Scrap the privatising health and care bill
For a publicly funded, democratically run, NHS
The Tories are in the process of forcing their new health and care bill through parliament, despite opposition from NHS campaigners and trade unionists. We interviewed Dave Nellist, Socialist Party member and secretary of Coventry 'Keep our NHS public' to find out what the bill means for those of us fighting to save our NHS.
What are the major changes introduced in the Tories' new health and care bill?
The bill breaks the NHS in England into 42 population areas of between one and three million people, with separate budgets, controlled by new Integrated Care Boards (ICBs). NHS England will set the budget for each ICB.
Separate budgets could lead to different healthcare priorities in ICBs, producing regional inequalities, more usually called 'post-code lotteries'.
Separate budgets could also open the door to weakening current NHS workers' national pay agreements. And proposals in the bill to allow deregulation of NHS professions could lead to deskilling and more 'flexible' staff who are easier to fire and cheaper!
The government has used the pandemic to give tens of billions of pounds in contracts to private companies with little scrutiny - much of it to firms with links to the Tories themselves.
This bill makes permanent the privatisation and cronyism of the last 15 months. It removes the rules for competitive tendering - not by bringing in-house the capacity for making medical equipment, PPE, or running test and trace etc - but to allow contracts to be awarded, for example, to private healthcare providers, without considering other bids.
How does the bill give more power to private companies looking to make a profit?
The bill embeds big business further into NHS decision-making - allowing private companies a seat on the new ICBs and associated Integrated Care Partnerships (ICPs). Billionaire Richard Branson's Virgin Care already has a seat on the precursor to the ICB in Bath, Swindon and Wiltshire.
Big business will be at the centre of NHS decision-making, on how budgets are spent, on how contracts are awarded, and on which services are, or are not, provided. It will be primarily, and legally, responsible for the profits of shareholders, not the needs of local people.
The ICB will control the budget. NHS England and the government will appoint the chair. The ICP will develop an area-wide health strategy and have a representative from the ICB, a representative from each 'relevant' local authority, plus others appointed by the ICP, such as social care providers that are overwhelmingly privatised.
Nowhere is there any provision for members of the boards or partnerships to be elected, or even that board meetings will be in public, with agendas published in advance. The bill talks about transparency but doesn't deliver it.
How do the changes affect what influence working-class communities have over what health services are delivered?
Each ICB will deliver healthcare over a vast area with no real, local control.
The power to 'reconfigure' services, ie close them, will be more centralised. At the moment, local authorities have certain powers of oversight and scrutiny regarding health, and can be susceptible to local public pressure against a hospital's closure, for example. This bill gives the secretary of state powers to call-in decisions on closures - perhaps at an earlier stage, before public campaigns can be built.
What next for the campaign against the bill? What changes to the NHS do socialists support?
Over much of the last 30 years, Labour and Tory administrations have had an overlapping agenda to run the NHS as a 'market' instead of a public service.
There are over 100 hospitals funded by Private Finance Initiatives (PFI), half of these with their business centres in tax havens. PFI, the internal market and private involvement drains billions of pounds from the NHS and into private profit every year and should be ended.
We need an NHS that is entirely publicly funded and democratically controlled and managed - involving staff through their trade unions, patients and representatives of local communities. Pharmaceutical and major medical equipment manufacturers should be nationalised and integrated into the NHS.
Current health minister Sajid Javid has warned that NHS waiting lists could rise from a massive 5.3 million people, to an enormous 13 million people waiting for treatment. This bill does not address this crisis, or the huge staff shortages. It does not propose anything for social care, which Boris Johnson claimed to have 'a plan' for 18 months ago. It does not reverse the decade of austerity and underinvestment.
But it does propose a further reorganisation of the NHS, opening the door wider to big business and private profit, and should be opposed. The trade unions need to urgently organise a national demonstration in the autumn against this Bill and in favour of real public ownership and democratic accountability for the NHS.
In The Socialist 14 July 2021: