NHS reshaped under cover of pandemic

Submitted by AWL on 9 February, 2021 - 7:35 Author: Jayne Evans
NHS workers' sign

For many, Covid-19 has exposed the need for urgent restoration of a public health system and an expanded publicly provided NHS. But, while applauding the work of “key workers”, the Government is steaming ahead with the plans to restructure the NHS. NHS England (NHSE) is currently consulting on their latest plans for “integrating care”, including changes to legislation.

The summary below of the key changes, and an explanation of where the current trajectory of privatisation and restructuring may end, is taken from a presentation made by the Save Liverpool Women’s Hospital campaign.

In 2012 the Health and Social Care Act created Clinical Commissioning Groups (CCGs). They were run by GP’s but “advised” by big business. These groups represented a departure from universality of provision of health care, i.e. there was no obligation to treat all patients in an area but there was an obligation to put out contracts to tender.

NHS England (NHSE) has since pushed through a policy to merge the 210 clinical commissioning groups (CCGs) into 42 CCGs coterminous with the 42 geographically based integrated care systems (ICSs). NHS England expects that merger to be achieved by 2022.

Not all areas have agreed CCG mergers and only 18 ICSs are in existence to date. Those areas where CCGs have not yet merged or have refused to merge are being coerced. In Merseyside, the four Cheshire CCGs have agreed to merge but the area that is intended to merge to form one organisation is Merseyside and Cheshire.

The deadline to take part in the NHSE “consultation process” on moves to ICSs was 8 Jan.

What difference will it make?

The “current direction of travel” is that an ICS will submit a collective operational plan for their area to NHS England. Instead of separate submissions for each CCG there will be one from each area. Within that area plan, agreement can be made for one part to make a surplus and another to run a deficit but overall the area is expected to break even. Keep our NHS Public have raised the following concerns:

1. Centralisation and loss of local democracy

ICSs are set up from top down as a bureaucratic fait accompli, with no public consultation or support. They involve not only CCG mergers, but also even larger-scale mergers of hospital and of mental health trusts. Each merger cuts any genuine local links and accountability that might have survived the past 30 years of reorganisations and market-style policies. The ICSs are not going to be responsive to demands or pressures from local communities.

2. Loss of accountability

ICSs lack any legal standing or accountability and are part of a wider NHS England project to enforce tighter regional-level control over cash-limited budgets, impose restrictions on the range of services provided by the NHS, and drive through new data-led schemes for “population health management”. New contracts are already being issued to private companies to “manage” GP referrals to hospital and other services.

3. Structures being established to make the process of privatisation faster

NHS England has set up the Health Systems Support Framework (HSSF) to facilitate even more rapid and easy involvement of private sector management consultants, number-crunchers and other providers into the new ICSs.

The HSSF is a list of accredited companies (plus a few NHS providers) offering trusts and CCGs a range of services that can “support the move to integrated models of care based on intelligence-led population health management”.

The HSSF has established a series of “framework contracts” through which companies seeking contracts can secure pre-approval, allowing contracts to be awarded without a tendering process, either with no competition or through a “mini-competition” between companies on the list. This framework has 83 NHSE-accredited companies, 22 of which are US-based.

Felicity Dowling of the Save Liverpool Women’s Hospital campaign argues that these new regional bodies pave the way for further cuts and privatisation via the route of outsourcing of services or not providing them at all, and also leads to the creation of regional bodies that mirror the US structure of health care provision. The new structure would lend itself to regional health and social care provision being handed over to private health care providers.

It would lead to a further break down of an integrated national health care system which guarantees provision of services. It could lead to an erosion of national agreements regarding pay and work conditions.

Felicity also reported that despite opposition to mergers in the North West, and even though policy hasn’t been announced or passed to agree mergers, finances are already being discussed on a regional level and the process of changing to the new structures continues without any democratic scrutiny.

These changes come on the back of years of cuts and privatisation of health care: Hospital bed numbers have fallen from 240,000 in 2000 to 166,000 in 2019. There has been a massive move from public to private health provision. In 2018-19 £9.2 million of CCG commissioned services were provided by the private sector. PFI projects have resulted in hospital trusts still having to repay £50bn in loan repayments (even if £12bn of NHS trust debts have been written off in the pandemic) and the list of services no longer available on the NHS continues to grow.

This is not a positive move leading to the “integration” of health with social care.

The idea of integration of services for physical and mental health, hospital care, GP care and social care, sounds desirable and logical. However, these changes are not about integrating care.

“Integrated Care Systems” are the ultimate misnomer. They involve a further disintegration of the NHS into more contracts, including many with private providers. Their purpose is to break up the system of integrated health care and create more opportunities for private companies to make a profit.

They are the latest incarnation of a notion that originated in the “accountable care organisations” (ACOs) referred to vaguely in the 2014 Five Year Forward View and the subsequent 44 STPs “Sustainability and Transformation Plans” (later becoming “partnerships”) that NHS England ordered to be developed in secret during 2016.

The Tories will undoubtedly argue that these changes are necessary because so much has been spent on managing the pandemic. Socialists and NHS campaigners know that a publicly funded NHS is the most efficient way of providing universal health care, and need to continue to explain this in our campaigning. However, while the pandemic continues, the Tories aren’t even having to make the argument that these changes are financially necessary. They are just getting on with it.

They have been giving contracts for test and trace to private companies (£12 billion on Deloitte/Serco test and trace); agreeing contracts with private companies to provide equipment and health care during the pandemic (£15 billion of PPE contracts, and private hospitals awarded upwards of £3 billion of contracts this year), moving to “Integrated Care Systems”. “To help reduce post-Covid waiting lists”, they have agreed private contracts of £10bn for the next four years.

The Tories also refused to support an amendment to the Trade Bill protecting the NHS and other public services in future trade deals (debated in House of Commons on 16 Jan, reinserted in the Lords on Feb, but liable to be taken out by the Commons again).

The health service, the life-saving care it provides, and the work done by NHS workers, have been at the forefront of public awareness over the last year. We need to direct that universal support into a renewed drive to defend health and social care provision from further cuts and privatisation.

We need to explain to those who work in health and social care and the wider trade union movement what the planned structural changes are and what the implications will be for the future of health and social care provision. We need to explain why we need trade union rights, which include the right to strike for political demands like universal public health provision, and why we should organise a campaign which includes the call for industrial action in defence of the NHS rather than wait for legal rights to be won.

We also need to defend the current Labour party policy, in the Labour Party manifesto of 2019, for ending privatisation and repealing the Health and Social Care Act 2012. Starmer and the Labour right will undoubtedly want to ditch this commitment. If we organise, the support exists in the movement to stop them.

The Tories are yet to publish the Bill that provides the legislation to enable the next stage of these reforms. When they do, we need to be ready to re-raise the call for a national labour movement campaign to stop them.

• The Save Liverpool Women’s Hospital campaign has recently produced a power-point summary of the changes that can be used by trade unionists and NHS activists.

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