If you surveyed a randomly selected group of one hundred people in the United Kingdom, and asked them to draw up a list of the things they are most grateful to have living in this country, one of – if not the – biggest points of intersection would be the National Health Service. It has been the backbone of this country for over 75 years, and as one of the first of its kind in the world, helped to set up a global precedent for universal healthcare. Its sustained popularity alongside other industries that have seen part or full privatisation can be noted across Parliament as well, being a cross-party issue that sees almost no dissenters. This Parliamentary consensus can be characterised by the speech Boris Johnson delivered upon his recovery after contracting Covid-19 in 2020: “We will win because our NHS is the beating heart of this country. It is the best of this country. It is unconquerable. It is powered by love.” However – as we know all too well by now – what our modern politicians say, and how they act, never seem to really correspond. This is made harrowingly clear in the case of the Health and Care Bill 2021-2022.
The bill, which was introduced by the Conservatives in the House of Commons in July last year, claims that it will “enact policies set out in the NHS’s recommendations for legislative reform”. These recommendations are summarised by Professors Allyson Pollock and Peter Roderick from the Population Health Sciences Institute, who highlight “reducing waiting lists and waiting times for services, reducing staff shortages, [and] providing adequate funding to rebuild and restore capacity in public health services.” These are indeed key issues that need addressing through administrative reform, as anyone who has visited a GP or A&E in recent time will tell you; as great and admirable that the NHS is, it is not without its imperfections. But upon inspection of the proposed bill, these recommendations are nowhere to be seen. Instead, it seems, the framework is being put in place to begin dismantling and selling off our beloved institution.
The primary piece of legislation that the Health and Care Bill lays out, according to the House of Commons Library, is the establishment of “existing Integrated Care Systems (ICS) on a statutory footing”. The context of these ICSs are greatly downplayed in the Conservative rhetoric, which are explained as organisational bodies set up to integrate health and social care parties across all sections of healthcare, including hospitals, GPs and mental health services. On paper, this would mean a more structured and centred administrative strategy as well as a more efficient scope for economic improvements. What fails to be mentioned, however, is the interjection of private interests, particularly in the form of giant American firms.
As of 2015, Centene – a US managed care and Fortune 500 company – has been introduced to over 20 vanguard ICSs, which are essentially prototypes for those to come. Some have since begun to partner with Centene, most notably the ICS covering the Nottingham area, of which Public Policy Analyst Stewart Player says has allowed Centene to “effectively design the entire system”. Putting the interests of private managerial firms into a greater context, it can be noted that last year Centene had to settle two lawsuits worth a total of $143 million in which they were alleged to have oversold insurance programs across Ohio and Mississippi. Furthermore, an eight-part investigation by Dallas News determined a string of systematic negligence in the name of increased profits: changing medical assessment rules to curb more costly cases, turning a blind eye to poor levels of care and reducing their own fines, to name but a few points.
Back in the UK, as of 2021, Centene’s ICS control puts 58 of our GPs in its hands. This motion of control will only go in one direction if the Health and Care Bill passes, and with it our system of care begins to mimic that of our market-obsessed friends over the pond. The icing on the cake is that, while this takeover remains covert due to the system being enforced through government contracts – meaning healthcare is still technically ‘public’ – it is also us who will be paying for these contracts. The proposed funding of this bill will come through an increased rate of National Insurance; not only will we pay more taxes towards this new healthcare system, but it will go towards such firms inflating the costs of medical products to then sell back to us. Enough has been written on the exhaustive implications of healthcare in the hands of private firms, so now, we’ll turn to the impact this bill will have in regards to governmental power.
The House of Commons Library states that the bill will “give the Secretary of State for Health powers to direct NHS England and to decide how some other health services are organised”. This is a not-so-covert transmission of executive power, from administrative healthcare professionals, into the hands of a politician in a rapidly changing Cabinet position. Is this really someone we want to trust to make such important and direct decisions on behalf of our NHS? The man who previously occupied the role, Matt Hancock – who studied PPE at Oxford – proved each and every day during the Covid-19 pandemic that he had about as much competency in the field of healthcare as a child playing make-pretend as a doctor. The intense media scrutiny he received provided a constant reminder to the public, to an almost comical effect, of just how under-qualified Hancock was for the job. This running joke on Hancock culminated in one particularly infamous interview on Good Morning Britain, where he appeared to be attempting to force himself to cry, while simultaneously giggling to himself.
After it managed to be a sex scandal that finally toppled Hancock, his replacement, Sajid Javid, also seems to be far from professionally qualified. An Exeter graduate of Economics and Politics, Javid has so far held six Cabinet positions as Secretary of Culture, Business, Housing and Home respectively, as well as Chancellor and now Health Secretary. If this is not as clear evidence as can be found that our government is in no way structured based on technocratic qualities, but rather, generalist ones, then I don’t know what is. The point I’m trying to make here is that, if this is the way we are going to go about appointing Cabinet positions, then allocated powers must remain more decentralised in order to maintain the integrity of decision-making and management within the NHS. The British Medical Association, who have unequivocally rejected the bill, describe this policy move as nothing more than a “power grab” by the government, which would lead to less scrutiny over changing strategies, as well as a greater risk of “political interference for political gain”. After the vast cronyism that was witnessed with subcontracts for medical supplies during the height of the Covid-19 pandemic, a Health Secretary working side-by-side with those at the top of newly-integrated private firms leaves much fear to the imagination.
The agenda of the Health and Care Bill is clear: more privatisation and more centralised power. Such a scenario seems almost impossible to imagine, considering the vehement denial of any privatisation echoes around the Houses of Parliament, as well in assessing the public’s undying support for the NHS. Unfortunately, though, the reality is much darker - for our healthcare professionals, for those most in need and for the livelihoods of all of us. The Conservatives’ mega majority will be enough to easily sweep this bill through the Commons, and so it is up to us, the people, to speak out against this and stand in solidarity with universal access to healthcare, a most basic human right.
To find out more about how to help oppose the Health and Care Bill 2021-22, head to the following link: https://www.yournhsneedsyou.com/
Image Credit: David Sandison
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