Why we must oppose the Health and Care Bill

By Jon Trickett MP

The Health and Care Bill completing its scrutiny in the House of Commons today is the latest piece of legislation to strengthen the hand of profit-driven private providers in the delivery of our essential public services.

After eighteen months of the coronavirus pandemic, chronically underpaid key workers, who have kept the health and care sectors running in the face of unacceptable staff and equipment shortages, now face new reorganisation from an aloof and disconnected Conservative government. 

Structurally, both health and care are seeing private providers take on more and more key decision-making powers while both suffer underfunding and understaffing. A new top-down reorganisation of the health sector will cause chaos and waste vital funds. The public’s beloved National Health Service continues to be salami-sliced and parcelled out to private providers.

For the care sector, the bill initially did little, despite its name. The government has now updated it overnight to insert the new funding proposal that benefits the wealthiest individuals. And still there is no sign of any willingness to bring the care sector together in a new public provider, which could improve standards and conditions for staff and patients.  

The result overall is to downgrade service provision and make it less accessible, hitting those on low incomes or living with health inequalities, who rely on universal provision.

For the health sector, the Bill hands over powers, piece by piece, from what should be a publicly-accountable NHS to private health providers – with the proposed Integrated Care Service boards being established to make decisions on commissioning services, likely to contain representatives of privately-run health providers. 

Labour MPs tabled amendments to expose the worst measures but as they are voted down, we will need to oppose the bill that builds on earlier Conservative privatisations. 

In terms of some of the detail, left MPs backed an amendment to create a presumption in favour of contracts being awarded to NHS trusts and NHS foundation trusts. As a point of principle, it should be the NHS delivering health contracts and not private health firms creaming off bonuses for directors, paying dividends to shareholders and making health decisions on what suits their profit margin. 

Similarly, another amendment sought to ensure that Integrated Care Partnerships are made up wholly of representatives from public sector organisations and that private companies are not represented on them.

It would be an outrage if the West Yorkshire Integrated Care Service Board included a representative of a private care provider who might potentially profit from services that board chooses to commission. But an earlier ‘Shadow ICS’, established in the South West of England, did include the local managing director of a private provider appointed to the board, highlighting what may come elsewhere.

That is the threat under this Conservative vision for the health service, and why we need to defeat this Bill. 

For the provision of social care, now deep in crisis, the Bill will do nothing to lift the fractured and fragile private care sector out of the hands of vulture capitalists and into a single National Care Service body, as Labour promised at the General Election. The private providers, stripping back services and holding down pay, will remain in place while a new unfair funding model is being proposed.

Conservative proposals will require personal contributions for social care costs up to a cap that will disproportionately harm those with fewer savings or lower value housing assets. The £86,000 cap would require many in the north, including so-called ‘Red Wall’ areas, to sell their houses to pay for care while in London and the South East, such a figure is often only a fraction of the market value of a house. The Tory commitment that no-one need to sell their house for social care may only survive in their southern heartlands.  

The key question here remains how we best deliver public services. 

The involvement of the private sector continues to be justified on a number of grounds. Efficiency has long been held up as the preserve of the private sector, yet a public provider has no need to reward private investors or offer bonuses to directors. Finance has also been used, by both Conservatives and New Labour, but repaying private finance initiative funding continues to cripple health and care service budgets. The alternative would be to introduce a wealth tax to fund the growing cost of services and ensure those with unearned income make the necessary contribution. 

Polling evidence continues to show that public ownership is popular with the public – not only in sectors like energy and transport, but also in health and care. We Own It commissioned polling by Survation and found 70% were concerned the Bill would mean NHS contracts being handed out to private companies without adequate scrutiny. A similar majority wish to make sure the NHS is the default provider.

On this basis, Labour would only benefit from setting out a clear vision for health and care firmly in the control of the public sector, including a restored National Health Service and a brand new offer of a National Care Service.

Jon Trickett is Labour MP for Hemsworth and a former member of the Shadow Cabinet under Jeremy Corbyn’s leadership.

Image: Jon Trickett. Source: https://api20170418155059.azure-api.net/photo/g2eLCe7R.jpeg?crop=MCU_3:4&quality=80&download=true. Author: Chris_McAndrew, licensed under the Creative Commons Attribution 3.0 Unported license.

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