Last month, with the antics of the honourable member for Mid Bedfordshire providing a useful distraction, the House of Commons passed a bill that outlined several radical changes to the structure of the NHS. Most dramatically it removed the duty of the Health Secretary to directly facilitate the provision of healthcare, which had been the backbone of all previous NHS legislation (compare section 1 of the current bill, here, with that of the 2006 NHS act, here). This simple measure, at a stroke, removes what makes the NHS the NHS: the provision of healthcare nationally through one organisation accountable to the democratically elected Government.
Making the administration of the NHS more independent of the government, which has under successive administrations, used the NHS as a political football, compromising the stability of the service, and increasing local accountability, where the issue of healthcare provision can be considered independently of other political concerns, is not in and of itself a stupid idea, but the devil’s in the detail. It is clear that privatisation, rather than democratisation and independence, is the main motivation behind the changes, with no democratic mechanisms included and ripe opportunities for extended private sector involvement.
This opening clause, sets the scene for the rest of the bill which outlines what it’s author, health secretary Andrew Lansley, envisages to replace the current system: healthcare commissioned, from a variety of providers, by a series of consortia, ostensibly controlled by local GPs. This detail is a little bit of PR genius. The public in general like and trust GPs, who currently work well as independent providers within the NHS. The reality of course, is that most GPs will not have the time, skills or inclination to take on a whole new range of administrative functions and many, if not most, will outsource the commissioning functions to outside bodies, and plenty of private companies are waiting in the wings to take up this role. The services “bought in” by consortia, will not be limited to those provided by the NHS. In fact legal advice, obtained by the campaigning organisation 38 Degrees, suggests that the new arrangement will be subject to EU competition law with multiple providers competing for contracts on the basis of commercial law. Both commissioning and provision will thus be transferred, on a large scale, to the private sector.
Let’s be clear, this country will continue to have universal, free at the point of use healthcare, and it may be that most patients won’t really notice the difference, a slight degradation of services here, where providers are dictated by competition not by expertise, a loss of provision there, where private companies skim off profitable services leaving unprofitable ones like, mental health, and emergency care, with depleted funds. Nevertheless, the bill represents a further encroachment of profiteering businesses into the NHS. Health care policy, over the past 30 years, has been driven by the big lie that publicly provided healthcare services are intrinsically less efficient and less effective. In fact the British NHS is one of the leanest systems in the world, doing more for less than anywhere else. This has lead to the internal market and various other “choice” and “competition” initiatives, each one adding a new layer of bureaucracy, diverting scarce funds away from patients and towards political vanity projects. This latest bill provides allows Andrew Lansley’s associates in the healthcare industry to profit at the expense of patients and the taxpayer and that is the greatest tragedy.
All is not lost, however. The bill may have passed through the Commons, but it still has to go through the House of Lords. With that in mind, the TUC has created an initiative called “Adopt a Peer,” whereby you are assigned a member of the House of Lords to write to. I was assigned Lord Collins, of Highbury, and wrote him the following letter:
Dear Lord Collins
I’m writing to you about the Health and Social Care Bill, which is currently being considered in the House of Lords. As you are probably already aware, it makes a number of substantial and possibly irreversible changes to the fabric of the NHS. In particular the bill makes changes in its very first section, removing the duty of the Secretary of State for Health to facilitate the provision of healthcare as codified in the 2006 NHS act and prior legislation. It also fragments commissioning roles amongst a number of bodies from where it will almost certainly end up in the private sector. This fundamentally compromises the principles of the NHS as well as being detrimental to service users, diverting scarce funds to profit making companies.
As a Labour Peer, I imagine that you will be opposing the bill. What measures can be taken by the Lords to oppose its passage? Neither of the Governing parties have a mandate to make changes this radical, with the Liberal Democrats having campaigned on a platform diametrically opposed and the Conservatives not having been upfront about these plans prior to the election, with their leader promising “no more top-down reorganisations of the NHS” and that the NHS was safe in their hands.
To which he replied, with impressive promptness the very next day:
Many thanks for your email regarding the Government’s Health and Social Care Bill which has now commenced its journey through the Lords stages of parliamentary procedure. I apologies for the delay in responding but I was heavily involved in the Labour Party Conference which took place in Liverpool last week.
Labour has always been clear that the proposed changes to the NHS envisaged by David Cameron, Andrew Lansley, and the coalition government are unnecessary, reckless, wasteful and bureaucratic. On top of this, the Bill goes against the coalition’s own promise, of only last year, for there to be “no more top-down reorganisation of the NHS”. They have no mandate for the changes they are planning.
Despite the pause and the Future Forum’s report, the Bill still contains the essential elements of the Tories’ long-term plan to set the NHS up as a full-scale market based on the model of the privatised utilities. That’s why so many experts still oppose the Bill.
I can assure you that Labour members of the House of Lords are committed to doing whatever we can to protect the NHS from the proposals in this Bill. Firstly we will try to stop the Bill in its tracks by voting against it at its Second Reading. Sadly, because the Lib Dems and Conservatives will vote together to keep the Bill, we are unlikely to succeed.
Over the next weeks and months, I and my colleagues will endeavour to make changes to the Bill in order to limit its damage to the NHS and improve the Bill. But we can’t do it on our own. We can only do this by building our own coalition. That means persuading independent crossbenchers, Lib Dems and Tories to vote with us on those key amendments. For that we need 80 peers from other benches to vote with us.
That’s where we need your help. Please contact crossbenchers and Lib Dems in particular to ask for their support. Without them Labour peers cannot limit the damage that this Government will do to the NHS. Please visit http://www.parliament.uk for full details of these Peers including email addresses.
Lord Collins of Highbury
What more encouragement could be needed? Sign up to “Adopt a Peer” and pay particular attention to Lib Dem and crossbench peers. Also, those who are enclined, can come along to the protest, on Westminster Bridge, on Sunday.