As a time when our understaffed and underpaid NHS staff struggle to cope with Covid and a massive backlog of people waiting for surgery, you might well wonder why the Government is pushing ahead with a major NHS re-organisation.
The main features of the Bill are a huge loss of local accountability and control, greater centralisation of decision-making and budgets and more lucrative contracts for the private sector without any competition.
The Secretary of State, Sajid Javid is to be given wide sweeping powers including the right to impose reconfigurations that can merge and close services as happened here in Ealing with the loss of our Maternity and Children’s Ward and the threat to close our A&E.
Well known campaigner and analyst JOHN LISTER unfolds the story in the latest copy of Health Campaigns Together in his article – ‘Listing key dangers in the Health & Care Bill’
Here are is a short summary of the key dangers from his article:-
No end to privatisation:
Although the legal requirement for Clinical Commissioning Groups to have to put services out to tender is to be scrapped there is plenty of scope in the new Bill for privatisation too.
“Scrapping Section 75 also raises the question of what new system will apply to regulate the awarding of contracts. On this issue the Bill is a pig in a poke: there is no clear mechanism or commitment to prevent more of the scandalous behaviour that became normalised during the pandemic – awarding contracts worth tens of millions to Tory donors and cronies without competition”
Fewer local bodies, even less local voice:
Over the last year, decision-making about local services has been become even more inaccessible as Clinical Commissioning Groups (CCGs), who commission our local NHS services, have merged across huge geographical areas. In North West London all 8 Borough based CCGs, including Ealing, have become a single NWL CCG meeting only 5 times in the year, with less then an hour for public questions.
This is the first step in the radical change that will further reduce decision-making and concentrate power into the hands of 42 ‘Integrated Care Systems’ (ICSs) which will cover populations of up to 3.2 million. The North West London ICS will continue to cover the 8 Boroughs with a population of over 2 million people.
“To make matters worse the new ICSs would each be collectively tied to a tightly limited single pot of allocated funding after a decade of austerity and falling real terms funding – and at a time when NHS England has already begun cracking the whip for tighter financial controls, and therefore looking for cuts to balance the books”
These new ICS bodies will have a Board with the Chair appointed by NHS England but Health Secretary Sajid Javid will have a veto over appointments and removals!
Charter for Cronyism
Given that the Chair has the power to make appointments – “On recent form, a rampant expansion of cronyism into the new bodies seems inevitable”.
This is further born out by the lack of any criteria or guidance for the appointments to the Board or their role or responsibilities.
“Nor is there any explicit requirement that the Boards must meet in public or publish their board papers, although NHS England has stated their preference for this: nor is there any commitment, given the wide geographical spread of some ICSs, for meetings to be made accessible online”
“And while local authorities have been weakened by a decade of brutal cuts in spending, and get just one seat on each ICS, the private sector could find itself gaining a stronger voice”.
Powers on reconfiguration:
New powers are to be given to the Secretary of State to intervene directly to either block local plans or enforce reconfigurations such as the dreadful ‘Shaping a Healthier Future’ here in North West London which would have closed our A&Es and beds at both Ealing & Charing Cross Hospitals.
But these powers are but a few of the 138 new powers in the Bill that are to be given to the Secretary of State.
Discharge to Assess:
Despite the title of the Bill including ‘Care’ and all the talk of integration there are hardly any concrete proposals for addressing the Social Care crisis. Instead we have increased CQC inspections of local authority services and the removal of the legal requirement for local authorities to assess the care needs of vulnerable patients before they are discharged!
With reported backlogs of more than 75,000 disabled and older people waiting for help with their care and support from overstretched Social services this is pretty disastrous and will place huge burdens on families and carers, for those who have them.
There is lots more in the Bill including the potential down grading of professional standards in pursuit of ‘financial and efficiency savings’
You can read the full story by John Lister here