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Proposed NHS Integrated Care Bill:
The Necessity for a Human Centred Health Care System
Over recent weeks, the government has been tearing up constitutional norms and conventions with such brazenness that it is causing serious disruption to the status quo itself. The new dominant faction of the ruling Conservative Party has swept aside any dissenting voice and has ejected the old guard from their posts. The government is now so far in the minority that in no way can it be said to command the confidence of the House of Commons, to use the jargon of parliamentary democracy. No longer is there any of the pretence of strength and stability of its predecessor. This has been replaced by the straightforward declaration that there will be no more business as usual. We Will Get Things Done, they cry. Thus they are setting themselves up as a Civil War government, lacking any legitimacy and already in conflict with other sections of the establishment such as that represented by the Supreme Court.
Discussing the "Necessity for Complete Democratic Renewal", Workers' Weekly said: "In this situation, the people are organising to bring into being new forms in which they not only express opposition to what the establishment is trying to impose on them but also voice their own concerns and work out how to empower themselves so as to be able to make the decisions to safeguard these concerns and what favours them, and to themselves participate in setting the agenda as to what these concerns actually are. In other words, the people's movement is striving to bring into being and to strengthen where they exist the kind of forms and forums in which their decisive participation is fundamental, in which they speak themselves in their own name."
In a reflection of this, there have also been calls for a Citizens' Convention to decide on a written Constitution.
Green MP Caroline Lucas said last month in Parliament before the prorogation:
"On a point of order, Mr Speaker. The events of tonight have clearly shown that our political system is broken. It is wrong that a Prime Minister can suspend Parliament as a mere inconvenience simply to avoid scrutiny. It is wrong that he can cynically try to use the proposal of a general election as a way of getting us to crash out of the EU while we are in the middle of a general election campaign.
"We cannot continue with this uncodified Constitution that depends on people playing by the rules, when we have a feral Government who are not only not playing by the rules but are not even going to abide by the law. We urgently need a written Constitution and a citizens' convention to inform it. No one voted for less democracy. We should design our constitutional settlement so that such a cynical power grab can never be allowed to happen again."
It is certainly the case that the lack of a written Constitution is a serious issue. This is an aspect of Britain's archaic political arrangements that reached their current basic form over three centuries ago, emerging out of the conditions of civil war in the 17th Century. Now those arrangements are in crisis and not fit for purpose, and the ever-simmering state of latent civil war is again beginning to heat up; the prospect of it boiling over into open conflict is not so far-fetched at this time.
It is also the case that, while it will certainly change the dynamics, the presence of a written Constitution per se will do nothing to change that fact, while the conception is that it should be formulated by the great and the good. Indeed, it may fulfil the role of attempting to consolidate the old arrangements. Modern arrangements are required reflecting that the people must be sovereign, where that means decision-making power is in their hands in a political arrangement where they themselves are empowered. The people are showing by their actions that the Old is not acceptable. It remains to be seen whether a call for a written Constitution will also arise out of this demand for the New, a demand arising out of the new conditions.
The events of the 17th and 18th Centuries gave rise to the arrangements of civil society and representative democracy. From the outset, this was a form to sort out the contradictions between the warring factions while keeping the multitude from power. It did so by instituting a division between the rulers and the ruled.
Rather than representation of the people's interests, the conception was instead that we authorise the representatives of the state itself to speak and act in our name. Rather than representation meaning representation of the people, representative democracy has, since that time, meant representation of the sovereign power (and implicitly, the ruling class interests behind it).
Governments are elected which are said to be representative of the wishes of the electors but they in fact govern in the name of the sovereign which, as the person of state, exists above them and is said to represent the national interest. This conception pervades our whole discourse, raising the necessity for the people to provide themselves with a new outlook on political life. Even the word sovereignty itself, which means to reign over, encapsulates this division into rulers and ruled. The challenge is to think outside of the box.
As Workers' Weekly said, "people cannot afford to get embroiled in the call that parliamentary democracy must be restored to resolve the situation, or to get divided on the basis that the fight is parliament versus the people."
A change from sovereignty residing in the monarch to sovereignty residing in the people is what is required, a radical departure from the rule of the few in their narrow interests over the many, to the rule of the many in the broad public interest. It is only possible to have a modern constitution consistent with the aspirations and demands of the people at this time in history if there is a clear affirmation and definition that the people are sovereign. Such a modern constitution would be based on modern definitions, starting with the recognition of inviolable rights that exist simply by virtue of being human and enshrining a modern definition of citizenship and the recognition that society must provide for all citizens all the benefits of society at the highest available level. It would further affirm that sovereignty lies with the people. It would be profoundly anti-war.
As far back as 1995, the Draft Programme for the Working Class stated:
"The lack of a Constitution, let alone a modern one based on modern definitions, means there is no yardstick by which arbitrary legislation may be measured or the rights of the people defined. For example, the government was able quite arbitrarily to legislate away the centuries-old right of silence recently in the Criminal Justice and Public Order Act.
"All these institutions, processes and practices act as a block to the empowerment of the people, to a realisation of their right to govern themselves which is consistent with the modern requirements of democracy. This situation has led to a widespread discontent among the different sections of society, particularly with politicians and the political parties. There is growing demand for change. It is imperative that this discontent and demand for change finds a direction which will open up a path to the solution of this problem."
In conclusion, to quote Workers' Weekly one last time: the calls for a written Constitution "can only have meaning in the context of the working class and people's movements making the work for democratic renewal and an Anti-War Government a way of life in itself. This is what our organising work is directed towards."
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 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 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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