From Prof Allyson M. Pollock and Peter Roderick

The Health and Care Bill which was introduced in the House of Commons on 6 July 2021 is a major reorganisation of the NHS in England which will complete the dismantling of it as a universal, comprehensive, publicly funded and provided service free at the point of delivery.

It is an astonishing attempt to allow the Secretary of State, an enlarged NHS England as ‘rule-maker and regulator’, and new public-private ‘Integrated Care Boards’ (ICBs), to reduce services, limit expenditure, further degrade local accountability and entrench the market.

Key points – summary

If Parliament enacts this Bill:

  1. there will no longer be a statutory duty on any body to arrange provision of secondary (i.e., hospital) medical services – only a power for ICBs to do so;
  2. ICBs will only have a “core responsibility” for a “group of people” in accordance with enrolment rules made by NHS England, evoking the US definition of a health maintenance organisation which provides “basic and supplemental health services to its members”;
  3. it will be possible for ICBs to award and extend contracts for health care services of unlimited value without advertising, including to private companies;
  4. private health companies will be able to be members of ICBs, their committees and subcommittees, which will plan NHS services and decide how to spend NHS money;
  5. NHS England will have new powers to impose limits on expenditure by NHS trusts and NHS foundation trusts;
  6. integrated care partnerships will be set up as joint committees of local authorities and ICBs to draw up integrated care strategies, with no restrictions on membership and without clear transparency obligations;
  7. payments will be determined by NHS England after consultation with providers, including private providers, and can distinguish between different types of providers, different groups of patients and different types of services;
  8. local authority representation on ICBs will be limited to one member covering (usually) several local authorities, whilst the more local ‘place-based’ ICB committees will not have power to determine their budgets;
  9. local authority powers to refer reconfigurations will be affected because the Secretary of State is to be given new intervention powers, but exactly how is unclear.

The Bill does nothing to:

  • rebuild and restore local, primary medical services, community, mental health and hospital services (e.g., staffing and beds) which the covid-19 pandemic has exposed as being seriously inadequate after years of service closures and cuts;
  • address the failings of the centralised communicable disease control system, and wider public health system, revealed during the covid-19 pandemic;
  • address the broken social care system with which health services are supposed to be integrated;
  • prevent corporate take-overs of GP services.