Boris Johnson stands accused of a ‘power grab’ over the health service – and it’s very complicated (Image: Getty Images)
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MPs have passed the first stage of an NHS shake-up despite claims it’s a "massive power grab" and a "corporate takeover" of the health service.
The Health and Care Bill cleared its first hurdle this week, despite almost all opposition parties and three Tories opposing its second reading in the Commons.
It’ll now go to detailed scrutiny. But what is it actually about, and why is it worrying so many people on the left?
The Bill unpicks Tory ex-health secretary Andrew Lansley’s disastrous 2012 NHS reforms, and bids to make England’s health services more integrated. The Nuffield Trust health think tank branded it the biggest overhaul in a decade.
But Shadow Health Secretary Jon Ashworth branded it a “top down reorganisation in a pandemic leading to a loss of local accountability”.
Tory health bill published today despite fears it puts 'private firms at heart of NHS'
Health and Care Bill branded a Tory 'power grab' over NHS by furious campaigners
Campaigners and experts meanwhile are split over how big a risk there’ll be from private companies, which can sit on new bodies and have contracts without tender.
Labour's Zarah Sultana branded the reforms the "NHS corporate takeover Bill”, something branded “complete nonsense” by Health Secretary Sajid Javid, and dismissed by the Nuffield Trust.
The Trust is however worried that ministers will get more day-to-day control over the NHS – in what the British Medical Association is calling a “power grab”.
And the Bill fails to reform social care which critics say is a greater priority.
Mr Javid – who inherited the Bill from Matt Hancock – reportedly asked Boris Johnson to delay the Bill but had to take it forward anyway.
So what are the main issues around the Bill in plain English, and will it really privatise the NHS? Here’s what you need to know.
What are the basic things the Bill will do?
The Bill will do away with 100 or so Clinical Commissioning Groups which decide how local NHS services are provided in England.
In their place will be Integrated Care Systems (ICSs) on a statutory footing in 42 regions of England, controlling the purse strings and setting five-year plans.
These are made up of Integrated Care Partnerships (ICPs) with representation from Integrated Care Boards (ICBs), plus councils, charities and more.
The Bill will also formally merge NHS England and NHS Improvement, and end the automatic requirement to put all health contracts out to tender.
And it includes plans from a February 2021 White Paper to give the Health Secretary direct power over some aspects of health services and NHS England.
Boris Johnson drinks a cup of tea in the canteen during a visit to the Royal Berkshire Hospital in Reading
(Image: Getty Images)
So why are these things controversial? Read on…
Private firms sitting on the ISCs
Sajid Javid says the 42 ISCs “will draw on the expertise of people who know their areas best” to ensure money is spent on the right care.
“They will be able to create joint budgets to shape how we care for people and how we promote a healthy lifestyle,” he told MPs.
But Labour and the British Medical Association have raised concerns that private sector representatives will be allowed to sit on these local boards.
The BMA warned: “The threat of private health providers having a formal seat on new decision making boards, and wielding influence over commissioning decisions, must be ruled out.”
Labour’s Jon Ashworth added: “These committees do permit a seat, if the committees want it, for the independent sector.
“In Bath, in Somerset, we have seen Virgin Care get a seat on the shadow ICS. [Labour] think that is unacceptable.”
Labour’s Jon Ashworth added: “These committees do permit a seat, if the committees want it, for the independent sector"
Prof Allyson Pollock of Newcastle University believes this will allow the Bill to “reduce services” and “entrench the market” in the health service.
Helen Buckingham of the Nuffield Trust disagrees, tweeting that where private firms sit on a local board “there will be quite a few other people around that table too – NHS leaders, local authority leaders and independent non-executives. Meetings will be held in public and decisions must be transparent.”
She added spending on non-NHS organisations, which include charities and councils, is “actually lower now than in 2015/16”, and the Nuffield Trust is “not really concerned” that the Bill opens the door to privatisation.
