Our parliamentary petition to Renationalise the NHS, scrap integrated care systems, and end PFI contracts in an effort to prevent the Health and Care Bill from becoming law topped 130,000 signatures. Thank you to all who signed it. You can read the petition HERE.
By reaching its 100,000 target, the petition led to a parliamentary debate on the Bill which took place on Monday 31st January 2022 at 6pm in Westminster Hall. You can watch the debate in full HERE.
It also meant that the government had to make an official response to the petition. The response is extremely dispiriting, full of misdirection and dishonesty. You will find the Government’s statement written in blue below. We have responded to their claims in the darker font.
The Government’s Response
This government has no intention of privatising the NHS.
Leading public health experts do not agree. For decades, they have furnished us with evidence of how advanced NHS privatisation is, see evidence at: www.yournhsneedsyou.com.
We firmly refute the claim that the Health and Care Bill undermines access to care or universal standards.
Your statement is not consistent with the Bill’s content. According to Newcastle University’s Clinical Professor of Public Health, Professor Pollock, the Bill has “removed the requirement for emergency services to be provided for everybody present in an area” and “there will no longer be a statutory duty on any body to arrange provision of secondary (i.e., hospital) medical services – only a power for ICBs to do so.”
It is not a privatising Bill. It delivers on the NHS’s own proposals for reform in its 2019 Long Term Plan…
By the NHS’s ‘own’ proposals, you are referring to changes introduced under NHS England boss Simon Stevens, who was previously employed for ten years as CEO of America’s largest private health insurer, UnitedHealth (UK subsidiary: Optum). Steven’s Long Term Plan was to cut 140 full A&E hospitals to as few as 40 nationally and 7500 GPs to just 1500 GP ‘superhubs’; while this is very much against the interests of many patients who won’t have a local A&E hospital or GP within reach, causing extensive loss of life, it just happens to be in the interest of the private sector and in line with US managed care, which creates economies of scale in fewer, larger care centres to cut costs and maximise profits for the private companies providing care. Stevens helped design this Bill to complete the transition to a two-tier NHS run along American lines by private health insurers like UnitedHealth. The Bill puts the measures that Stevens set in place on a legal footing.
… and makes permanent some of the innovations we have seen in the system due to Covid. It captures learning from the response to the pandemic and the vaccine rollout.
Your statement here is misleading as the intentions of the Bill were laid out before the pandemic arose. Worse still, your reasoning is problematic even on its own terms. Why should we make measures permanent that were introduced to deal with a global health emergency? It is hard not to conclude that the pandemic is being exploited to drive through unpopular reforms that have long been in the pipeline.
And it goes even further, improving access and standards with a range of measures to level-up health outcomes across the country, enabling people to live longer and healthier lives.
Since the Conservative government came to power in 2010, the NHS has tumbled down the international rankings of health systems after spending decades in first place (or thereabouts). At the same time, UK life expectancy has been falling fast.
The Bill establishes Integrated Care Boards (ICBs) to take on the commissioning functions of existing CCGs and some of NHS England’s commissioning functions. They will be directly accountable for NHS spend and performance, and will be NHS bodies. They will bring in representatives from a range of other NHS bodies including NHS commissioners and NHS providers.
Commissioning is the purchasing of services from providers who supply them, which was introduced as part of the entirely unnecessary and counterproductive NHS market, wasting huge amounts of public money. We should be returning to a system in which the NHS directly provides services without the need for any commissioning. The new Integrated Care Boards (ICBs) are modelled on insurance pools. As Professor Pollock explains, they will “create groups of people allocated to an ICB under rules made by NHS England, without parliamentary process… This new concept closely resembles the US health maintenance organisation (HMO). In the US… the government mostly funds healthcare… through private health companies such as HMOs and other ‘managed care organisations.’”
US-style HMOs (here re-named ICBs) are run by private health insurers, many of which have already been embedded in the NHS, ready to: “only at the last stage create a national health insurance scheme separate from the tax system”, see Conservatives Oliver Letwin and John Redwood’s NHS privatisation guide Britain’s Biggest Enterprise.
The work of ICBs will be driven by health outcomes, with no space for profit, competition, or private interests.
The fact that it was a Conservative-led government who appointed Stevens to his role as head of NHS England makes a mockery of your claim that no one appointed to ICB’s will be a representative of private healthcare interests! This year alone, US private health insurer Centene took control of 49 GP surgeries. Centene now own 70 surgeries in England covering half a million patients. Many other private multinationals are already embedded in the NHS and are nominated NHS providers including Atos, Capita, Deloitte, Ernst & Young, KPMG, McKinsey, Optum/UnitedHealth, PWC and Serco. The NHS-partnered patient access website for GP appointments, repeat prescriptions and ‘discovering local health services’ is already “offering mostly private healthcare with lists of tests and treatments to be paid for.” The NHS, then, is already riddled with private interests, and every serious analysis of your proposed Bill has concluded that it will significantly worsen the situation.
The new commissioning bodies being set up are all public bodies and will not, indeed cannot, be controlled by private providers. Independent providers, as corporate entities, will not be able to sit on Integrated Care Boards, nor will any individual appointed there be a representative of such an interest in any capacity.
This is untrue. Professor Pollock warns, “After a weasel-worded amendment from the government, which failed to rule out private companies sitting on the ICBs or their committees, the new bill will still allow these multinationals, together with private health insurance companies such as Bupa and Spire, to join the ICBs. These ICBs will decide how the budget should be distributed.”
The Bill includes ample safeguards to ensure that the interests of the public and the NHS are always put first.
Since privatisation began in the 1980s, at least £300 billion has been diverted from patient care, beds and staff into the unnecessary internal and external markets in flagrant disregard of the public interest. The government recently appointed two ex-bankers, Sajid Javid and Richard Meddings, as health secretary and chairman of the NHS respectively, evidence that commercial rather than public interests are still being put first. In 2011, Dr Tim Evans of the Independent Healthcare Association stated the government’s intentions clearly: “The NHS would simply be a kite-mark attached to the institutions and activities of a system of purely private providers.” Your own former employee at the Department of Health, Mark Britnell, admitted in 2010 that, ‘In future the NHS will be a state insurance provider not a deliverer.” In 2016, then Conservative Secretary of State for Health, Jeremy Hunt, admitted on camera to a Health Select Committee that the Conservatives were ‘finding a way forward to the budgetary arrangements that you would have in [US private health insurers] Valencia or Kaiser Permanente.’ The Bill ramps up this theft of public resources and completes the switch to the American system.
The ICB chair has the power to veto members of the board if they are unsuitable,…
ICBs will be fronted by people who, even if they want to, will find they are unable to override the perverse incentives to denial of care inherent in the new system ushered in by this Bill.
… and NHS England has the power to issue guidance to ICBs in relation to appointments as part of its general guidance-making power.
The fact that a former president of global expansion for medical insurance giant UnitedHealth was put in charge of NHS England, which subsequently spent £millions embedding United Health/Optum personnel, software and methods throughout the English NHS is evidence of policy intent; NHS England’s power over ICBs is therefore of immense concern, as is the fact that “NHS England will have new powers to impose limits on expenditure by NHS trusts and NHS foundation trusts,” warns Professor Pollock.
That sits alongside the robust requirements on ICBs to manage conflicts of interests, including publishing and maintaining a register of Members’ interests, and NHSE’s wider duty to issue guidance to ICBs.
This gives no reassurance at all, as the Bill embeds conflicts of interests in the very structure of ICBs which, as Professor Pollock explains, are modelled on American Health Maintenance Organisations (HMOs). Of equal concern is the fact that ICBs have no specific transparency obligations: https://allysonpollock.com/?p=3690
At Report Stage the Government further clarified, by amendment, existing provisions that ensured private sector organisations would not be able to sit on ICBs.
We refer you back to the earlier analysis given by Professor Pollock: “After a weasel-worded amendment from the government, which failed to rule out private companies sitting on the ICBs or their committees, the new bill will still allow these multinationals, together with private health insurance companies such as Bupa and Spire, to join the ICBs. These ICBs will decide how the budget should be distributed.”
It is the view not just of this Government but of the NHS that local commissioners are the best people to determine what services a local population needs.
Doctors are the only experts qualified to decide on what health services a local population needs, yet successive governments have spent £hundreds of billions of tax payers’ money handing control of health services to a bloated layer of highly paid bureaucrats.
Commissioners will continue to be responsible for managing contracts to ensure services are arranged with all providers, including those with the independent sector, to provide high quality of care at efficient prices.
Independent sector providers are businesses that must make profits for their shareholders, so can never be as efficient as public service providers. Given that private companies are motivated by profits not care, they are also prone to cut corners and costs, and to employ cheaper, less qualified practitioners. This can result in deadly harm to patients, as when construction firm Carillion blinded patients in the recent cataracts scandal.
In line with NHS recommendations on competition and procurement rules, we are changing the way the NHS arranges healthcare services in a way that provides more flexibility, reduces bureaucracy for both commissioners and providers and reduces the need for competitive tendering where it adds limited or no value.
The government’s failure to put contracts out to competitive tender during the pandemic allowed them to hand massive contracts to unqualified corporations in the private sector, wasting £37 billion in public money (equivalent to a third of the NHS budget) on Serco and Deloitte’s failed Test & Trace, which is now being disbanded.
The vast majority of NHS care has and will continue to be provided by public sector organisations. However, successive Governments of all political affiliations have allowed the NHS to commission services from the private and voluntary sector…
The commissioning of private sector services in the NHS was carried out against the will and knowledge of the vast majority of the British people. Governments failed to reveal in their election manifestos their intention to gradually turn the NHS into a privatised US-style system. The process began under the Conservative Party and continued under New Labour, even though Tony Blair stated repeatedly before he was elected that he would reverse NHS privatisation. Unfortunately, he reneged on his election campaign promises and did the exact opposite. We are a cross-party campaign willing to work with any MP who opposes NHS privatisation. At present, however, it is your party, and only your party, that is pushing through this privatising Bill.
… whether that is to improve accessibility and experience for patients, to increase capacity quickly, or to introduce innovation.
