The government has just published the Health and Care Bill, the first piece of major NHS legislation since Andrew Lansley’s Health and Social Care Act 2012.
The legislation seeks to scrap much of the Lansley system that our union has been campaigning against for most of the past decade.
UNISON has established policy from our last Health Conference and the recent Special Delegate Conference committing the union to support moves to end the current competition regime.
However, there are concerns that this Bill represents new ways to privatize the NHS by admitting private providers into the decision making process for example
Prof Allyson M Pollock and Peter Roderick wrote recently
The Health and Care Bill which was introduced in the House of Commons on 6 July 2021 is a major reorganisation of the NHS in England which will complete the dismantling of it as a universal, comprehensive, publicly funded and provided service free at the point of delivery. It is an astonishing attempt to allow the Secretary of State, an enlarged NHS England as ‘rule-maker and regulator’, and new public-private ‘Integrated Care Boards’ (ICBs), to reduce services, limit expenditure, further degrade local accountability and entrench the market.
If Parliament enacts this Bill:
(1) there will no longer be a statutory duty on any body to arrange provision of secondary (i.e., hospital) medical services – only a power for ICBs to do so;
(2) ICBs will only have a “core responsibility” for a “group of people” in accordance with enrolment rules made by NHS England, evoking the US definition of a health maintenance organisation which provides “basic and supplemental health services to its members”;
(3) it will be possible for ICBs to award and extend contracts for health care services of unlimited value without advertising, including to private companies;
(4) private health companies will be able to be members of ICBs, their committees and sub- committees, which will plan NHS services and decide how to spend NHS money;
Update; At the meeting of the parliamentary committee scrutinising the NHS bill on Tuesday, the government made an important concession. They said they agreed that “individuals with significant interests in private healthcare” should not be allowed to sit on NHS boards. This is a BIG concession from the government. And it was down to campaigning work by UNISON and others like We Own It
(5) NHS England will have new powers to impose limits on expenditure by NHS trusts and NHS foundation trusts;
(6) integrated care partnerships will be set up as joint committees of local authorities and ICBs to draw up integrated care strategies, with no restrictions on membership and without clear transparency obligations;
(7) payments will be determined by NHS England after consultation with providers, including private providers, and can distinguish between different types of providers, different groups of patients and different types of services;
(8) local authority representation on ICBs will be limited to one member covering (usually) several local authorities, whilst the more local ‘place-based’ ICB committees will not have power to determine their budgets;
(9) local authority powers to refer reconfigurations will be affected because the Secretary of State is to be given new intervention powers, but exactly how is unclear.
The Bill does nothing to:
rebuild and restore local, primary medical services, community, mental health and hospital services (e.g., staffing and beds) which the covid-19 pandemic has exposed as being seriously inadequate after years of service closures and cuts;
address the failings of the centralised communicable disease control system, and wider public health system, revealed during the covid-19 pandemic;
address the broken social care system with which health services are supposed to be integrated;
prevent corporate take-overs of GP services.
Further analysis from UNISON will follow. In the mean time you can read the Bill here https://publications.parliament.uk/pa/bills/cbill/58-02/0140/210140.pdf
Patients waited longer for treatment under a flagship pilot scheme to integrate health and social care, figures reveal, as experts warn the programme may exacerbate the backlog.
The think tank is now calling for the NHS to slow down the roll out of the 44 regional ICS’s, due to be completed by April.
“Now is not the time to push through costly and disruptive reforms that are not supported by the data, especially given the current pressures on the NHS and its staff.”
Louise Patten of the NHS Confederation, which represents Integrated Care Systems, said: “NHS leaders support the move to greater integration of local health and care services in England through the creation of integrated care systems.
“Any delays to the Bill will set back months of progress and, ultimately, harm patients.”