BY RETIRED BMA MEMBER ANNA ATHOW
THE main story on BBC news on Saturday, was that Boris Johnson was proposing to reverse the Cameron health reforms.
We were told all day: ‘There has been a leaked document.
‘Boris Johnson is planning to reverse the health reforms and reduce the role of the private sector.’ This was to be in order to focus on hospitals and social care working together and better care of the elderly.
According to The Daily Telegraph, the leaked document is a draft of a White Paper published by the ‘Health Policy Insight website’.
This seems to be the latest update of the government’s plans to legislate in the spring to make Integrated Care Systems into statutory bodies, instead of ‘ad hoc’ bodies, and get rid of Clinical Commissioning Groups (CCGs) of GPs, as the main commissioners of hospital and community care.
The leaked document apparently links up lessons learned during the coronavirus pandemic to ‘join up hospital and social care’, for example, by making it easier to discharge hospital patients to care in their own home or care homes, to underline the governments desire to push the legislation through in the next few weeks.
The BBC itself is projecting this legislation as a complete reversal of the Lansley Health and Social Care Act, (H&SC Act) brought in by the LibDem-Cameron coalition government in 2012.
This H&SC Act mandated that NHS services must be competitively tendered on the open market to be provided by private companies. It installed an NHS commissioning board now called NHSEngland, as an ‘independent’ Arms Length Body, carrying out a yearly government privatisation mandate.
This was completely alien to the founding principles of Bevan’s 1948 NHS, built on the public funding, provision and staffing of the NHS, and bitterly opposed by many members of trade unions and campaign groups.
It was Simon Stevens the Chief Executive of NHS England who first promoted the idea of ‘Integrated Care systems’ ( ICSs), then called Accountable Care Organisations inspired by the US health care system, in his Five-Year Forward View 2014.
It was his follow-on from the ‘NHS Long Term Plan’ published January 2019, which demanded that the ICSs should become statutory bodies and become legally responsible for NHS long term budgets.
This is what former health secretary Jeremy Hunt had to say about it in his interview on the BBC Radio 4 ‘Today’ programme on Saturday morning.
Question: The government is to reduce the role of the private sector to reverse the Cameron reforms.
Answer by Hunt: This is from a leaked document.
Q. Is this an admission that the Lansley reforms were wrong?
A. This goes back to Alan Milburn, and right back to Ken Clarke and the internal market. It is right to change. There is a big difference between now and then. There are more older people over 65 years. They need a programme of care, not just a single visit to hospital.
Q. Is this the right time?
A. Frontline staff will welcome it. The new ICS’s will allow the joining up of care. Local authorities have a seat on the board. So health and care will be more integrated. They can sort out long term workforce pressures.
Q. We did hear from an ICU doctor that it works at full capacity all the time, and they need more capacity.
A. We need more doctors and nurses. We have to learn the lessons of history. Originally, Kenneth Clark was against cosy local monopolies. If we allow them back, it has to be a properly accountable system. They would be accountable for huge sums of public money.
Q. What about the independence of NHSEngland (NHSE)? Will there be greater power for the health secretary?
A. It will make NHSE even stronger than it is at the moment. It will take over NHS Improvement. It will increase the weight of NHSE. It is given £150bn of public expenditure. The minister needs some powers to guide how this is spent.
Q. There was anger when the reforms were brought in. Is there to be an apology to those people?
A. Some things were right. It was right to put NHSE as an Arms Length Body. It was good that health was depoliticised.(!!) Some things were wrong. It brought in many layers. CCGs caused the fragmentation of commissioning. This will simplify commissioning.’
Other prominent supporters of the H&SC Act like Prof Chris Ham, former head of the King’s Fund, now non-executive Director of the Royal Free Hospital were interviewed by the BBC.
He said: ‘The changes to get ICSs as statutory bodies will be welcome.
‘This is not down to restructuring by politicians. This is different from the past. In the world now – we need joined up care for an ageing population. This will be welcomed by people in the NHS.’
Alan Milburn, former health minister under Tony Blair, a key architect with Simon Stevens of Blair’s privatisation reforms in the 1980s told the Telegraph how wonderful the proposed new laws will be. ‘What emerged from Covid is that tech is the key that unlocks meaningful reform.
‘Do you need outpatient departments at all? GP consultations became virtual. You can establish remote wards that are effective clinically and financially.’
The only dissenting opinion interviewed on the 10pm BBC News, was from John Lister, a health academic and Keep Our NHS Public member who said: ‘This government is more dependent on the private sector than ever before, in their Test and Trace and private labs.
‘They brought in a four-year plan to use private hospitals, and let NHS beds close.
‘They are NOT looking to marginalise the private sector.’
John Ashworth, the Labour shadow health secretary said: ‘What is the logic of such a big change during a national pandemic crisis?’
Dr Anna Athow, retired NHS consultant surgeon and BMA member commented: ‘The fact is Simon Stevens’ NHS Long Term plan to make ICSs into statutory bodies, with responsibility for spending £150bn of public money, does not represent a dismantling of the H&SC Act privatisation reforms at all. It is but a continuation of it in a new form.
‘ICSs are versions of US- style Accountable Care Organisations modelled on Health Maintenance Organisations, which are public private partnerships. The state supplies the funds and the public/ private partnership agrees to provide cheap “integrated” health and social services in return for turning a profit on those services for the private companies involved.
‘The boards of ICS do contain representatives of public bodies like local authorities but they also contain private companies and management consultancies.
‘These new reforms are about kicking out the small not-for-profit businesses like GPs and handing NHS long term contracts over to big corporates to be given NHS long term contracts.
‘As for workforce change, they glory in more “flexibility” and the substitution of volunteers and lower trained staff for fully trained staff, as demonstrated in the dilution of intensive care nurse to patient ratios in the management of Covid patients in this pandemic.
‘Johnson’s ‘‘U-turn” is a sham, and this new legislation must be urgently opposed by the trade unions and the Labour Party.
‘Only a workers’ government that will nationalise the banks and the major industries can deliver the health care and Social Care as required in the period ahead.
‘This is the lesson of the pandemic, with its 112,000 dead in the UK and its 465,861 deaths in the USA.’