Health and Care Bill: What changes do healthcare leaders want to see?
BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1806 (Published 15 July 2021) Cite this as: BMJ 2021;374:n1806
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Dear Editor
The role of the private sector in the NHS is a source of anxiety for many and is widely discussed in many fora. The bill currently under discussion and the general trajectory of health policy under this administration appears to favour stealthy privatisation, the exclusion from the process of patients and professions and the prioritisation of commercial considerations, control and influence over policy.
The gaslighting of the electorate is abundantly evident.
Healthcare, properly provided, is not and can never be a commercial undertaking. The conflicts of interest, the perverse incentives, the record of private provision failure in the UK and elsewhere and the moral hazard inextricably woven in are insuperable obstacles.
But:
For so long as the present administration endures and in anticipation of future administrations with similar views taking office there is merit in patients, professions and political cadres with more civilised views consulting together to agree common positions on the terms of private sector engagement that would minimise harm and protect care.
Every £ voted by parliament for healthcare should be spent on the patients. Every £ that haemorrhages from the system as profit, bonuses, dividends, transaction costs and commercial management salaries represents treatment denied. This needs to be explicitly understood by the public.
The private sector must bear the full costs of any failures that emerge within it and not offload them onto the NHS.
Wherever service is delivered it remains essential that every patient has a single coherent and complete patient record, accessible to all providers - standard record keeping is a sine qua non governing the safety of patients, not to mention legal considerations.
Healthcare should be excluded from ISDS.
Only providers subject wholly to the jurisdiction of our national courts should be given contracts.
In instances where standards fall under a private provider, summary termination of contract and full surrender of sums received to date should be the rule.
Care standards across public and private sectors must be equal and access universal.
No cherry-picking profitable items.
I am sure other will wish to add to these ideas and hope that together we can moderate the harms that the current administration favour.
Yours sincerely
Steve Ford
Competing interests: No competing interests
Re: Health and Care Bill: What changes do healthcare leaders want to see?
Dear Editor,
It is puzzling to read that one of the aims of the Bill is to end the internal market since clauses 68 and 69 both relate to procurement processes. Putting one major commissioner and representatives of providers in a single body does not abolish the purchaser provider split.
I am pleased that the BMA has come out firmly against the Bill. If passed, it will disrupt the NHS for the next two years while it is struggling with huge pressures from covid, staff shortages and work backlog. The workforce crisis and the massive problem of social care are not addressed, and it brings no extra funds to help trusts reopen closed beds. Not one more nurse will be recruited or one extra patient treated, and neither does it bring any genuine integration of NHS and social care. It will, however, divert time and effort away from patients to another top down reorganisation while making the service even less accountable to local communities.
The Secretary of State will be given 138 new powers; vagueness and repeated reference to ‘flexibility’ leaves plenty of room for reduction in services. Opportunity is created for the private sector to step into positions of influence. The Bill is not about reversing privatisation, and repeal of section 75 of the 2012 Act (requiring competitive tendering) will not stop contracting out. The 42 Integrated Care Systems have populations up to 3.2 million, chairs will be appointed by NHS England and signed off by the Secretary of State, whose agreement will be needed to replace them. The chairs are able to appoint other members of ICS boards and there is no bar on private companies taking seats. The private hospitals have just been given a £10bn contract to treat funded NHS patients – the biggest ever privatisation of clinical services.
There will be some who choose to believe that the government that has handed out billions in covid contracts to inept and incompetent PPE suppliers and test and trace contractors headed by cronies and donors really wants to limit privatisation and integrate services. I am not one of them.
Competing interests: co-chair Keep Our NHS Public