The full version of Eleanor Smith MP’s NHS Bill has now been published ahead of its scheduled second reading in the House of Commons on 26th October 2018. It is going forward with the support of the Labour leadership.
Publication of the Bill follows;
this version of the Bill which was provided to Eleanor by Allyson and Peter ahead of the Bill’s first reading on 11th July 2018;
and this further version provided on 14th September 2018 to Eleanor by Allyson and Peter after discussions with Lachlan Stuart in the Leader of the Opposition’s Office.
More details of the development of the Bill, and the two differences between the first and the further version of the Bills provided to Eleanor, are set out in this statement from Allyson and Peter.
The national consultation, promised by NHS England after the JR4NHS judicial review, is currently underway. It ends on 26th October 2018.
NHSE has now dropped the term ‘accountable care organisation’, preferring instead ‘integrated care provider’ (ICP). But don’t be fooled by a change of wrapper.
The judicial review succeeded in forcing NHSE to retreat from its original radical intentions but major problems remain with what’s proposed. NHSE is still pressing ahead without new primary legislation, and without ICPs having to be public NHS bodies.
Professor Allyson Pollock and Peter Roderick have been discussing the re-tabling of the NHS Reinstatement Bill in the House of Commons on 11th July 2018 with Eleanor Smith, MP for Wolverhampton South West. We are delighted that an MP with Eleanor’s experience and commitment wants to do this.
In short, the Bill proposes to fully restore the NHS in England by 2021 as an accountable public service by reversing nearly 30 years of marketization, by abolishing the purchaser-provider split, ending contracting and re-establishing public bodies which plan and provide integrated services and accountable to local communities.
The Bill gives flexibility in how it would be implemented, led by current bodies, including local authorities.
reinstate the government’s duty to provide the key NHS services throughout England, including hospitals, medical and nursing services, primary care, mental health and community services,
integrate health services under the Secretary of State, whilst allowing delegation of public health services to local authorities, and allowing for integration of social care services following and subject to further legislation,
declare the NHS to be a “non-economic service of general interest” and “a service supplied in the exercise of governmental authority” so asserting the full competence of Parliament and the devolved bodies to legislate for the NHS without being trumped by EU competition law (for so long as the UK is an EU Member State) and the World Trade Organization’s General Agreement on Trade in Services,
exclude the NHS from international trade deals,
require the NHS Commissioning Board (NHS England), clinical commissioning groups (CCGs), NHS trusts, NHS foundation trusts, and local authorities, including combined authorities and elected mayors, to develop a ‘bottom up’ process so that by 2021 services would be planned and provided without contracts through regional and local public bodies – which could cover more than one local authority area if there was local support, and taking into account English devolution – to be known as Strategic Integrated Health Boards and Local Integrated Health Boards,
allow Health Boards to employ GPs, end pay beds and private practice in NHS hospitals and end contracts for GP services with commercial companies,
abolish NHS England, CCGs, NHS trusts and NHS foundation trusts, following completion and approval by the Secretary of State of the Health Boards,
repeal the competition and core marketization provisions of the 2012 Act, and abolish Monitor – the regulator of NHS foundation trusts, commercial companies and voluntary organisations,
re-establish Community Health Councils to represent the interest of the public in the NHS,
stop licence conditions taking effect which have been imposed by Monitor on NHS foundation trusts and that will have the effect of reducing by April 2016 the number of services that they currently have to provide,
introduce a system for collective bargaining across the NHS,
impose a duty on the Treasury to minimise, and if possible to end, the expenditure of public money on private finance initiatives in the NHS in England, and
abolish the legal provisions passed in 2014 requiring certain immigrants to pay for NHS services.
Positive news from Peter Roderick, co-author of the NHS Bill and campaigner with #JR4NHS:
“Thanks to the fantastic, far-reaching and committed campaign involving thousands of people, and our brilliant legal team, the government and NHS England have now accepted that there must be a national public consultation on ACOs, and that no ACO contract will be signed until that’s happened. This is great news, and a clear concession in response to our seeking a judicial review.
