Why the Queen’s Speech on 19 May should include a bill to reinstate the NHS in England

US models

Simon Stevens, now head of NHS England after his stint in the United States at United Health, knows full well what is in store for us all. In the US, neither health maintenance organisations—nor the accountable care organisations created in the wake of the 2010 Affordable Care Act—are backed by a government duty to provide (like CCGs). They don’t have a duty to everybody, only to their members (like CCGs). Like CCGs, they are not accountable to local residents; and their public resource allocation is person based capitation, not geographic, and doesn’t cover everyone.

With ministerial legal accountability for services gone, Jeremy Hunt, the health secretary, said in June 2014, “We need CCGs to become accountable care organisations.”6 The US public’s distrust and dislike of health maintenance organisations (rebranded as accountable care organizations) is well documented, resulting from the denial of care to millions of people going hand in hand with overtreatment, care inequalities, restrictive networks of providers, and cherry picking of healthy patients.7 8

The US organisations are characterised by loss of clinical autonomy, huge administration costs, exorbitant salaries to chief executive officers, and fraud.9 Since 1948 no one in the UK has been made bankrupt because of healthcare bills; in the US a fifth of adults struggle to pay healthcare bills, which account for two thirds of all personal bankruptcies.10

Under universal healthcare systems, governments ensure that the risks and costs of care do not fall on patients. In marketised systems, contracts require risks to be identified and allocated by contractors and providers. Commercial providers need to be able to decide which risks they will take, which they won’t, and how they will price and select those risks. In healthcare high risk groups are typically older, poor, chronically ill, disabled, or mentally ill. And membership based bodies are by definition not intended to cover everybody.

NHS England’s embrace of the market is moving apace. Foundation trusts and general practices can merge and enter into joint ventures with health insurers, PFI consortiums, and corporate providers. Such arrangements are being taken forward through the “vanguard sites” and new models proposed in NHS’s Five Year Forward View. These resemble the US accountable care and health maintenance models: primary and acute care services, multispecialty community providers, and large federated GP networks offering out of hospital care.11 12 The Manchester devolution plan, in which 15 NHS providers, 12 CCGs, and 10 local authorities will co-commission and provide care, crystallises the health maintenance organisation form, with mixed sources of funding and networks of providers.13

Rescue bill

US healthcare “solutions” are the death knell for the NHS. The NHS must be reinstated and 25 years of pernicious marketisation reversed. Hence the need for the National Health Service Bill tabled in parliament on 11 March 2015 with cross party support.14 The Greens, the Scottish National Party, and the National Health Action Party have pledged support.

Labour’s plan to remove compulsory commercial contracting (section 75 of the Health and Social Care Act), to cap the profits of the private sector to 5%, and to limit foundation trusts’ income from private patients to 2% of the total are palliative, but they will not halt the terminal decline of the NHS or stem the rot of market models. The NHS Bill (www.nhsbill2015.org) would abolish the internal market and contracting, centralise PFI debts, and restore the health secretary’s duty to provide national health services throughout England—as in Scotland and Wales.

The question for all election candidates: will they be true to the founding vision of the NHS and support the inclusion of the NHS Bill in the Queen’s Speech on 19 May?