We are about to see the end of the NHS. Unless we stop the government’s Health & Care Bill currently going through parliament, the NHS will be all but abolished by next April. The Bill totally undermines the central principles of the NHS as envisioned by its founders – a comprehensive, publicly provided and funded service, accessible to all, in which the risk of ill-health is shared nationally.
The Cameron government promised that there would be “no top-down changes to health care” but it embarked on exactly that, expanding privatisation, failing to recruit adequately and underfunding. The Johnson government is following suit. No wonder Tory ex-Prime Minister John Major warned that the NHS would be “as safe with Johnson and Gove as a hamster with a hungry python”.
Like all such bills, this one is complicated. Central to it, however, is the full roll-out of 42 ‘Integrated Care Boards’ (ICB’s), replacing Clinical Commissioning Groups who buy and provide health services. ICB’s are inspired by an American model which rewards spending reductions in State-funded healthcare.
Gone is the national structure. And where integration really is necessary – the integration of health and social care – the Bill has nothing to offer.
All that is integrated is the position of corporate power. The Bill expands the role and representation of these interests and downgrades the role of local authority involvement. Private providers are already sitting on some ICBs, putting them in a prime position to give themselves advantages. Currently the health service has a statutory duty to provide hospital services. The Bill abolishes this.
It also abolishes the obligation to tender for contracts – something we’ve seen trailered in the current pandemic with the government handing out contracts to friends and donors. For example, behind the repeated references to NHS Track and Trace, that operation is not run by the NHS but by private providers. So we have both too much marketisation and – the worst of all worlds – a deregulated market. The repeal of the requirement to tender is likely to have serious adverse effects. Contracts may be awarded with little or no oversight.
What we are about to see if this Bill is approved is a reduction in state-funded care and a consequent pressure on people to ‘go private’. Suddenly the incentive is no longer to increase the availability and quality of health and social care but to cut costs and create opportunities for profiteers.
It does not address crucial problems within our health and care system caused by decades of underfunding, exacerbated by COVID.
Following the third reading in the House of Commons at the end of November, the Bill is now with the House of Lords. Only members of the Lords can now make crucial amendments. Without amendments, the NHS as we know it will die as life support systems are gradually withdrawn.
Ed: Mike Brooker is the Chair of the Witney Constituency Labour Party. He would like to thank Andrew Hornung, and Judith Wardle of the Socialist Health Association.