Workers' Weekly On-Line
Volume 51 Number 25, November 13, 2021 ARCHIVE HOME JBCENTRE SUBSCRIBE

Health and Care Bill 2021-22

The Pay-the-Rich Direction of the Government in the NHS Continues to be Opposed

Protest in July outside Parliament against the Second Reading of the Health and Care Bill

Opposition to the Health and Care Bill 2021-22 continued on Saturday October 30 [1] with Keep Our NHS Public North East and "We Own It" actions on Halloween in towns and cities particularly delivering letters to MPs in opposition to the Bill. The petition against the Bill now stands at 108,000 [2] and over recent weeks many trade unions, medical associations, other organisations and individuals have continued their opposition by presenting their evidence in opposition to the Bill to the sessions of the Parliamentary Public Bill Committee (PPBC) [3]. Now is the report stage of the Bill in which some amendments will be presented to Parliament in the third and final report stage reading in Parliament on November 22 and 23. At the same time, the Health and Social Care Levy Act 2021 received the Royal Assent and was passed by Parliament on October 20. This Act imposes a new temporary health and social care levy [4] on most people who pay national insurance from April 2022 to April 2023. Then f rom April 6 2023 it will become a separate permanent tax levy that will include those over pensionable age.

Over the last year this opposition to the Health and Social Care Bill has centred around opposing this wrong direction for a system of health care, which has further taken the NHS from a public system to one that is increasingly dedicated to paying the rich. This has become very marked during the pandemic with vast sums being handed out to the private companies whilst the public NHS system has continued to be starved of the investment it needs in human and material resources. At this time, as the waiting lists increase for routine operations and procedures, NHS bodies are increasingly being forced to give over to the private sector less complicated elective surgery and diagnostics enabling those companies to profit and even pay more for professional staff and attract theme from the public bodies. This leaves an increasingly underfunded and understaffed NHS to pick up the costly and complex emergency surgery and diagnostics. At the same time, the Health and Social Care Levy Act 2021 will impose a further tax levy next year to ensure that the rich who privatise and profit from the NHS get paid. This Act should also be opposed as it is part of government pay the rich schemes for the NHS.

In the written evidence to the PPBC Professor Allyson Pollock and Peter Roderick, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University point out that [4]: "The Bill is a 'hands-off Bill' which goes in the wrong direction. It fails to address the serious challenges facing the NHS, public health and social care. We cannot see it making any difference to reducing waiting lists and waiting times for services, to reducing staff shortages, or to providing adequate funding to rebuild and restore capacity in public health services." In further bullet points they highlight among other things that the Bill "replaces the principles of universal and comprehensive coverage throughout England with the limited concept of 'core responsibility' for specified groups of people and the conferring of 'discretions' on providers" as to what health services they provide and how they provide them. It will "lead to some 40+ integrated care boards (ICBs) which will cover ar eas that are too large to ensure local and public accountability which has already been degraded over many years" and "allows private companies to make decisions on allocating public expenditure through their membership of ICBs, reduces provision and access to medical services and emergency services, further undermines the rights to life and health and conflicts with the NHS constitution."

In the face of this opposition to the Health Bill Health minister Edward Argar told MPs in the debate on the Bill last month that the government would introduce an amendment "to protect the independence of Integrated Care Boards (ICBs)" by preventing individuals with "significant interests in private healthcare" from sitting on them". However, he said the government will not extend the same prohibition to the Integrated Care Partnerships (ICPs). Yet, the new legislation is precisely about the ICPs working in close partnership with the ICBs and so this means very little if nothing to the aim on this Bill. As one commentator [5] put it the "bill would also remove the procurement of healthcare services for the purpose of the health service from the scope of the Public Contracts Regulations 2015. As a result, contracts could be handed out to the private sector without the stringent arrangements one would expect in the awarding of public money. This is a recipe for cronyism." This was a lso highlighted by when Sajid Javid, the new Secretary of State for Health when he said in the previous debate on the Bill: "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 cronyism that has been seen by government Minsters during the pandemic is to be enshrined in this new Bill to further enable this pay the rich direction for the NHS.

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 new legislation is designed as a new corporate-led model of handing out contracts with their new ICBs and ICPs, covering in some cases some 2 million people with no accountability to those communities, cities and towns. 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."

Whilst building the resistance of the people to the attacks on health services the necessity is for a new direction where public authorities involve health staff, and the people in the communities they serve, empowering them to speak directly about their needs and participate in making the decisions. This is the direction to take our NHS forward as a human centred system providing a universal and fully funded public health and social care system which is free to all humans as of right. This is the requirement of a modern society today.


1. "We Own It" national day of action against the Health and Care Bill
Keep Our NHS Public North East
2. Protect the NHS: Scrap the health and care bill
3. Written Evidence to the Parliamentary Public Bill Committee
4. Policy Paper Health and Social Care Levy.
This measure provides for a temporary 1.25 percentage point increase to both the main and additional rates of Class 1, Class 1A, Class 1B and Class 4 National Insurance contributions for the 2022 to 2023 tax year and revenue raised will go directly to support the NHS and equivalent bodies across the UK. From April 2023 onwards, the National Insurance contributions rates will decrease back to 2021 to 2022 tax year levels and will be replaced by a new 1.25% Health and Social Care Levy where the revenue will be ringfenced to support UK health and social care bodies.
Individuals above State Pension age will not be affected by the temporary increase to National Insurance contributions for the 2022 to 2023 tax year but will be liable to pay the levy from April 2023.
The new Health and Social Care Levy will be subject to the same reliefs, thresholds and requirements of the qualifying National Insurance contribution (Class 1, Class 1A, Class 1B or Class 4) in respect of which the Levy is payable.
The levy doesn't include Class 2 contributions that are fixed weekly amounts paid by self-employed people, or Class 3 contributions which are voluntary NICs paid by people wanting to fill gaps in their contributions record.
5. Vote looms on health bill that would subject English NHS to cronyism and cuts - Margaret Greenwood, Open Democracy
6. Continuing the Wrong Direction for a System of Health and Social Care


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