Health and Care Bill: urgent action needed to save the NHS

Felicity Dowling writes: The Health and Care Bill hits the Committee Stages in Parliament on the 6th of September 2021. Parliament will break for party conferences. The Bill will have to go through the Lords before the final stages in the House of Commons and it being enacted as law. This is a very short to time to fully organise the popular opposition required to defeat it, or even slow it down. This is the list of the committee members.

If the labour movement was better organised, the Tories would not have dared to present such a bill. We don’t have the huge union actions that would have stopped it in the past, so we are down to the local campaigns, but these might still wake the sleeping giants of the workers’ movement. The NHS will last as Nye Bevan said as long as there are folk to fight for it. We are fighting but we need many more actively in this struggle.

In the post-war Labour Government, we gained a fully functioning national system, referred to as the Bevan model, to provide:

  • Healthcare free at the point of need.
  • A public service provision – not for profit.
  • A national service.
  • Universal Care (care for everyone).
  • Comprehensive care (all the treatments we need).
  • National conditions of pay and working conditions.
  • Funded directly by the government.

You can see something of the founding of the NHS in Ken Loach’s Spirit of 45 about 20 minutes in to the film.

Campaigners demand a world-class health service for all, as once we had in the UK.

Each of these aspects are likely to be removed in the implementation of the Bill, though charges may be introduced indirectly by denying care and forcing people into the private sector for treatment. It can go the way of council housing! Prescription charges for the 60+ workers are about to be introduced.

At the second reading of the Bill, the votes were 218 to 356. Three Tories voted against. Some leading Conservatives including Theresa May have protested not against the system as such, but against their Integrated Care System boundaries. Bernard Jenkin MP said “but it is not widely known or understood that the NHS in England is being prepared for a major reorganisation. The clinical commissioning groups established by the Lansley reforms have gradually been subsumed into groups called integrated care systems. These ICSs are not legal entities, but single executive teams that have effectively merged the CCGs.

If the public or even the NHS workforce knew what was happening, the force of public opinion would stop it. There are dozens of campaigns to save the NHS around the country, some local and some national, doing outstanding work informing the public, using stalls, leafleting, hanging banners, leafleting hospitals. The response from the public has been very supportive including in Conservative voting areas. There is even a wonderful display of needlework for the campaign to save the NHS, and campaigners have been distributing embroidered hankies, saying Don’t blow it Save the NHS to Conservative MPs.

Some people still believe that the Conservatives would not dare do this, but sadly they are doing it. They dare see our children go hungry. We have seen the poverty grow in many parts of the country. Childhood hunger is a thing in this country: “Almost two million children in the UK went short of food this year, according to a new report. The findings suggest child poverty and hunger are deeper and broader issues than previously thought and have become an “urgent national challenge”, according to the Social Market Foundation (SMF) think tank.9 Dec 2020”. However they have stepped back at least for now from the Data grab of your personal healthcare data after 3 million sent in letters and forms refusing them access. Campaigns can work.

Campaigners against the Bill have prioritised pressure on Conservative MPs over the summer, as restrictions have been lifted. Those MPs must realise that they will not be forgiven if they damage our health care. It’s our experience from this campaigning that Tory MPs do not understand what’s happening either. They didn’t in 2018, and the new lot understand less. What they do understand is that they could lose their seats over this. This government has a big majority, but it is fundamentally unstable. Crisis follows crisis! Corruption follows corruption. The shortage of lorry drivers has disrupted flu vaccines for this coming ominous winter for the NHS.

They call it the Health and Care Bill, but it does not do anything about the care system, which is in its own crisis involving about 40% turn over per year. The care system is fragmented, privatised, means tested, badly paid, with a staffing crisis and very profitable. We, of course, support the call to renationalise social care, to fund it on the Bevan model of the NHS, free at the point of need, funded by the Government, nationally regulated with good training and national conditions of employment. Given how personally this affects its users, they need to have the right to say how it is run. There is no point in a service that disables its users.

They call it the Health and Care Bill, but it does not mention the maternity crisis, nor women’s health. Bill but not Jill.

Labour too must show some courage, vote and campaign against the Bill, and not listen to siren voices saying that they should concur or try just cut out the worst parts. There are excellent campaigners in the PLP (and of course Jeremy Corbyn) some of whom moved a good amendment to the Bill in the second reading.

