Some fear a reorganisation opens the door to the so-called “Americanisation” of the NHS.
Brexit dominates the headlines as Theresa May stumbles from one crisis to another. But for the NHS, winter is here. Hospital bosses warn the extra £335m for the NHS this winter has come too late to have the full effect needed on the frontline. The truth is seven long hard years of underfunding has left the NHS teetering on the edge. The result is ever-lengthening queues of the sick as waiting lists climb beyond 4 million. Last year 2.5 million people waited more than four hours in A&E, while over 560,000 people waited unable to be found a bed designated as ‘trolley waits.’
In the past seven years,14,000 beds have disappeared from the NHS. Hospitals are regularly occupied at unsafe levels. Communities have seen their walk-in-centres closed. This week, we learnt there are vacancies for more than 30,000 nurses, and despite promises to recruit more GPs, we have a thousand less than a year ago. What’s more, the effective abandonment of the 18 week target for “non urgent” operations will mean more and more of our constituents waiting longer in pain and distress. Sadly, we’ve already seen some evidence of those who can afford it turning to self-pay private healthcare because of intolerable waits.
Every day we see more evidence of how disastrous the Health and Social Care Act impacts negatively on patient care. Last week, it emerged that Virgin Care had extracted a sizeable sum from the NHS in Surrey through legal action.
This toxic mix of austerity economics and privatisation must come to end. It’s why Labour’s manifesto promised an extra £37bn for our NHS and restated our commitment to reverse the Health and Social Act. It’s my view that we need to restore a universal, publicly administered and accountable NHS.
It’s in this context we are raising serious concerns about the latest NHS reorganisation. Sustainability and Transformation Plans, or STPs, were drawn up across 44 areas of the country with the expressed intention of fitting NHS services to the shrinking budgets imposed by Tory Ministers in Whitehall. As a result they were hugely unpopular, with threats of hospitals being closed, staff numbers slashed, even more beds cut, A&E services moved, and children’s wards shut.
Now – confusion reigns. Eight STP areas will progress into so-called Accountable Care Systems which are then in turn expected to become Accountable Care Organisations. These will bring health sector bodies, like hospitals trusts, GPs or mental health trusts, together with local government.
Health campaigners warn these new organisations potentially represent the biggest change made to our NHS for a decade, which some fear opens the door to the so-called “Americanisation” of the NHS.
The government's reluctance to put details of the new arrangements into the public domain has raised suspicions. We do know Health Secretary Jeremy Hunt intends to change secondary legislation to enable ACSs to operate in England. The Health Secretary has consulted on technical changes to 12 regulations which would define ACSs and let them operate under contract, and which he intends to bring in by February.
NHS England says that it will consult on a standard model contract for ACOs in 2018. But campaigners have pointed out that if Hunt’s changes are brought in before then, ACO contracts could be introduced before the public consultation.
That’s why I am launching Labour’s new campaign to make sure that any new changes which ministers want to make to our NHS are made in public, on the floor of the House of Commons – rather than in a backroom deal with no involvement of patients or the public.
On Thursday, I tabled a motion in the House of Commons, together with Jeremy Corbyn and our front bench colleagues, demanding that the government provide parliamentary time for members to debate and vote on these proposed changes on the floor of the House of Commons. And I’ve written to Andrea Leadsom, Leader of the House of Commons, to ask that she provide the time for a debate.
It’s essential that the decision around whether to introduce ACOs into the NHS is taken in public, with a full debate and vote in Parliament.
Even in the areas where Accountable Care Organisations are already proposed, there are outstanding questions which the Secretary of State must now answer. The unacceptable secrecy in which these ACOs have been conceived and are being pushed forward is totally contrary to the NHS's duty to be open, transparent and accountable in its decision-making. The manner in which the government is approaching ACOs, as with STPs before them, fails that test.
Labour of course agrees that integration of health services is desirable. But for integration to work, investment and time is needed.
The government has given us no assurances that this process won’t end up being just another cost-cutting exercise, leading to greater rationing of treatments locally. The NHS is already undergoing the greatest funding squeeze in its history, and with services at risk across the country, Accountable Care Organisations must not be used as a vehicle for yet more restrictions.
And given the government’s track record, why would anyone have any faith that these new models will not be used as a means of crow-barring in a greater role for the private sector? Before they go any further with these plans, the government must commit to guaranteeing that all ACOs should be entirely public sector entities and not a means for private sector companies to step in as vehicles for delivering integration.
We also need clear guidance on data. Once a private sector company wins the contract for an ACO and has control of an area-based system with a capped per capita funding rate, it will have access to huge amounts of potentially valuable data and as a consequence the power to influence which future services are provided and how.
The government often talks up its desire to foster greater integration between health and social care, and yet it is increasingly clear that much of the local government sector feels completely excluded from what is taking place Sustainability and Transformation Plans and now accountable care. Some inside local government have said that they are at “breaking point” as a result of the push to ACS status.
And of course there are huge questions for the health and care workforce, wary of their employment prospects, pensions and terms and conditions if the establishment of ACOs leads to large-scale transfers or secondments.
These changes will have far reaching implications for commissioning in the NHS, as well as for the relationship between health and local authority led care services. There are implications for the structures of the NHS as drawn up by the government’s Health and Social Care Act of 2012. If the changes from that Act are now going to be unpicked, then the public have a right to transparency and openness as the changes are made.
It is inconceivable in this context that the government should make such wide changes behind closed doors, rather than on the floor of the House.
Labour want to foster a new phase of openness and engagement in the public’s relationship with the NHS. We’ll begin by forcing ministers to account for their Accountable Care plans in public – rather than behind closed doors.
Jonathan Ashworth is the shadow Secretary of State for Health.