Workers' Weekly On-Line
Volume 49 Number 16, October 5, 2019 ARCHIVE HOME JBCENTRE SUBSCRIBE

Proposed NHS Integrated Care Bill

The Necessity for a Human Centred Health Care System

House of Commons meeting to oppose Accountable Care Organisations in 2018

In September this year NHS England and NHS Improvement published their response to the report of the Commons Select Committee on Health and Social Care and made a proposal for new legislation after an "engagement process" on an NHS Integrated Care Bill. There was even a letter of support from 18 senior health and care leaders to Matt Hancock, Secretary of State for Health, which said among other things: "We write with unanimous support for a focused NHS Bill within the forthcoming Queen's Speech... The bill should be tightly focused on the issue of care integration to foster collaboration within the sector, including removal of section 75 of the 2012 [Health and Social Care] Act with its unnecessary procurement processes."

According to reports from Health Campaigns Together, both Unison and the Royal College of General Practitioners signed this letter. However, the British Medical Association while welcoming the scrapping of section 75 did not sign, explaining that it is concerned about the rest of the proposals. As a result of this approach from NHS England and NHS Improvement, as well as the Commons Select Committee on Health and Social Care, a new NHS Bill is most likely to be announced in the government's next Queen's Speech scheduled for Monday, October 14.

Whilst there is an attempt to present such a Bill as coming from health professionals and even trade unions, the Bill has its origins in the Commons Select Committee[1] which in 2018 called on the government to "bring forward legislation to remove legal barriers imposed by the Health and Social Care Act 2012". They also said it was "to rebuild the trust that previous and repeated top-down reorganisations have eroded, the Committee recommends representatives from the health and care community". They complained that "debate on NHS reform is often polarising. This has been true in the case of sustainability and transformation partnerships, STPs, and, more recently, accountable care organisations, ACOs - forms of healthcare services that share their name with but are essentially different to models from the US." In other words they were concerned that there had been so much opposition to their plans to downgrade District Hospitals and opposition to these so-called "sustainability and transformation partnerships" that they wanted to now carry out "engagement" for the same ends.

The Select Committee also called for the evaluation of pilots "to extend the use of Accountable Care Organisations (ACOs ) in the English NHS", copying the private sector ACOs in the US which claim to do the same thing for a fully privatised health care system. The Committee recommended "that these should be introduced in primary legislation as NHS bodies. The Committee does not believe that the introduction of ACOs in England threatens the founding principles of the NHS or that they are likely in practice to be private sector led, but recommend establishing these as public bodies would reassure on that point."

So, very early on, the agenda for health and social care had been set. It was to rebrand the NHS Five-Year Forward View of using "sustainability and transformation partnerships" and "Accountable Care Organisations" all of which had been so far rejected by health professionals and people throughout England and Wales. The same old direction was now to be changed to "integrated care" with the proposed wholesale merger of Hospital Trusts and private providers of health care and Clinical Commissioners into committees of ACOs. Now, however, they are to be called "Integrated Care Partnerships" and "Integrated Care Systems", but his time involving some health professionals in adjusting their plans.

This is why the proposed Bill is being sold in the health journals as scrapping "great chunks" of "independent competition regulation" of the hated Health and Social Care Act, 2012. But nothing in this can disguise that this is another piece of legislation to protect and further take the NHS in a corporate-led direction rather than a human-centred direction.

Calderdale and Kirklees 999 Call for the NHS points out in a recent article[2] that even the stated purpose of the legislation is a sham: "It will not save the NHS from big business - rather, it props the door wide open for it... The proposed legislation leaves intact contracts and their procurement, which we do not think should be the basis of providing NHS services. Tellingly, Andrew Taylor, former director of the NHS Cooperation and Competition Panel, is on record as saying that the government's proposed legislation is about deregulating markets in the NHS, that it in no way removes them, and that 'no one is seriously talking about removing the private sector'."

In other words, its aim on "integration" is to further the health care system along the same private/public corporate direction that will continue to deepen the crisis of health care provision unless the real problem of this direction is addressed.

A human-centred system of health care starts from the claims of human beings in society for health care which is a right and must be guaranteed for all. Claims which must be made on the overall economic and social wealth that the working class and people create are the essence of a human-centred system. It is not a privilege bestowed by the ruling elite to be imposed in a regime of corporate debt on hospitals and health services. This corporate driven "debt" is used to turn the screw of rationing on health care. It is used to roll back health care to the so-called "undeserving" sections of people such as immigrants and deprive us of the right of all to health care. It is used to justify the wrecking of NHS services driving through these cuts in the name of "sustainable transformation partnerships", "path to excellence", and so on. This is the corporate-led direction that does not recognise claims or needs of complex modern societies today where all have rights because they are human. This is an anti-human and not a human-centred approach to health care.

What is needed to move forward is the negation of this corporate-led direction of the health care system and wrecking of the NHS and their funding of private interests. The necessity is for the creation of a human-centred health care system. This requires everyone to take a stand, to speak out in defence of the right of all to health care.

Oppose the wrecking of the health service! Fight for real public oversight and for the right of health workers and professionals, and the people as a whole, to set the agenda and be involved in decision-making! Safeguard the future of the NHS as a human-centred health care system!



2. MPs must block the government's NHS Integrated Care Bill


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