Others in Labour are less sound: Karin Smyth MP wrote in the Health Service Journal about amending it, not defeating it. This will not do. And, of course, Tony Blair worked hand in glove with the project to Americanise the NHS and some hospitals are still paying the huge cost of the PFI project: “In 2017/18 hospital and acute sector PFIs in England that started under Labour cost £1.4 billion.” Amendments at this stage should be to show the project for what it is, not ways of making it work more smoothly.

It would be a real help if Labour CLPs leafleted their communities against it. There is still time to do this. If Labour does not come out in full opposition to this bill, then they too will deservedly take the anger of voters in the future.

However, many councillors are tied into the myth that somehow it will help with social care, and that integration is per se a “good” thing, but this ignores the huge cuts and fragmented, privatised means-tested structures of social care in England. “Over the past decade, adult social care costs have risen by £8.5 billion, while total funding has grown by only £2.4 billion. This has left councils with a gap of £6.1 billion to fill. Of this, £4.1 billion has been met by making savings to adult social care services, whilst a further £2 billion has been diverted from other services; cutting them faster than otherwise would have been the case.

Campaigners have produced a number of letters to councillors (another more detailed one here).

If you would like to join the campaign to defeat the bill there are a lot of ways you can help in this article.

This though is an urgent issue for the whole working-class movement. We urgently need the trade unions to take up this issue. It must get onto the TUC agenda, and the action lists of all the unions. Sharon Graham from Unite met with health campaigners during her election and has promised support for the campaign to defeat the Bill. The leverage work for which she is so well known would really help this struggle. Ideally we need the unions to be telling their members in the workplace. There is concern that those unions in the NHS have already come to an agreement with the employer on this matter, a detail that few of their own members, even activists, are aware of.

Covid has, as well as killing more than 133,000 of us, leaving as many as 2 million or more affected by ‘Long Covid’ and other lasting effects, disrupting routine work of hospitals and exhausting the already understaffed NHS workers, made calling big demonstrations very difficult.

The staff of the NHS not only kept us going through the darkest days of Covid, but they also kept the service afloat by going way beyond what they are paid for in the earlier years of austerity. The insulting one percent pay offer was a smack in the face. We of course support #paynhs15. And hope the pay ballot goes well.

There is a murky web of challenges facing patients and staff, the real-world NHS, in the hospitals, clinics, and GP surgeries; not least the resurgent Covid pandemic, the huge (in part manufactured) waiting lists, staff shortages, exhaustion, anger and sickness.

Ten years of cuts, huge reductions in available hospital beds, bad workforce planning resulting in staff shortages, closure of And Es, the rundown of the GP service, the Hostile Environment discouraging and penalising migrant staff, outsourcing, and the PFI system which still leeches off NHS funding, all made for a difficult situation and a stage from which the Government could proclaim its reforms as necessary. They have caused the problems and now will make them worse

Rather than tackle these life and death issues, the upper bureaucracy of the NHS and the Conservative Government are intent on a major reorganisation of the whole system. If there is one service valued by British people it is the NHS. No political party would dare go to an election on a pledge to privatise the NHS in any form, but that is in effect what is happening.

What this Bill will produce is a minimum service, and push people into paying. The private hospital sector depends on the NHS to provide the services it does not find profitable to provide, like intensive care and ambulance services and A and E.

The Health and Care Bill, if enacted, will cause real harm to patients, staff, the wider community and the economy. Centene is spreading its scope throughout the NHS in doctors’ surgeries and hospitals and in the ICS systems.

Alongside shrinking the NHS, the new system will grow the private hospital sector, using Covid as an excuse. Before the pandemic, the private hospital sector was in a bad financial state. But Government funding has bolstered it immensely.

We have seen what has happened in mental health provision, where there is a major presence of the private providers, (many people know of the Priory Group) not providing “better” care, but rock bottom basic care, causing concern to patients, family, and staff.

The Priory boss, Steve Filton, the executive vice-president and chief financial officer of Universal Health Services said some years ago:

What we like about the UK is a system that, for those of you familiar with the UK health care system, the National Health Service is effectively the insurer for the entire British population,” Filton said, according to a transcript of his 2018 remarks. Filton noted that as the NHS pushes to “outsource more and more of those patients to the private sector,” a dynamic that UHS is poised to benefit from, the firm stands “to capture a lot of that.”

