David Owen's NHS bill offers a final chance to save our health service

Labour and the Lib Dems must support a bill that restores the right of all citizens to comprehensive care.

David Owen has today published in full a bill in the House of Lords to reinstate the NHS and the secretary of state’s legal duty to provide a national health service throughout England. This duty has been in force since 1948 and is the legal foundation of the NHS and our rights and entitlements to health care, a duty the coalition’s Health and Social Care Act 2012 is abolishing.

Owen’s 'reinstatement' bill puts into reverse the monstrous 473 H&SC Act, which from April this year abolishes the NHS throughout England, reducing it to a stream of taxpayer funds and a brand or logo for the public bodies and private companies which will receive them. The bill does not entail yet more disruptive reorganisation, it simply restores the democratic basis of the NHS and the rights and entitlements of all citizens to comprehensive care; rights which were shredded by the 2012 Act.

As Owen has warned: "the NHS has remained by far and away the most popular public service because people sense rationing and restrictions are inevitable, and resources limited but that they value and recognise the fairness of those decisions being taken not by market forces or quangos but by some overall democratic, open, transparent decision-making."

This bill comes at an important moment. Next week, Health Secretary, Jeremy Hunt will determine the fate of Lewisham hospital and very soon the fate of many more hospitals as cuts and shareholders' profits bite deep into NHS budgets. By putting power into the hands of quangos, the government hopes to protect itself from the full force of public anger at the implementation of a four-year 'efficiency' plan expected to generate £20bn savings by 2014.

The plan, drawn up by US management consultants McKinsey on PowerPoint slides, the electronic equivalent of the back of a cigarette packet, has already led to the sacking of thousands of nurses and loss of services.

David Nicholson, the chief executive of the new NHS Commissioning Board, who appeared before the public accounts committee last week, warned of worse to come: "We are just going into a phase now where quite a lot of fairly contentious service change issues are surfacing." "Fairly contentious" makes a mockery of the scale of proposed losses and closures.

In north west London the government plans to cut 25 per cent of beds, and throughout London at least seven accident and emergency departments will close; 5,600 jobs in North West London will be lost by 2015, 4,000 in Merseyside, and thousands more in Rotherham, Devon and Cornwall, Bolton, and Portsmouth. Hospital closure and downgrading will take place in several major cities. Meanwhile, payments to private contactors continue to escalate, from those to management consultancies that have taken over from public officials, through expensive PFI deals involving payments that are contracted to rise each year, to outsourced services from which shareholders are seeking returns ranging from 15-25 per cent.

And yet the NHS returned over £2bn to the Treasury last year. Hospitals have deficits because the government chooses to load them with these costs, not because they are badly run. The government is manufacturing a financial crisis which is not of hospitals' own making.

The Health and Social Care Act legalises the break-up of the NHS under the efficiency plan. Some services will become the responsibility of local authorities and others will be the responsibility of private, for-profit firms; many services may no longer be provided free. For instance, mental health, immunisation and sexual health are being transferred to local authorities. Services for pregnant or breast-feeding women, for younger and older children, for the prevention of illness, even for the care of persons suffering from illness or needing after-care may no longer be mandatory parts of the free health service. In fact, pretty much everything is up for grabs.

MPs and the public have yet to realise that the Act will abolish the NHS by splitting up services in this way and removing the secretary of state’s control over provision. Unfairness has already been creeping in under existing rules. Two weeks ago the medical director of the NHS, Sir Bruce Keogh, admitted to the public accounts committee that for the last two years he has been "deluged by letters from people saying, 'This PCT isn’t paying for that', or that one PCT takes a different view on (entitlement of patients to) hip surgery or cataracts to another." We are outraged by the unnecessary pain this causes and authorities must be held to account for the denial of care. After April, when the Act is implemented, that will no longer be possible. Instead, a range of bodies not accountable to parliament, including for-profit companies, will decide which services will be freely available and who will receive them. That is no longer a national health service and people must understand that.

