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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

Even the telegraph is critical

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.

In Manchester, where efforts to mesh various parts of the system are most advanced, there was a 65 per cent increase in delays between hospital and further care.
Billed as the future of health and social care in England, the new regional Integrated Care Systems (ICSs) are intended in part to prevent such waits.
Analysis of official figures by the Centre for Policy Studies (CPS) also found an “alarming” rise in emergency readmissions in ICS pilot areas.

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.

Introducing new layers of bureaucracy
Although intended to streamline the patient experience by better linking up parts of the health and social care system, the statutory-based top-down implementation of ICSs could be introducing new layers of bureaucracy that divert attention from patient care, according to the CPS.
The number of NHS patients waiting for treatment is more than 5,454,300, according to the latest figures.
Last month, the Institute for Fiscal Studies warned that the list could reach 14 million by autumn next year.
Karl Williams, who led the new CPS analysis, said: “Ministers need to take a step back and let the pilot schemes run their course so we can properly evaluate their success.

“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.”

He added: “”These reforms could potentially soak up a lot of time and energy and money, which could be better used elsewhere, including the imperatives of recovering access and clearing up the NHS backlog caused by the pandemic.”
The think tank is calling for a “bottom-up” model of care integration, with less control from Whitehall.
The report found that between 2016 and 2020 in Manchester there was a 65 per cent rise in delayed transfers of care under the region’s devolution settlement, which is akin to the future ICSs.
The increase is far higher than an average rise of 14 per cent across England.
No target set to be met
The researchers could not identify a single target set out in Manchester’s own plan that the devolved system was on course to meet before the pandemic struck.
The data also showed a significant decline in productivity, with a nine per cent increase in the size of the Greater Manchester region’s NHS workforce relative to its population, and a 23 per cent rise in the number of senior managers.
The performance came in spite of the upfront creation of a £450 million fund.
Outcomes in the West Yorkshire and Harrogate area were better than in Manchester, but there was still no evidence of overall improvement, according to CPS analysis.
Despite the findings, NHS figures last night backed the ICS drive and the NHS Bill, currently going through Parliament, that will underpin it.

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.

The NHS Bill going through Parliament is merely catching up with collaboration of local services that have been taking place for several years.
“NHS leaders want this and believe the changes will improve care for patients and deliver more value for money for taxpayers.

“Any delays to the Bill will set back months of progress and, ultimately, harm patients.”

The King’s Fund, a leading health policy think tank, also backed the Bill in its current form.
A Greater Manchester Health and Social Care Partnership spokesperson said: “We’re really proud of our achievements in Greater Manchester and can point to good progress in many areas, such as improved school readiness and reduced mortality from killer diseases.
“We have prioritised population health outcomes, trying to influence all the factors that are stopping people from being healthy.”
An NHS spokesman said: “This report fails to recognise that only half of these systems have been in place for a year, and largely ignores the very obvious benefits of integration to patients and the public that we have demonstrated in the past year, including the world-leading precision and pace of the NHS Covid vaccination programme, where local health services worked closely with their community partners to protect tens of millions of people.”
UNISON Head of health Sara Gorton takes a pragmatic view and is still working on amending the worst aspects to retain the better (It is a Tory Bill and unlikely to be all we would want it to be)
Read her blog on the link below