Tagged: NHS reinstatement Bill

The abolition of the NHS in England

This first appeared in the Huffington Post UK on 14 March 2016

Written with Peter Roderick, co-author of the NHS Bill

On Friday, the cross party NHS Bill returned to the Commons for its second reading (watch the video). The Bill was filibustered by the Conservatives, and following only 17 minutes of debate, it was adjourned. The second reading is unlikely to continue.

Most people are probably unaware of what’s happening. But increasingly the market is invading. Virgin now has over 300 NHS contracts, and an active litigation department. They have successfully prevented commissioners in Hull from allowing local GPs to run primary care services, and are facing a legal challenge from the local trust in Kent to their £128 million contract because of concerns about patient and staff safety. Meanwhile Monitor the regulator has now issued 114 private provider licences. The amount spent by local commissioners and trusts on non-NHS providers went up from £6.6 billion in 2009 to £10 billion in 2014. Industry analysts estimate the community services market to be worth £10bn-to £20bn annually. Trade unions have described “a surge in privatisation“.

Nick Clegg said in 2010 that “breaking up the NHS is exactly what you do need to do“. It’s a painful irony that this is one of the more successful things the coalition government achieved. Its 2012 Health and Social Care Act, piloted by Andrew Lansley, abolished the duties of the Secretary of State to provide and secure services in accordance with the Act, and to provide listed health services throughout England. The latter was replaced by a duty on over 200 new clinical commissioning groups to make contracts for those services for persons for whom each CCG is responsible and establishing the NHS Commissioning Board (NHS England). NHS trusts were prospectively abolished, with the intention of them all becoming NHS foundation trusts which can now receive 49% of their income from outside the NHS. “Public health” functions were created as two legal categories split between the Secretary of State and local authorities, and carved out of the NHS. Virtually compulsory contractual tendering for providing NHS services was introduced and Monitor’s role as an economic regulator was extended with functions aimed at preventing anti-competitive practices.

But the rot didn’t begin with Lansley’s Act. Ken Clarke started it in 1990 with his great split. He ended direct management of services by health authorities and created “purchasers” and “providers”, turning hospitals into ‘NHS trusts’ with borrowing powers, and their own finance, human resources and PR departments. New Labour built on that by scaling up the exorbitantly expensive Private Finance Initiative, so that for one hospital built we may be paying for two. Alan Milburn paved the way for foundation trusts, and now runs a very profitable private healthcare consultancy, while Lansley advises Bain & Company, which helps healthcare companies with their strategy.

Politicians pushing laws from which they then benefit corrode the political process, and these laws have wasted billions of pounds, year on year. The purchaser-provider split was introduced to open up the market in health services. Providers compete for patients and service income. Lawyers, accountants and management consultants are needed to administer – and challenge – the market, and they can’t do their jobs without pulling clinicians away from theirs. Quantifying the costs of a market bureaucracy is fraught with difficulty, but the costs of a market bureaucracy are significantly more than the costs of a public bureaucracy. The House of Commons Select Committee in 2010 was “appalled” that the four most senior civil servants in the Department of Health could not tell them the cost of the market.The usually-cited figures for NHS administrative costs are about 5% before the 1980s, and 14% by 2005 – whilst in the US in 2009, about 30% was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Professor Paton puts the extra cost of the NHS market at about £5 billion.

This sickening state of affairs need not continue, but it will unless Parliament passes a law to stop it. The NHS Bill aims to do this, by restoring the duty to provide and returning the NHS in England to full public ownership, as in Scotland and Wales, based on bottom-up proposals developed by current commissioners, trusts and local authorities with patients, voluntary organisations, trade unionists and academics.

The most common criticism of the Bill from those who can’t see the wood for the trees is that the last thing the NHS needs is another top-down major reorganisation. Nobody wants unnecessary disruption, but massive and expensive fragmentation and disorganisation is currently underway and this is appreciated by many who work in the NHS – hence support for the Bill from Unite and the BMA.

