A major piece of legislation that would overhaul England’s NHS passed its second reading in the House of Commons last week.
The controversial Health and Care Bill includes reforms to the structure of the health service, repeals section 75 of the Health and Social Care Act 2012 – which made it mandatory for all contracts over £615,000 to be put out to tender – and gives the health secretary more power to intervene in service decisions, even at a local level.
The government says the changes are “vital to help the NHS build back better from the pandemic”. But critics describe the bill as a “corporate takeover” and say it will “add steroids to the cronyism on steroids seen during the pandemic”. Labour also warned it could lead to stark funding cuts of more than £200 a patient in deprived areas of England.
The British Medical Association, the trade union for doctors and medical students in the UK, says it is the “wrong bill at the wrong time” and is calling on MPs to reject the legislation. The professional body described it as a “power grab” by Health Secretary Sajid Javid, and argued that it “fails to address chronic workforce shortages or to protect the NHS from further outsourcing and encroachment of large corporate companies”.
But what do frontline health and care workers think of the bill? I spoke to NHS doctors and nurses to find out.
Dr Bob Gill, a Campaigner and NHS Doctor in Kent
VICE: Would the bill really allow us to “build back better” after COVID?
Dr Bob Gill: Build back better for who? Corporate shareholders and CEOs? Yes, most definitely. Patients, public, taxpayer? Definitely not. The bill learns all the wrong lessons from the pandemic, and is designed to double down on the decades of catastrophic privatisation policy that caused such a heavy toll.
The bill would split the NHS into larger areas, right? What does this mean for how much money goes to each area?
The bill creates new legal entities, breaking up the NHS into 42 separate “managed care” systems. The integration the government desires is of social care and health care budgets to provide the largest possible pot of cash from which their friends in private corporations can extract profit.
The other aim is to expand patient charging systems already commonplace in social care. None of this is about improving quality of care for patients or enabling excellence within the staff. The proportion of funding spent on delivering care will reduce as the administration, bureaucracy and profit-taking expand to reach US levels.
Long waiting lists and backlogs, worsened by COVID, are among the biggest problems facing patients and the NHS. How does the bill tackle this?
Waiting lists destroy faith in the NHS and provide an excuse for more private sector contracts to “help with the backlog”.
The goal of reforms is to generate money for global corporations, not to provide high-quality healthcare for all. We have already seen life expectancy decline as infant mortality and maternal mortality increase over the last decade, thanks to austerity defunding public services. I see no reason why this race to the bottom will not continue.
Dr Anas Nader, an A&E doctor in London and CEO of Patchwork Health
Critics have said the bill will do nothing to address NHS workforce shortages. Is that right?
Dr Anas Nader: The NHS has nearly 100,000 vacancies, 44 percent of staff members have reported feeling ill because of work-related stress, and one in five plan to quit after the pandemic. The Health and Care Bill should include an outline of new measures to address the chronic NHS staffing shortages and high prevalence of burnout. This could be a prime opportunity to set in motion meaningful and long-called-for reforms to NHS workforce systems.
Dr Owain Rhys Hughes, an ENT surgeon in London and founder and CEO of Cinapsis
Opponents claim the bill would increase private companies’ involvement in the NHS and allow them to “wield influence over commissioning decisions”. Is this true, and should we be worried?
Dr Owain Rhys Hughes: The NHS has a long history of partnering with private providers to deliver – and support the delivery of – patient care; without these partnerships, at this time, services would collapse. So there is nothing in the bill that marks a change in that regard.
What the bill is going to change are the rules about how local health services buy this private care for patients. Instead of publicly announcing and tendering out contracts over £615,000, it’s now going to be possible for contracts to be rolled over if the health service is happy with the work of the current provider. The local NHS must still act transparently and in the best interest of patients, however.
If the built-in checks and balances are strictly adhered to, I see no reason for the public to worry about this new bill heralding the start of a corporate NHS takeover.
Would the proposed integrated system of care mean that all NHS services work together properly now? For instance, if I were to need help from a specialist service – say, for mental health – the communication and care between it and my GP would be joined up?
The roll-out of Integrated Care Systems is, on balance, a positive move, because it shows willingness by government to pursue a more cooperative approach to care delivery between healthcare organisations. I’m conscious that this will involve significant reorganisation during a hectic period for the NHS; service and staff are incredibly overstretched, and a mismanaged transition could pile more work onto their plates and burden their budgets.
However, I’m hopeful we can use the opportunity to focus on the needs of patients and remove some of the barriers that have made delivering care difficult in the past. In my experience, one of the most impactful ways to join up care in the NHS would be to streamline and digitise communication between clinicians working in different parts of the health and care system.
The bill has been described as a government “power grab” of our health service. Would the health secretary have more power over local services, and what would this mean for patients?
Clauses in this bill mean some decision-making powers will pass upwards to top politicians, such as the health secretary. As a result, I think it’s important for MPs to now consider how major – and minor – decisions will always be made in the best interests of patients, NHS staff and the organisation as a whole, rather than what might serve one particular political party.
The NHS has serious challenges to surmount this summer. These are set to worsen as autumn and winter approach – the dual problems of huge waiting list backlogs and workforce burnout – and I’d like to see politicians putting aside any narrow party-political interests to focus on delivering change that will really improve outcomes for patients, and also reduce the burden on clinical and administrative staff.
Dr Shireen Kassam, a consultant haematologist in London and founder and director of Plant Based Health Professionals.
The bill would introduce tougher calorie labelling requirements on food and drink, and ban junk food adverts before the 9PM watershed. Is this really what’s needed to tackle obesity when we know there’s a link between poverty and obesity levels?
Dr Shireen Kassam: We expect our food system to produce healthy, nutritious food that is sustainable for producers, people and the planet. Yet, our farming and food systems are major drivers of the climate and biodiversity crises, and fail to promote the health of populations.
I was pleasantly surprised with the recommendations published this week in the UK National Food Strategy plan. It fully acknowledges that those with lower incomes suffer the worst of the consequences.
Of course, I would have wanted the recommendations to be bolder and more ambitious, but just having an open dialogue on the harms caused by our food system – particularly animal farming – feels like huge progress, as usually the farming lobby shuts these down.
Matt Tacey, an NHS psychiatric nurse in the Midlands
What is the general feeling among nurses about the bill?
Matt Tacey: It is a feeling of frustration and confusion. Frustration at the fact that this is another attack on health care workers, and confusion to understand why we continue to be undervalued. We have fought tirelessly and relentlessly over the last 18 months to protect our communities. Still, the government repeatedly shows their true colours by attacking our rights, pay and safety, but most concerning is the attack on our patients.
Critics complain there is a lack of focus on social care. What are your thoughts on this?
Dangerous changes can now be forced through against local opposition by the government, providing another example of the bullyish behaviour from government. The truth is that the NHS needs integrated care, but to provide this requires home social care and care in nursing homes to become free as part of a publicly funded health and social care service. This bill pushes us into a healthcare system for profit, not people. Health workers and campaigners need to come together to stop this bill from becoming law. Please, join a union, speak to others, stand together as one and fight back. Together, we can win!
Interviews have been edited for length and clarity