Given your track record, this reads as a convenient justification for a privatisation agenda in conflict with the public interest. Of course, we acknowledge that in times of national emergency there can be an urgent need to increase capacity, as in the recent pandemic. But, historically, the most effective examples of this such as the WW2 mobilisation in Britain and the United States involve the state taking control of privately owned resources, whether hospitals or factories, to meet the demands of the nation. This is not what you did during the pandemic, when you spent millions of pounds on private hospital provision rather than NHS provision, and wasted tens of billions of pounds on unqualified private companies who failed to deliver—just the latest examples of your government channelling public money into corporate hands.
NHS commissioners may commission services to meet the needs of their local area from any CQC-registered provider, regardless of their corporate status, provided they follow procurement rules and regulations.
The PM has been caught telling serial lies on camera; ministers have broken the law; the government has failed to follow its own procurement rules during the pandemic, instead creating a fast-track lane for businesses with links to the Conservative Party, and broken its own regulations by holding repeated gatherings during lockdown, all of which has caused a complete loss of confidence in this government and its ability to tell the truth and follow rules and regulations.
NHS England will remain accountable to the Secretary of State and Parliament.
If this is an attempt to reassure the public, it is again massively underwhelming. A Conservative-led government put a US private health insurance industry boss in charge of NHS England for the last seven years—the very same Simon Stevens who, during the Blair years, paid foreign multinationals to advise on how to reorganise the NHS. This “accountability” appears to be worth little in protecting public assets against foreign and domestic private sector predators. Professor Pollock’s view is that, “for the first time since 1948, parliament will not determine to whom NHS services must be provided.”
The Health Secretary has duties, including to the continuous improvement of quality of services, and to the NHS constitution…
You write of the Health Secretary’s ‘duties’, but the most important duty — to provide a comprehensive health service throughout the nation — was abolished in HSCA 2012 by the Conservative-led government, and is not reintroduced by this Bill. Professor Pollock warns that, in practice, the bill “will allow providers to decide what, where and how services will be provided. So much for our so-called rights under the NHS Constitution.”
… which as one of its guiding principles has that NHS services are free of charge, except in limited circumstances when sanctioned by Parliament. Access to NHS services continues to be based on clinical need, not an individual’s ability to pay.
The phrase ‘free of charge’ is fully compatible with a requirement to pre-pay through, for example, mandatory purchase of health insurance as in US Obamacare.
The NHS is and always will be free at the point of use.
The description ‘free at the point of use’ is also completely compatible with privatisation. Treatments offered by the NHS ‘free at the point of use’ are being whittled down, driving many people to access care from private healthcare providers. The NHS is under-staffed and front-line care is underfunded, reducing the quality of care and leading to record-breaking waits for treatments. Again, this will increasingly force anyone who can afford it to seek private, or private insurance-based, care.
The government has been steadfast in its commitment to the guiding principles of the NHS which mean the NHS is not and never will be for sale to the private sector.
Successive governments have already sold off swathes of NHS property and land, wasted hundreds of billions of pounds on the internal market, and over £100 billion on the private sector (including US corporations) for NHS services and care. The British people have been comprehensively sold out by previous administrations, and this Bill is the nail in the coffin for a genuinely comprehensive public service.
Experts respond to the Department of Health and Social Care
Health Policy Progress Group
This is a public relations response which seeks to dismiss all critique of the Bill by asserting its harmlessness without addressing any of the problems identified in it. This lack of specificity and use of PR platitudes gives the overall impression that the authorities are unable to defend this privatisation bill except by repeating empty assertions that the changes it includes are not privatising changes; in fact, this type of response looks like a tacit admission by the authorities that YNNY’s critique is correct and not refutable by the authorities.
Stewart Player — Health Policy Analyst
The response to the petition is very much as expected. This and other governments over the past 40 years have remained steadfast in their commitment to destroying the NHS and securing England’s place within a US-led global market. The political and legal ratification of Integrated Care Systems – modelled on the US system of managed care – will effectively put the seal on this.
Dr Bob Gill — NHS expert and campaigner
The government response to the petition is entirely consistent with all the previous denials about privatisation, but the reality is our NHS is far from its guiding principles of public control and provision. The NHS is already marketised, outsourced, fragmented, shrunk and dysfunctional. It is so denuded of capacity and staff that an estimated 4,500 patients died as a result of overcrowded A&E departments in 2020.
Its appointed leadership dominated by private sector recruits is supervising the mutation into a US-style ‘managed care’ system which the Health and Care Bill delivers.
The UK’s catastrophic privatised pandemic response is the shape of things to come—unaccountable corporations handed billions of pounds and delivering appalling service. Control of our NHS data and budgets is being given away to foreign corporations to exploit commercially and siphon off profit for shareholders and executives. The predictable outcome is higher financial cost of healthcare perversely with worse outcomes: waiting times, longer; life expectancy, lower; maternal and infant mortality, higher; preventable harm and death normalised… all of which destroys confidence in the NHS and serves to push people into buying top-up private health insurance in an attempt to make up for lost healthcare provision. Yet, in the US system this Bill imposes here, three quarters of those bankrupted by healthcare costs had health insurance!