign was unambiguous:

“It is clear that the drafters of the Health and Social Care Bill intend that the functions of the secretary of state in relation to the NHS in England are to be greatly curtailed. The most striking example of this is the loss of the duty to provide services pursuant to section three of the NHS Act 2006. Effectively the duty to provide a national health service would be lost if the bill becomes law. By passing these duties down to an unknown number of commissioning consortiums, the government, will be effectively fragmenting a service that currently has the advantage of national oversight and control, and which is politically accountable via the ballot box to the electorate”.

To my mind, one of the most sinister things in the BIll is the proposal to lift the cap on private beds in foundation hospitals. To balance the books, such hospitals will start to give privately paying patients priority over NHS patients. NHS waiting lists and waiting times will expand as increasing numbers of beds are taking by fee paying bed blockers. The hospitals will gradually become private, and there is nothing that could be done to stop it as the hospitals are subjected to competition law.

And what is even worse is that this £2bn disruption is hitting the NHS as it confronts its harshest financial squeeze. Budgets are not ring-fenced as the Coalition promised. The VAT rise to 20%, the increase in national insurance contributions, inflation (which is at an even higher rate in healthcare than the already high general rate of inflation) are all hitting local NHS budgets. Nationally, the Coalition has also cut £500m from the NHS for social care costs in local authorities (which are also facing 25% cuts). The growing ageing population and the cost of expensive new drugs, treatments and procedures all increase the pressures. Waiting times are already increasing and local hospitals are in deficit. How can the Coalition waste £2billion at such a time?

Labour’s efforts to save the NHS yielded good results The Commonwealth Fund put  the UK NHS top for effectiveness, care and efficiency and for patient confidence, equity and safety; the UK is significantly less expensive than France, Germany and the US. Mortality from cancer and heart disease was falling faster than anywhere, while waiting lists were all but abolished.  All this is now being destroyed due to the Coalition Government’s ideological obsessions.

This is why we have to do all we can, to stop the Bill. So please sign the petition, and please contact your friends, and ask them to do the same, without delay!