Will the Health and Care Bill really privatise the NHS?

The government’s controversial Health and Social Care Bill is heading to the House of Lords after “stumbling” through the Commons this week, said The Guardian.

The bill, which is the first piece of primary legislation on health and social care in England since 2012, is focused on restructuring parts of the NHS to make England’s public health services more integrated.

The Unite union has branded it the “NHS privatisation bill”, with general secretary Sharon Graham saying it will be “used to further run down the NHS and to bring in more privatisation by the back door”. But Health Secretary Sajid Javid has dismissed objections as “complete nonsense”.

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Despite Javid’s denials, anti-privatisation campaigners have continued to warn against the bill, claiming it could entrench the role of private sector firms in the health service.

Will private firms ‘contol the purse strings’?

The proposals include the establishment of 42 independently run Integrated Care Systems (ICSs) that will cover the whole of the country, “controlling purse strings and setting five-year plans”, explained The Mirror. Each ICS will oversee the local NHS across areas containing one to two million people.

These will remove “traditional divisions between hospitals and family doctors, between physical and mental health, and between NHS and council services”, said NHS England – divisions that have meant “too many people experienced disjointed care” in the past.

Anti-privatisation campaigners have expressed concern over the make-up of these ICSs, which will include representation from councils, charities, trusts and local authorities, as well as Integrated Care Boards (ICBs). These ICBs will be “accountable for NHS spend and performance within the system” and will have the power to decide on the type of healthcare that groups in their local area will receive, according to the government.

Sajid Javid has ‘absolute power’

Anger has been sparked by the decision to allow these powerful ICBs to include representatives of private health firms, as well as NHS clinicians and council public health leaders. Under Javid’s plan, said The Mirror, private sector appointees to ICBs will be blocked only if they “could reasonably be regarded as undermining the independence of the health service”.

What’s more, the health secretary has “seized power to overrule the independence of any ICS”, said Polly Toynbee in The Guardian. This means Javid can “upend their decisions on mergers or appointments according to political whim or cronyism”. He also has “absolute power” over the appointments of all directors to the ICBs.

In the Commons this week, Labour tried to block the bill from allowing any private healthcare representatives (except for GPs) on these influential health-commissioning boards.

“In Bath, in Somerset, we have seen Virgin Care get a seat on the shadow ICS,” said shadow health secretary Jon Ashworth, describing the situation as “unacceptable”.

His party colleague Richard Burgon and Cat Hobbs, the founder of public ownership campaigning organisation We Own It, were quoted in The Mirror as saying that the bill “entrenches an even greater role for private companies in our NHS, one where private companies not only profit from people’s ill health but increasingly get to decide who gets what treatments and when”.

More contracts for cronies?

Another major criticism of the bill by anti-privatisation campaigners is a change to the procurement rules that govern how the NHS locally buys care for people.

The proposal is designed to cut red tape and save time and money, said The Mirror, but the British Medical Association has warned that the rules “allow contracts to be awarded to private providers without proper scrutiny or transparency”.

Under the new bill, there is “every possibility” that private companies “will have the opportunity to extend their contracts or even be awarded new contracts without competition”, wrote Sian Norris in Byline Times.

The government is already facing “accusations of cronyism after it emerged that some firms were given access to a High Priority Lane which fast-tracked their bids for personal protective equipment (PPE) contracts”, said The Independent.

But not just private providers at the table

However, major voices in the health industry have disagreed that the inclusion of private sector appointees to ICBs and changes to NHS procurement rules are steps towards privatising England’s health service.

The Nuffield Trust’s Brexit programme lead Mark Dayan and senior fellow Helen Buckingham said they did not see a widespread “corporate takeover” of the NHS as a likely effect of the bill.

“There is nothing in the bill that would change the NHS from being a publicly funded service, free at the point of use except for existing charges for services like dentistry,” they wrote.

Dayan and Buckingham added that the NHS has paid private providers to deliver free care since it was founded in 1948 and that money has gone to private “secondary care” services since the early noughties.

Referring specifically to the inclusion of private providers on ICBs, Dayan and Buckingham noted that “NHS leaders, GPs, council leaders and independent non-executives will also be at the table”. Unlike private firms, they wrote, the bill insists that all boards must include them, while meetings will be held in public and “decisions must be transparent”.

“Why is it any more likely that a representative of a private provider will succeed in getting more money, rather than the representatives of NHS trusts or GPs?” they added.

Similarly, health minister Edward Argar has argued that “no one will be appointed to an ICB who would undermine the independence of the NHS”, The Mirror added.

The bill is now heading to the House of Lords, where several influential Conservative peers have said they will attempt to amend the government’s blueprint for how health and social care will work going forward, before sending it back to the Commons.