Mr Javid claimed the boards “will not be driven by any private interests, and will constantly make use of the most innovative potential of non-NHS bodies”.
Not all services going out to tender
In a bid to cut red tape, the NHS will no longer have to automatically put contracts out to tender even if, say, an established local body is doing the job well.
In the future the NHS will only have to tender services where it can lead to better outcomes for patients.
But while the end of competitive tendering – which allowed Virgin Care to sue the NHS – has been welcomed, there are fears it could be hijacked.
The Nuffield Trust insists this won’t lead to ISCs “handing contracts to their chums”, but says “it will become easier not to open contracts up to the market”.
The BMA however warned the rules “allow contracts to be awarded to private providers without proper scrutiny or transparency”.
A think tank insists the process won't lead to jobs being 'handed to chums' – but campaigners are not so sure
And Labour’s Jon Ashworth said: “This is not the end of contracting with the private sector.
“Without clauses to make the NHS the default provider, it would be possible for ICBs to award and extend contracts for healthcare services of unlimited value without advertising, including to private companies.
“Given the past year, when huge multibillion-pound contracts have been handed out for duff personal protective equipment and testing, we naturally have concerns about that and will seek safeguards in Committee. We are worried about further cronyism.”
A ‘power grab’ by the Health Secretary
Labour and the Nuffield Trust have united in criticising new powers for the Health Secretary in the Bill.
Currently, controversial changes to NHS services can be referred to the government. But in future the Health Secretary can intervene in minor local plans at any time.
Labour’s Jon Ashworth has branded the Bill a “Trojan horse to hide a power grab by the Secretary of State”.
And the Nuffield Trust warned: “We are concerned that these new powers will result in a more politicised NHS, with ministers dragged into micromanaging how local services work.
“We see a real risk that politicians under successive governments will feel pressure to distort decisions about services, staff and treatment to meet political goals. This could have result in a loss of trust from the public, and in bad choices taken for the wrong reasons.”
Health Secretary Sajid Javid will assume more power over the health service
(Image: JESSICA TAYLOR/UK PARLIAMENT/UNPIXS (EUROPE))
Fears small poorer areas could lose out
With 42 regions, the new ISCs will be covering far bigger areas in some cases than the CCGs that came before them.
Some MPs have raised concerns about whether this will end up with boundaries that look sensible on a map but make no sense to local people.
The Nuffield Trust warns: “By splitting the NHS into larger areas, the calculation that steers money to areas who need it more will be less precise. There is a risk that small areas with higher needs will lose out.”
No action on social care
The Bill is not a plan to reform social care – and these separate reforms are only promised by the end of the year.
Labour’s Jon Ashworth told Parliament: “The Bill is spun as an attempt to integrate health and social care.
“But there is nothing in it actually to integrate health and social care – because there is nothing in it to fix social care.”
The Nuffield Trust agrees the Bill “does very little” to tackle the crisis, and “much wider” reforms are needed.
Careworker Fabiana Connors visits client Jack Hornsby in Elstree
(Image: Getty Images)
Duties to provide medical services
Prof Pollock, in a joint briefing, says there will no longer be a “statutory duty” to arrange hospital medical services – only a “power” to do so.
“The reasons for these exclusions are not explained,” she writes.
Why is it all happening now with Covid?
The changes are planned for 2022, but the Nuffield Trust says this is “unrealistic” while the NHS is still reeling from Covid-19.
Sajid Javid insists: “This is exactly the right time for these reforms. The response to Covid-19 has quickened the pace of collaboration across health and social care, showing what we can do when we all work together, when we adopt new technology and when we set aside bureaucratic rules.”
But Labour’s Jon Ashworth puts it: “This is the wrong Bill at the wrong time.
“Will the person with learning difficulties or the older person who needs social care experience improved care? No.
“Will social care be brought back in from the wilderness? No.
“Will the cancer backlog be tackled more effectively? No.
“Will health inequalities be narrowed? No.
“Will parity of esteem for mental health be delivered? No.”