“it remains a devastating piece of legislation that will open the NHS up to widespread privatisation”Margaret Greenwood MP
By Margaret Greenwood, Labour MP for Wirral West
The government’s Health and Care Bill returns to the House of Commons on 30 March for Consideration of Lords Amendments, having completed its Third Reading in the Lords this week.
MPs will now have a chance to debate and vote on a series of amendments that have been made to the bill.
Despite a small number of positive changes to the bill, for those of us who believe in the NHS as a comprehensive public service run for the benefit of patients, it remains a devastating piece of legislation that will open the NHS up to widespread privatisation and embed a postcode lottery.
NHS guidance last year stated that ‘The Health and Care Bill, if enacted, will enable ICBs (Integrated Care Boards) to delegate functions to providers including, for example, devolving budgets to provider collaboratives.’
Provider collaboratives are one of a range of sub-committees that can be made up of private companies, and as we know, private companies are accountable to shareholders.
Thanks to an amendment from the Lords, conflict of interest rules that apply to an ICB will also apply to commissioning sub-committees. However, the very fact that budgets can be devolved to sub-committees in the first place remains a matter of serious concern.
The replacement of the national tariff with a new NHS payment scheme is still provided for in the bill.
Since private providers will be consulted on the scheme, there is significant concern that it will, in effect, give private healthcare companies the opportunity to undercut NHS providers and we will see healthcare that should be provided by the NHS increasingly being delivered by the private sector.
This has implications for NHS staff who may find themselves forced out of jobs that are currently on Agenda for Change rates of pay, NHS pensions and other terms and conditions, with only private sector jobs with potentially lesser pay and conditions available for them to apply for if they wish to continue working in the health service.
It is a great pity that Lord Hendy’s amendments designed to protect NHS workers from the consequences of outsourcing were not adopted by the government.
It is, however, notable that the government has said that it would expect NHS England to consult with trade unions when setting up the NHS payment scheme; it is vitally important that this happens, and the government must be held to account on this.
The clause which would allow for a profession currently regulated to be removed from statutory regulation also remains part of the bill. This is deeply concerning because once a profession is deregulated, we can expect the level of expertise in that field to decline over time. As well as potentially affecting the status and pay of those carrying out professional roles, there are also possible serious long-term implications here for the health and safety of patients.
There have been some ‘wins’ for opposition parties during the bill’s journey through the Lords.
Perhaps the most important of these is Baroness Pitkeathley’s amendment which retains the principle and duty on a hospital, whether it be an NHS hospital or an independent hospital, to ensure that a patient must be safe to discharge from hospital and mirrors carers’ rights which were established in the Community Care (Delayed Discharges, etc) Act 2003.
The government’s original intention was to legislate to allow an approach known as ‘discharge to assess’. This would allow for patients to be discharged from hospital before their social care needs have been assessed, with vulnerable patients potentially sent home without the support in place that they need, leaving families to pick up the pieces and those without family at risk of neglect.
There is an important amendment on workforce too which requires the government to publish independently verified assessments every two years of current and future workforce numbers required to deliver care to the population in England, taking account of the economic projections made by the Office for Budget Responsibility, projected demographic changes, the prevalence of different health conditions and the likely impact of technology. This has an important part to play if the staffing crisis is to be addressed.
The removal of the clause on ‘Reconfiguration of services: intervention powers’ is also a welcome change from the Lords. This would have given the Secretary of State a new discretionary power to call in and make a decision on a local reconfiguration proposal at any stage of the process.
People have just a few days in which to lobby their MPs to call on them to support these amendments.
It is important that every single MP in England is held to account on how they vote.