NHS England’s lawyers promised this to our lawyers on Monday evening, and Jeremy Hunt confirmed this at the Health Select Committee yesterday.
But don’t be fooled into thinking they’ve given up. Despite repeated questioning from Sarah Wollaston MP, the Committee chair, Hunt refused to delay the ACO regulations that he’s still planning for February, which are intended to facilitate the ACO contract – even though there’s no longer an urgent need for them – and he has still not accepted the need for an Act of Parliament before ACOs can operate lawfully.
This is very important because the government has said they will change the definition of ACOs with input from NHS England, but we have absolutely no idea what the new definition will be.
We still remain very concerned about the lack of transparency and the need for primary legislation on ACOs, and so we have told the court this afternoon that we want to press ahead with these points.
Private companies lack transparency and accountability, the opposite of what we want for our public NHS.
This is why we want to make absolutely sure of the definition of “Accountable Care Organisations” in any consultation. We think there is no point in a consultation if the ACOs they consult on are unlawful.
We have been told by the court that we can expect a decision on permission tomorrow, or very early next week.
Thanks once again for all your incredible support.
Stephen Hawking has joined the lawsuit seeking to stop the introduction of the first accountable care organisations (ACOs) into the NHS in England in April without proper public consultation and without full Parliamentary scrutiny.
The Judicial Review is against the Secretary of State for Health Jeremy Hunt and NHS England to stop them introducing new commercial, non-NHS bodies to run health and social services without proper public consultation and without full Parliamentary scrutiny – ACOs.
ACOs would be governed by company and contract law and can be given “full responsibility” for NHS and adult social services. They were conceived in the US about 12 years ago, and are now being imported into England although they are not recognised in any Act of Parliament. They would be able to decide on the boundary of what care is free and what has to be paid for. They will be paid more if they save money.
They can include private companies (e.g. Virgin in Frimley, Circle in Nottinghamshire), including private insurance and property companies, which will make money from charging. They could also include GP practices, in which case people on their lists will automatically transfer to the ACO in order to be entitled to services – new patients will also have to register with the ACO. They will be allowed to sub-contract all “their” services.
Such commercial ACOs would fundamentally change the NHS and could profit from a radical reorganisation of health and social services. They would have control over the allocation of NHS and taxpayers’ money. Their accountability for spending it and their obligations to the public would be under commercial contracts, not statutes.
It is also against the public interest that they are being introduced by stealth, without proper public consultation and without full Parliamentary scrutiny.
Integration of health and care services is a desirable aim, but not whilst their funding and population bases are so different and without new primary legislation. This affects everyone in England.
The Secretary of State for Health has carried out a consultation on technical changes to regulations in order to facilitate ACOs. But he did this without providing meaningful information about ACOs themselves and without consulting the public or Parliament about what his plans entail.
The technical changes include suspending GP contracts so that GPs – and their patients – can transfer to the ACO. They also provide, for the first time, a definition of an “ACO” which confirms that they could be private companies.
The correspondence makes clear that the Secretary of State and NHS England intend that the first ACOs should come into being as soon as the regulations are passed and before there has been public consultation.
The claimants say that the Secretary of State and NHS England are obliged to consult and that ACOs lie outside the framework of the current legislation.
The claimants also say that the decision to introduce them in this way is contrary to their duty of transparency in decision making in the NHS.
The lawyers have studied the replies received to the first letter before action and have sent a further letter to both the Secretary of State and NHS England.
The claimants intend to file proceedings in the court shortly, in time to stop the introduction of any ACO.
Professor Allyson Pollock, co-author of the NHS Reinstatement Bill, and three other eminent health professionals, Dr Colin Hutchinson, Professor Sue Richards and Dr Graham Winyard have begun a legal action against Jeremy Hunt, Secretary of State for Health.