We have seen also the problem of accessing dentistry that people who are at all hard up can afford or even get an appointment for in some areas of the country.

The system is being given over to the profit-making companies. The 10 per cent of GDP the UK government pays for health care will still be spent, but fed to, leaked away by, many more private companies. The private companies don’t put their own money in, they take from the government. And then they restrict the service or if that doesn’t pay them enough simply push the responsibility back onto the NHS

There is no requirement to provide hospital care for all in the Bill. The Bill “allows” rather than requires the 42 systems to provide hospital care. “Discharge to Assess” can see people discharged from hospital without a care package to cope and heal at home leaving them unsupported and without necessary equipment.

Every urbanised country has some form of health care, otherwise disease wipes out communities. There is self-pay where the rich and some middle class pay directly or through insurance (and the others go without), there is a social insurance system first established in Germany, and the NHS model which is the most cost effective, more equitable and most efficient model. However, the NHS model cuts out the middlemen and the big US health companies, and so is seen as fair game by Conservatives and some Labour politicians who have been hooked in by the Health Industry lobbyists.

In a study by the Commonwealth Fund in 2017 the NHS came out as the top health care system in the world, but it has lost that crown, now being placed 4th with some very poor outcomes in “core outcomes such as infant mortality and cancer survivability, the UK came in ninth with only Canada and the US ranking worse”.

The Guardian reported that “According to this report, our previously world-beating health service is at risk of moving to the middle of the pack, largely due to growing delays across the system in people’s ability to access care quickly” said Siva Anandaciva, the chief analyst at the King’s Fund,

We can’t brush this under the carpet as being solely a consequence of the impact of the pandemic on patients, staff and services. Even before Covid, waiting lists for treatment were already sizeable after a decade of stalling funding and a growing workforce crisis.

The likelihood is that this Bill and the system it will entrench will make health care more expensive for the government, and less available to the people. Human need comes second to the need to make profit. In the ICS system, we will be paying people to cut our services.

Much of what the Bill describes has been begun prior to parliamentary approval, and there is pressure from these systems (ICSs) operating prior to Parliamentary approval for the legislation to go through quickly. There has been no major research on the clinical or financial effectiveness of these systems. Indeed one, far from left-wing, study of Manchester whose system is further advanced, says it has not helped at all.

However, CPS analysis of existing pilot schemes finds no compelling evidence of overall improvement.

In Greater Manchester, where integration is most advanced, results have been generally poor.”

The Bill breaks the national character of the NHS, breaking it into 42 areas each with their own budget and systems creating discrepancies and inter-system charging. This will affect the treatments provided and staff conditions of work. Full analyses of ICS can be found here.

The Bill gives greater powers to prove for profit companies to drive the direction of the ICS with Virgin already ensconced in the Bristol ICS.

The Bill brings in powers to outsource to the Companies pre-approved in the HSSF, who will not even have to go through tendering, and their powers will include employment. Down-skilling and down grading of jobs will mean that people will get worse healthcare, and staff will be more under pressure.

Fully regulated professions and the principle that our first contact with healthcare should be with fully qualified staff is at risk.

Government policy is also damaging the GP service as many know to their cost. We need more GPs, and we need them as soon as possible. It should be GPs not apps, or companies brought in to reduce demand, who say if we can see a hospital doctor. Apps can be useful in health care, but to assist doctors, not to be administered by underqualified people or by doctors who are not allowed to challenge the app.

Maternity is in crisis, with infant mortality way worse than other advanced countries, a real shortage of midwives, and numerous crises across the country. Despite the Ockendon report into unnecessary baby deaths, the Bill can’t be bothered with maternity. Donna Ockendon mentioned in a webinar run by the Independent that maternity struggles to be heard in big hospital trust meetings, hence the insistence that there is an Ockendon person on each board. The underlying issue is shortage of midwives and midwives leaving the job.

Much can be done. We need to get still more local campaigns going, with stalls, meetings, banners, and leafleting.

Try to wake up the unions! This will not be won or lost just in parliament, but in the campaigns in the streets, communities and union branches. Contact us if we can offer any help to your local campaign.

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