Over 62,000 people have signed a petition urging MPs to turn up in the Commons on Friday and to support the Bill. We wait to see whether they are worthy of our trust.

NHS Reinstatement Bill. 2014

Restoring the NHS in England as an accountable public service

04 November 2016 – NHS Bill to receive second reading in the House of Commons

08 September 2016 – Viscount Hanworth raises bill to reinstatement the NHS in a Lords debate on the Health & Social Care Act 2012

NHS Reinstatement Bill is reintroduced to the House of Commons, 13 July 2016

Pollock AM, Roderick P. National Health Service Bill. Legal and Policy Briefing for the Second Reading in the House of Commons, on 11th March 2016. 03 Mar 2016. download

Why we support the cross-party NHS Bill

Pollock AM. Radical new bill is now the only chance to save our service – so get behind it. Morning Star. 2015 May 6.

Why the Queen’s Speech on 19 May should include a bill to reinstate the NHS in England. BMJ. download

BMJ: A letter to the next secretary of state for health

Bring back the NHS: videos from event hosted by Sir Ian McKellen

Saving the NHS: the twilight bark

17 April 2015: SNP MPs to vote to restore England’s NHS

See the Campaign for the NHS Reinstatement Bill

NHS Reinstatement Bill

On 11 March 2015 12 MPs from five political parties tabled the National Health Service Bill  in the House of Commons based on the second version of the NHS Reinstatement Bill.

Brief summary of the NHS Bill

In short, the Bill proposes to fully restore the NHS as an accountable public service by reversing 25 years of marketisation in the NHS, by abolishing the purchaser-provider split, ending contracting, and re-establishing public bodies and public services accountable to local communities.

This is necessary to stop the dismantling of the NHS under the Health and Social Care Act 2012. It is driven by the needs of local communities. Scotland and Wales have already reversed marketisation and restored their NHS without massive upheaval. England can too.

The Bill gives flexibility in how it would be implemented, led by local authorities and current bodies. It would

  • reinstate the government’s duty to provide the key NHS services throughout England, including hospitals, medical and nursing services, primary care, mental health and community services
  • integrate health and social care services
  • declare the NHS to be a “non-economic service of general interest” and “a service supplied in the exercise of governmental authority” so asserting the full competence of Parliament and the devolved bodies to legislate for the NHS without being trumped by EU competition law and the World Trade Organization’s General Agreement on Trade in Services
  • abolish the NHS Commissioning Board (NHS England) and re-establish it as a special health authority with regional committees
  • plan and provide services without contracts through health boards, which could cover more than one local authority area if there was local support
  • allow local authorities to lead a ‘bottom up’ process with the assistance of clinical commissioning groups (CCGs), NHS trusts, NHS foundation trusts, and NHS England to transfer functions to health boards
  • abolish NHS trusts, NHS foundation trusts and CCGs after the transfer by 01January 2018
  • abolish Monitor – the regulator of NHS foundation trusts, commercial companies and voluntary organisations – and repeal the competition and core marketisation provisions of the 2012 Act
  • integrate public health services, and the duty to reduce inequalities, into the NHS
  • re-establish community health councils to represent the interest of the public in the NHS
  • stop licence conditions taking effect which have been imposed by Monitor on NHS foundation trusts and that will have the effect of reducing by April 2016 the number of services that they currently have to provide
  • require national terms and conditions under the NHS Staff Council and Agenda for Change system for relevant NHS staff
  • centralise NHS debts under the Private Finance Initiative (PFI) in the Treasury, require publication of PFI contracts and also require the Treasury to report to Parliament on reducing NHS PFI debts
  • abolish the legal provisions passed in 2014 requiring certain immigrants to pay for NHS services
  • declare the UK’s agreement to the proposed Transatlantic Trade and Investment Partnership and other international treaties affecting the NHS to require the prior approval of Parliament and the devolved legislatures
  • require the government to report annually to Parliament on the effect of treaties on the NHS.