Tony O’Sullivan, chair of Keep Our NHS Public, reflects on events at the Labour Party Conference September 2017:
“Progress was made on Tuesday 26 September at the Labour Party Conference: an excellent motion was passed including a robust call for a defence of the NHS now and a move to reinstate it ‘as per the NHS Bill (2016-17)’. (You can read the full motion below.)
Moved by Alex Scott-Samuel of the Socialist Health Association and seconded by Sue Richards of Islington CLP – both members of Keep Our NHS Public, the motion received strong support and was carried. It names accountable care systems and accountable care organisations as a dangerous move towards enforced capping of damaging cut budgets, which would lead to restricted access to a diminished range of services – the inevitable result of the imposed, disastrous £22bn of underfunding of the annual NHS budget by 2020/21.
The motions goes further. It opposes the sell-off of £5bn of NHS estate planned under the Naylor Review adopted by the Conservatives. Under the terms of this motion, the 2012 Health & Social Care Act would be replaced by legislation restoring a universal and comprehensive fully publicly funded, owned and provided NHS restoring full duties to the Secretary of State. This reaffirmed the position the 2016 conference voted for, but which had not been adopted by the Shadow team.
On Sunday 17 September, Jeremy Corbyn stated his commitment on the Andrew Marr Show that the Labour Party would adopt conference-agreed policy direction. If this practice is realised, then we could be on the cusp of a dramatic strengthening of commitment from Labour – confident as they are in predicting they will be the next government – to restoring the NHS to its former vision. The policy as agreed would end the era of privatisation, and of internal or external markets, would end use of new PFI contracts and bring back into the NHS’ the current PFIs used to extract profits from NHS core funding and undermining the stablility of so many NHS hospitals and trusts and deliberate defunding of the NHS. There is also the commitment to reinstating NHS student bursaries and an end to the pay cap impoverishing and demoralising the 1.3 million NHS staff. The end to the ideological defunding of the NHS will require greater level of funding than is currently being recognised.
It is important to follow up these important developments in discussions with the Labour shadow team.”
Alex Scott Samuel’s speech at the Labour Party Conference:
Sue Richards speech at the Labour Party Conference:
Contemporary Composite Motion 8: NHS
The NHS Accountable Care System (ACS) contracts announced on 7 August impose a basis for 44+ local health services to replace England’s NHS. This has bypassed Parliamentary debate and due legislative process.
On 9 August, the House of Commons Library revealed a doubling of the number of NHS sites being sold off. 117 of these currently provide clinical services.
Like their US templates, ACSs will provide limited services on restricted budgets, replacing NHS hospitals with deskilled community units.
This will worsen health indicators like the long term increase in life expectancy, stalled since 2010.
The ACSs and asset sell-off result directly from the 5 Year Forward View (5YFV) currently being implemented via Sustainability and Transformation Partnerships (STPs). The 5YFV precisely reflects healthcare multinationals’ global policy aims.
Labour opposes ACSs.
New legal opinion finds STPs lack any legal powers or status under the 2012 Act: yet they seek through bureaucratic means to eliminate or override the already minimal remaining level of local accountability and democratic control over NHS commissioning and provision. They could eliminate remaining statutory powers and rights of local authorities, commissioners and providers. Many of these also outline plans to establish ‘Accountable Care Systems’.
Conference condemns the current Tory NHS pay cap for all staff and the scrapping of the university training bursary for health Students as significant contributors to the current staffing crisis.
Conference welcomes the commitments made in the Labour manifesto to scrap the pay cap for NHS staff.This Conference Calls on our Party to restore our NHS by reversing All privatisation and permanently halting STPs and ACSs.
Labour is committed to an NHS which is publicly funded, publicly provided and publicly accountable. We therefore call on the Party to oppose and reverse funding cuts meeting Western European levels.
