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Volume 52 Number 8, April 16, 2022 ARCHIVE HOME JBCENTRE SUBSCRIBE

Health and Care Bill

Imposing the Path of Privatisation and Cronyism in the NHS

The Health and Care Bill returned to the House of Commons on Wednesday March 30, 2022, for a debate on 14 amendments made by the House of Lords to the Bill [1]. The Bill had been debated in the Lords since December 7 last year. In the Commons debate, most of the Lords amendments were either rejected or amended by the government [2]. In the ping-pong debate, the Bill was sent back to the Lords for consideration of the government's amendments. However, whilst the Lords started its debate on April 5 - agreeing with some of the government's amendments and disagreeing with others - the Lords is now in recess from April 7, and will not return until April 25. The Commons is already in recess, returning on April 19. Thus the parliamentary process on the Bill is likely to continue after the end of the recess in April.

The Lords' amendments have to be seen in the context of the resistance to the Health and Care Bill which has been continuing with NHS workers, trade unions and health campaign organisations across England over the previous year and to date. There have been several rallies outside Parliament. One, on November 22, 2021, was joined by MPs in presenting petitions signed by over 300,000 people against the Bill on the day that it was being presented to Parliament for the Report stage. Whilst the Lords' amendments confronted some of the open cronyism that the government is introducing into health legislation, the Bill is continuing along the wrong direction for a system of health and social care in England.

One of the more important amendments was the Lords Clause Amendment 11 on "the process by which any appointment of a member to the Integrated Care Board (ICB) or any appointment to any committee or sub-committee of the integrated care board that has a commissioning function" [3]. Whilst the government's amendment 11A was challenged in the Commons debate by Margaret Greenwood, Wirral West Labour [4], this amendment was passed by the Commons. On return to the Lords on April 5, this amendment 11A went through without a vote, after the proposer, Lord Hunt, accepted the government's amendment.

In the debate in the Commons, Margaret Greenwood MP was almost alone in speaking in support of the Lords Amendment 11 when she said that it "is a step in the right direction, although it does not go far enough. It would ensure that conflict of interest rules that apply to integrated care boards would apply to commissioning sub-committees of integrated care boards." But in speaking about the government's amendment 11A to the Lords' Amendment she said: "I am concerned that the phrasing is clearly open to interpretation, and it by no means rules out people with interests in private healthcare from sitting on these sub-committees. It is wrong, too, that the power should rest with one person, namely the chair of the ICB. If we are serious about providing governance that rules out the possibility of the private sector influencing the expenditure of public money, an organisation carrying out the functions of an ICB on its behalf should be a statutory NHS body. It is a great pity that the Government have not legislated for that."

She continued: "We cannot forget that NHS guidance last year stated that the Health and Care Bill, if enacted, would enable ICBs to devolve budgets to provider collaboratives, which are one of a complex array of sub-committees that could take on commissioning functions. Representatives of private companies, which are accountable to shareholders, should not be able to influence these commissioning sub-committees in any way. Lords' amendment 11 at least improves the original Bill, and I therefore welcome it."

She also went on to welcome Lords' Amendment 105 which the government opposed, which, she said, "would mean that the membership of an ICB must include at least one member with expertise and knowledge of mental health in the integrated care board's area. The fact that the Government did not provide for that originally shows that they are still not treating mental health with the level of seriousness it deserves. It is disappointing that the Government have indicated that they disagree with the amendment." The government's amendment 105A watered down the Lords' amendment. It would be sufficient "that at least one of the ordinary members has knowledge and experience in connection with services relating to the prevention, diagnosis and treatment of mental illness". Amendment 105A was also passed in the Commons and accepted by the proposer Lord Bradley in the Lords on April 5 without any vote.

The Health and Care Bill is designed as a new corporate-led model for handing out health contracts with new ICBs and Integrated Care Partnerships (ICPs) and other sub-committees. These have already been put in place in many parts of England. For example, in the north of England the ICB will cover some 2 million people with almost no accountability to those communities, cities and towns of the north that it covers. ICBs will have no statutory duty even to make their decisions in public, and the Bill tasks them with "overcoming the bureaucracy" of the regulatory systems of "procurement and market bureaucracy". In other words, the present corporate direction that requires locally based Clinical Commissioning bodies (which will be abolished by the Bill) to only commission private or public services after an extensive procurement procedure is to be short-circuited by the Bill. It enabled ICBs and their sub-committees to enact the type of cronyism that we have seen used by the government in the pandemic. Nothing in the Bill addresses real problems in the NHS and social care. For example, the largest crisis in the NHS is that of staffing. The NHS can no longer be patched up by recruiting health care workers from poorer countries abroad. Nothing in the Bill addresses the investment needed, or a plan to train doctors and nursing staff, care workers and other hospital staff to meet the needs of a national health and social care service for this year let alone for the 21st century. On the contrary, the increasing staff shortages become the excuse to close down more and more hospital and community services.

Nothing in the Bill or indeed the amendments to it address the necessity for a new direction for the NHS that meets the needs of all for health and social care. The public and private sector care system of the NHS is in crisis and less and less able to meet people's needs. These facts emerge every day even though billions are spent particularly on the inefficient and wastefulness of private hospital and other health contracts. Of course, this starts with paying the rich corporations first, whilst increasingly cutting investments in the public health and care services. The Health and Care Bill and the remote "Integrated Care Boards" will not solve this, but will push the health care system down the same corporate road and into further crisis.

What is revealed by the Health and Care Bill is that people require new public health authorities which are human-centred. These must be new democratic authorities that involve health staff and the people in the communities that they serve in speaking directly about their requirements for health and social care services and participate in making the decisions. Such a direction for society must be to fully fund a public health and social care system that is free to all humans as of right regardless of any other consideration. The inhuman treatment of charging immigrants and visitors to England must stop. Health and social care is a human right in a modern society and must be upheld by all.

1. Lords Amendments to the Health And Care Bill will push the health care system into further crisis.
2. Marshalled list of motions to be considered on consideration of Commons reasons and amendment
3. Lords Clause 14 Amendment 11 with Government's amendment 11A
4. Margaret Greenwood MP, Wirral West Labour, speaking in the debate - March 30 2022


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