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Volume 51 Number 22, October 16, 2021 ARCHIVE HOME JBCENTRE SUBSCRIBE

Health and Care Bill 2021-22

Continuing the Wrong Direction for a System of Health and Social Care

Demonstration against the Health Bill outside Parliament on July 14, 2021

On Wednesday July 14, the day that the Health and Care Bill was to have its Second Reading in Parliament, the British Medical Association (BMA) council called on MPs to reject the Bill. The Health and Care Bill is at present at its Committee Stage in the Commons, with sittings due to take place on October 19 and October 21.

In its press release, the BMA council said that it had "overwhelmingly passed a resolution calling for the Health and Care Bill to be rejected, arguing that it is the wrong time to be reorganising the NHS, fails to address chronic workforce shortages or to protect the NHS from further outsourcing and encroachment of large corporate companies in healthcare, and significantly dilutes public accountability". In this resolution, the BMA reflected the sentiments and stands of the public and health professionals and health workers everywhere and also of patients. At the same time, Keep Our NHS Public also held a protest outside the Parliament at the Second Reading. The protest, led by its Chairperson Tony O'Sullivan, a retired paediatrician, was joined by MPs Jonathan Ashworth and Zarah Sultana. Caroline Lucas MP also sent a statement, and other MPs spoke against the Bill, either from inside the Palace of Westminster, or remotely. A petition was also launched by Keep Our NHS Public's ret ired GP Louise Irvine against the Bill, signatures to which presently stand at over 107,000 [1].

In the Second Reading in Parliament later that day the government once again ignored the overwhelming concerns expressed by the BMA and public and health professionals and informed public opinion. An Opposition Amendment which would have at least led to a redrafting of the Bill was rejected, as was to be expected, and the Bill passed through to the Committee Stage [2]. In moving the Bill, Sajid Javid, the new Secretary of State for Health following the resignation of Matthew Hancock, said: "We have seen bold new ways of working, of overcoming bureaucracy and of people working seamlessly across traditional boundaries. New teams were forged, new technologies adopted and new approaches found." In other words, the Bill is intended to allow the Secretary of State for Health and the new 42 Integrated Care Partnership Boards (ICBs) to perpetuate the handing out of contracts [3] worth vast sums of money to wealthy individuals and corporations at the expense of a publicly-provided and compr ehensive health care system that is accountable to all. This in the same way that previously Matt Hancock had claimed that this Bill was about removing some of the "cumbersome boundaries to collaboration".

During the debate, Dr Philippa Whitford, the SNP MP for Central Ayrshire, pointed to what was missing from the debate when she said: "Instead of taking the opportunity to return to a publicly funded and delivered health service, as we are lucky enough to have in Scotland, the purchaser-provider split remains and the principle of commissioning and procurement means that financial competition continues. The administrative costs of such transactional systems waste funding that would be better spent on direct clinical care. Unfortunately, the government are still wedded to the flawed idea that financial competition drives up quality, yet there is no evidence of that. Indeed, financial competition can mean that, when a service starts to struggle, the loss of funding makes its failure become inevitable. It is actually a relentless focus on safety, clinical audit and peer review that can drive improvement in the quality of patient care."

In the debate, the Health and Care Bill was also described as a "kitchen sink Bill, with many disparate components". Yet for a Bill that the Health Secretary claims to be "working seamlessly across traditional boundaries", it is almost silent on one of the most important questions as to how the alignment of health and social care services and funding of health and social care will take place. Previous governments introduced charges and "means testing" for "social" care and the whole care home sector was privatised.

Writing before the Second Reading of the Bill, Professor Allyson Pollock and Peter Roderick [4] pointed out that 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" or "prevent corporate take-overs of GP services".

In other words, the Health and Care Bill is continuing the wrong direction for a system of health and social care in England. It is the wrong direction towards a corporate-led and privatised system of health and social care being rolled out on the back of the present health crisis. The government expects that the new legislation will be designed as a new corporate-led model of handing out contracts with their new ICBs, covering in some cases some 2 million people. These bodies will have no statutory duty even to make their decisions in public, but are said to be tasked with "overcoming the bureaucracy" of the regulatory systems of procurement and market bureaucracy. As Dr Philippa Whitford pointed out in the debate: "They should be statutory public bodies focused on how to provide the best services to their local population, including working with local government to provide social care and tackle the social determinants of health. Instead, private companies can sit on the integrat ed care partnership boards, as is the case with Virgin Care in Bath, Somerset, and could influence the commissioning of services for which they are hoping to win contracts. It is hard to see how this is anything other than a blatant conflict of interest and suggests that private providers are moving higher up the ladder and could exert influence on a larger scale."

This all points towards the necessity for a new direction where public authorities are based on health staff, and on the people in the communities they serve, and are empowered to speak directly about their needs and participate in making the decisions. A human-centred system providing a universal and publicly-funded health and social care system which is free to all is the requirement of the times.

1. Petition - Protect the NHS: Scrap the health and care bill
2.Jonathan Ashworth (Leicester South) (Lab/Co-op); "I beg to move an amendment, to leave out from 'That' to the end of the Question and add":
"this House declines to give a Second Reading to the Health and Care Bill, notwithstanding the need for a plan for greater integration between health services and social care services and for restrictions on junk food advertising to improve population health outcomes, because the Bill represents a top down reorganisation in a pandemic leading to a loss of local accountability, fails to reform social care, allows further outsourcing permitting the private sector to sit on local boards and fails to reinstate the NHS as the default provider, fails to introduce a plan to bring down waiting lists for routine NHS treatment or tackle the growing backlog of care, fails to put forward plans to increase the size of the NHS workforce and see them better supported, and fails to put forward a plan that would give the NHS the resources it needs to invest in modern equipment, repair the crumbling NHS estate or ensure comprehensive, quality healthcare."
3. Formerly the role of over 100 Clinical Commissioning Groups which will be abolished by the Bill.
4. Health and Care Bill 2021-22 - Key points and questions for the second reading, 14 July 2021


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