The coalition has deceived the public over the NHS. The Health and Social Care Act is not about making the service GP or patient-led, it is about abolishing the national service and transferring public funds and services to the private sector through a process of closure and the manufacture of a financial crisis. Loss of services coupled with new discretionary powers mean that people will be forced to pay out of their own pocket for more of their care. Owen’s bill exposes the truth behind the Act. For sixty years, the public , unlike their US cousins, had no fear of health care bills; this freedom from fear and commitment to the NHS model has stood the test of time. Will Labour and the Liberal Democrats support a Bill that restores the democratic and legal basis of the NHS and the principle of health care for all on the basis of need and not ability to pay?

Allyson Pollock is professor of public health policy and research at Queen Mary, University of London, and the author of NHS PLC

David Price is a senior research fellow at Queen Mary, University of London

Demonstrators protest against the proposed closure of the Accident and Emergency and maternity units at Lewisham hospital. Photograph: Getty Images.

 

Allyson Pollock is professor of public health policy and research at Queen Mary, University of London, and author of NHS PLC

David Price is a senior research fellow at Queen Mary, University of London

 

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Cabinet audit: what does the appointment of Andrea Leadsom as Environment Secretary mean for policy?

The political and policy-based implications of the new Secretary of State for Environment, Food and Rural Affairs.

A little over a week into Andrea Leadsom’s new role as Secretary of State for Environment, Food and Rural Affairs (Defra), and senior industry figures are already questioning her credentials. A growing list of campaigners have called for her resignation, and even the Cabinet Office implied that her department's responsibilities will be downgraded.

So far, so bad.

The appointment would appear to be something of a consolation prize, coming just days after Leadsom pulled out of the Conservative leadership race and allowed Theresa May to enter No 10 unopposed.

Yet while Leadsom may have been able to twist the truth on her CV in the City, no amount of tampering will improve the agriculture-related side to her record: one barely exists. In fact, recent statements made on the subject have only added to her reputation for vacuous opinion: “It would make so much more sense if those with the big fields do the sheep, and those with the hill farms do the butterflies,” she told an audience assembled for a referendum debate. No matter the livelihoods of thousands of the UK’s hilltop sheep farmers, then? No need for butterflies outside of national parks?

Normally such a lack of experience is unsurprising. The department has gained a reputation as something of a ministerial backwater; a useful place to send problematic colleagues for some sobering time-out.

But these are not normal times.

As Brexit negotiations unfold, Defra will be central to establishing new, domestic policies for UK food and farming; sectors worth around £108bn to the economy and responsible for employing one in eight of the population.

In this context, Leadsom’s appointment seems, at best, a misguided attempt to make the architects of Brexit either live up to their promises or be seen to fail in the attempt.

At worst, May might actually think she is a good fit for the job. Leadsom’s one, water-tight credential – her commitment to opposing restraints on industry – certainly has its upsides for a Prime Minister in need of an alternative to the EU’s Common Agricultural Policy (CAP); a policy responsible for around 40 per cent the entire EU budget.

Why not leave such a daunting task in the hands of someone with an instinct for “abolishing” subsidies  thus freeing up money to spend elsewhere?

As with most things to do with the EU, CAP has some major cons and some equally compelling pros. Take the fact that 80 per cent of CAP aid is paid out to the richest 25 per cent of farmers (most of whom are either landed gentry or vast, industrialised, mega-farmers). But then offset this against the provision of vital lifelines for some of the UK’s most conscientious, local and insecure of food producers.

The NFU told the New Statesman that there are many issues in need of urgent attention; from an improved Basic Payment Scheme, to guarantees for agri-environment funding, and a commitment to the 25-year TB eradication strategy. But that they also hope, above all, “that Mrs Leadsom will champion British food and farming. Our industry has a great story to tell”.

The construction of a new domestic agricultural policy is a once-in-a-generation opportunity for Britain to truly decide where its priorities for food and environment lie, as well as to which kind of farmers (as well as which countries) it wants to delegate their delivery.

In the context of so much uncertainty and such great opportunity, Leadsom has a tough job ahead of her. And no amount of “speaking as a mother” will change that.

India Bourke is the New Statesman's editorial assistant.