We were promised one thing by David Cameron during the 2010 election campaign: “no top-down reorganisation of the NHS.”
The Health and Social Care Bill was first introduced in the House of Commons on 19th January 2011. Since then there have been 25 days worth of debate and over 1,000 amendments. An unprecedented pause in legislative progress, which the government called a ‘listening exercise,’ gave Andrew Lansley some time to deal with the amount of criticism the Bill was receiving.
The final vote on the Bill followed a last attempt by Labour and a few Lib Dems for the Department of Health’s register of risks to be published. The motion was, for the third time in four weeks, defeated in favour of the government. As such, the public are yet to see the potential risks associated with this piece of legislation, even as admitted by the Con-Dems.
Throughout the legislative process, the Bill lost support from GPs, consultants, nurses, trade unions, patients and health care organisations. The Bill passed the final emergency debate in the House of Commons on 20th March 2012 with a government majority of 88. A survey undertaken in the Guardian the day before suggested that only three out of twenty three health organisations supported the Bill by this stage.
Despite last minute Lords’ amendments, the Health and Social Care Act 2011, which attempts to make savings of £20billion, will lessen the duty of the Secretary of State to provide health services. As well as introducing a ‘postcode lottery,’ this means a significant reduction in democratic accountability for the NHS, with the responsibility for securing the provision of healthcare services lying with an unelected quango, made up of unelected commissioners, GPs and representatives of private companies, instead of with the government.
The Act also contains a number of measures which will promote competition within the NHS. These measures include increasing the cap on how much hospitals can earn from private patients from 1.5% to 49%. All hospitals will now compete for treatment contracts from local clinical commissioning groups, which is especially worrying as it is now the right of ‘any qualified provider’ to be given a contract to deliver health services.
It is difficult to see who, if anyone, will be in charge of the NHS in terms of the Health and Social Care Act 2011. It is not clear how the five national bodies will interact or how they will provide coordinated and consistent governance of the NHS. Nor is it clear if the duty to provide health to everyone will be the raison d’etre of the NHS any longer.
The shock and awe tactics which the Con-Dem government are using to force through their austerity package is worrying. Whilst Thatcher went for salami slicing, the Con-Dems have us caught like rabbits in the headlights. Privatisation through the backdoor has been happening in the NHS for years, but for a government to take the NHS head-on shows a deluded sense of bravado from the Con-Dems. This political and economic arrogance will filter through into NHS Scotland.
The Act is long and complex. It does not make for easy reading, and perhaps deliberately so. However, two sections are clearly applicable to Scotland.
Firstly, the Act states that ‘the appropriate authority’ i.e. the Scottish Ministers, must take steps which they consider appropriate for the purposes of protecting the public from radiation including providing services for the prevention, diagnosis or treatment of illness arising from exposure to radiation. The appropriate authority may make charges (whether or not on a commercial basis) in respect of anything done by it under this section. Currently, this function is undertaken, not for profit, by Health Protection Scotland. Health Protection Scotland is the equivalent of the Health Protection Agency in England, which was abolished by this Act. A section like this appears to be an indication of what could be in store for Scotland.
Secondly, the Act allows any relevant providers i.e. companies which provide services to the NHS in Scotland, to go into administration and be taken over by a person appointed by the Courts, to manage its affairs, business and property. ‘To exercise the functions of the health service’ appears to have been added in as an after-thought. An application for an administration order may be made only by Monitor who are an independent (price) regulator of NHS Foundation Trusts. NHS Foundation Trusts don’t currently exist in Scotland, but again it is perhaps a premonition of things to come. Nevertheless, this section makes provision for more profitable ‘providers’ as administrators to manage the affairs, business and property of NHS providers in Scotland.
This Act shows yet more creeping privatisation into the Scottish NHS. More worryingly, the Scottish Government was given a chance to comment on the applicable sections of the Bill, as health is a devolved matter. However, the SNP Government declined to comment, leaving the Bill to the mercy of Westminster.
It is likely that, as the Act comes into force in April 2013, there will be more evidence of the dodgy financial dealings of the private health care companies and the links between those in the Lords and Commons with private health care corporations. This gives us time to build a pro-active rather than re-active campaign in Scotland. This campaign can of course link into our independence, anti-austerity campaign.
As Aneurin Bevan said of the health service ‘It will survive as long as there are folk with the faith to fight for it’.