Conference opposes FYFV policy:
downskilling clinical staff;
Tory cuts to the NHS including the Capped Expenditure Process;
the sell-off of NHS sites;
reclassifying NHS services as means-tested social care;
cementing the private sector role as ACS partners and as combined health/social care service providers.
replacing 7500 GP surgeries with 1500 “superhubs”.
Conference recognises that reversing this process demands more than amending the 2012 Health & Social Care Act and calls for our next manifesto to include existing Party policy to restore our fully-funded, comprehensive, universal, publicly-provided and owned NHS without user charges, as per the NHS Bill (2016-17).
Conference opposes the Naylor Reports call for a fire-sale of NHS assets and instead resolves that the next Labour government will invest at least £10 billion in the capital needs of the NHS.
Conference therefore calls on all sections of the Party to join with patients, health-workers, trade unions and all other NHS supporters to campaign for:
increasing recruitment and training
an NHS that is publicly owned, funded, provided and accountable;
urgent reductions in waiting-times;
adequate funding for all services, including mental health services;
tackling the causes of ill-health, e.g. austerity, poverty and poor housing, via a properly funded public health programme;
reversing privatisation, PFIs and the debts which they entail;
reversing private involvement in NHS management and provision;
recognition of the continuing vital NHS role of EU nationals;
constructive engagement with NHS staff-organisations;
rejecting the Tories Sustainability & Transformation Plans (STPs) as vehicles for cuts in services;
urgent reductions in waiting-times;
scrapping the Tories’ austerity cap on pay-levels; restoration of NHS student bursaries;
excluding NHS from free trade agreements and repeal and reverse the 2012 Act, to reinstate and reintegrate the NHS as a public service, publicly provided, and strengthen democratic accountability.
Conference welcomes Labour’s commitment to making child health a national priority, including investment in children’s and adolescents’ mental health services. Labour created our NHS. Labour must now defend it.
Mover: Socialist Heath Association Seconder: Islington South and Finsbury
“Current reforms to health and social care services, and radical redesign of the local government finance system, may signal the end of the NHS and local government in England as we know them, argue Shailen Sutaria, Peter Roderick, and Allyson M Pollock”
STPs, accountable care organisations, devolution deals, joint commissioning of health and social care services, and redesign of the local government finance system are radically changing the NHS and local government in England.
The effect on service provision of the fundamentally different funding bases for health (free at the point of delivery) and social care (means tested) services has been ignored.
The changes are likely to lead to reduced services and entitlements, more private provision of publicly funded services, and potentially more user charges.
People in poorer areas are likely to lose out as funding will depend more on the wealth of local areas and less on the principles of redistribution and need.
The evidence for and effects of these changes on access to care, equity, and widening inequalities must be disclosed and understood.
*Who is supporting #NHSTakeback? #NHSTakeback is supported by the Campaign for the Reinstatement Bill, Health Campaigns Together, Keep Our NHS Public, Doctors for the NHS, the Socialist Health Association and the NHS Support Federation. If you know other organisations who might want to sign up, please ask them to get in touch.
Are you convinced your MP won’t sign up? Please try them anyway. It was probably Conservative MPs that swung it with the NHS Professionals campaign, and we can learn a lot from the responses of different MPs.
Are you in Scotland, Wales or Northern Ireland? Please write to your MP. SNP MPs are all behind the Reinstatement Bill already and we’d like them to support the pledge too. We need your solidarity. Plus, NHS policy in England can spread throughout the UK and funding levels in England affect funding elsewhere too – so we’re all connected.
Is the pledge the same as the Reinstatement Bill? No. The Reinstatement Bill is a comprehensive plan for legislation that would take back our NHS. The pledge has 5 key principles for a public NHS – it reflects the demands in the Bill but it’s much simpler. If MPs sign up to the pledge, they’re not signing up to the Bill. But they might want to sign up to both, because the Bill is the best way of putting the pledge into action.