The House of Commons have now voted through the government’s controversial Health and Social Care Bill, and passed it on to the House of Lords as the next step towards becoming law.
Despite the government’s “listening exercise” and changes to the Bill, what was passed in the Commons yesterday is still a toxic combination of competition, markets and fragmentation that strikes at the founding principles of the NHS. To take just a few examples of the areas where we still have serious concerns:
- The Bill means increased competition instead of collaboration. This is despite evidence that the NHS is one of the most cost effective health care systems in the world – much more so than in the USA, where competition is central. Plans to allow ‘Any Qualified Provider’ to deliver NHS services will open up swathes of the NHS to private and voluntary sector providers.
- It still means private patients jumping the queue. The Bill removes the cap on the amount of money NHS hospitals can make from private patients. This could mean NHS patients being pushed to the back of the queue for care. With foundation trusts strapped for cash, the temptation to prioritise paying patients will be strong.
- It means a fragmented system and lack of accountability. The government would no longer have a direct duty to provide a comprehensive health service. It would be up to local commissioning groups to determine what to provide as part of the NHS. This could intensify postcode lotteries for care.
- There are still fears about transparency. Private and voluntary sector providers will have a much bigger role delivering NHS services if the Bill goes through, but the Bill doesn’t hold them to the same standards of transparency as NHS providers.
- The reform is getting even more expensive. On the tightest financial settlement in many years, the NHS is also being asked to make ‘efficiency savings’ of £20bn by 2014-15. The cost of the reorganisation is estimated to be up to another £3bn. We already know that tens of thousands of jobs are being cut, including clinical posts.
Despite the Commons vote, the campaign to halt this Bill is not stopping here. With senior Liberal Democrat Peers concerned about the repercussions of the Bill, there could be a lot of scope for resistance and amendments to it. We’ll be pressing Peers of all parties to take an active role in the debate and to listen to the widespread concerns of NHS service users and staff about the risks to the future of our National Health Service.
In the No Camp: Martin Shapland on TotalPolitics.net
If you had been on Twitter on Wednesday night after the vote on NHS reform, you might have got the impression from the vitriol of the miscellaneous lefty masses that the coalition government had just asset-stripped hospitals, privatised cancer wards and thrown grandmothers out on the streets to sell off the beds. ‘It’s a Tory Privatisation!’ ‘The Liberal Democrats have sold out!’ -#lowerthanvermin was the hashtag of choice.
Of course all of that is complete tosh.
No party or ideology has a monopoly on the NHS. A free at the point of use, national and public health service is something Labourites, Liberals and Conservatives alike passionately believe in and that is something the NHS reforms will not change. If you don’t believe me, read the explanatory notes yourself here.
The Bill's aims are to restructure the NHS; abolishing Primary Care Trusts and setting up Commissioning Boards, which will have much more local accountability, give GPs more autonomy over local services and allow much more transparency than the existing setup. They will also encourage efficiency and give NHS providers new freedoms to improve quality of care.
It will not, as online campaigning portal 38 Degrees and others have suggested, allow the secretary of state for health to ‘wash their hands’ of the NHS, lead to privatisation, or subject the NHS to new aspects of UK or EU Competition Law.
38 Degrees' assertions are particularly misguided as they contradict the legal advice they commissioned themselves.
Where 38 Degrees told their members that ‘the bill will remove the duty of the secretary of state to provide’ (Sections 1 and 3 of the 2006 act) their legal advice states: The duties set out in Sections 1 and 3 of the 2006 Act are executed on behalf of the Secretary of State by Primary Care Trusts … Thus, there is no change at all. Incidentally the Bill itself retains the wording ‘The secretary of state has the duty to promote a comprehensive health service’ - something retained from the original 1946 Act.
Where 38 Degrees told their members the Bill will ‘make it almost inevitable that UK and EU competition law will apply as if it were a utility like gas or telecoms’, their legal advice states: ‘The current procurement law contained in the Public Contracts Regulations 2006, which derives from European law, has always applied to NHS purchasing … As regards the applicability of domestic and European competition law to the NHS, it is likely that… competition law already applies to PCTs and NHS providers. ‘
Apart from the fact that Labour’s 2006 NHS act delegated the duty to provide to Primary Care Trusts and exposed the NHS to European competition law, the charge that the Liberal Democrats somehow ‘sold out’ is risible.
It was a motion at the Liberal Democrat Spring Conference led to the Bill being paused and a massive rewrite taking place that guaranteed no privatisation of the NHS, no special favours to the private sector, retained the legal requirement that services be free of charge, ensured
continuous improvement in the quality of services and put in place a clause to reduce health inequalities – all of which, incidentally, is the duty of the secretary of state.
I note the cries of ‘privatisation’ ‘shame’ and ‘sellout’ come from the same Labour party that financed new hospitals using expensive private finance initiatives, created ‘private’ foundation hospitals and paid the private sector £250m for operations that weren’t carried out.
There are complaints you can make about the bill – it's rushed, it’s a top-down reorganisation and it’s not what’s in the coalition agreement – but it is not privatisation through the back, or any, door.
Of course the art of politics is about presentation, something the coalition is relatively poor at, but it is important to get the facts right, and not scaremonger as 38 Degrees and Labour have. We received an email in the office this morning from a member of the public worried about paying for healthcare and asking whether they were going to have to start paying for their healthcare.
The very clear and understandable answer is no: the NHS will remain free at the point of use – I’m saddened to learn that you have been misled.After watching the Labour response to the tuition fees bill, I'm deeply suspicious of anything they say. HOWEVER, I'm not too keen to trust Tories with the NHS either. IDK ontd_p, maybe it's a bit more complicated than news reports would lead us to believe?