This week has seen a flurry of pro-NHS activity, in advance of the proposed second reading of the NHS Bill on Friday. The number of threats to the NHS as we know it are so great that it has become quite complex to understand what the legislation is that is being debated. What is the NHS bill and should we be bothered about it?
The NHS Bill proposes legal changes that undo the structural reforms of the last few years, which essentially took responsibility for healthcare away from the Secretary of State for Health (currently Jeremy Hunt) and gave it to commissioning groups. The NHS Bill suggests giving back responsibility to the Health Secretary, making it his job again to provide good quality healthcare for all, free at the point of access: the original NHS aim.
Most people won't know what a Clinical Commissioning Group (CCG) is. Confusing changes in commissioning of health services make it hard to know who to hold accountable (see this King's Fund animation if you want to know more). CCGs made up of GPs now decide which services are needed for local areas, increasing the likelihood of postcode lotteries and giving GPs more responsibility for decisions which often involve highly specialist services which they may not know much about.
Detail from an original leaflet about the NHS launch
Decisions about commissioning involve not only deciding which services are provided in the area, but also who provides those services. Contracts for healthcare services which used to be NHS are continually being put out to tender. Private companies can bid for these tenders, and have already taken over several, for example Virgin Healthcare which is expanding in the Southwest. Private companies can pick and choose more profitable services, leaving the over-strained NHS to manage more complex ones. Private companies can also come and go, sometimes (though not always) leaving services to go back to NHS management in a messier state than when they were acquired, costing the NHS money and adversely affecting patient care.
Dividing up the NHS like this and putting it up for tender, whilst moving responsibility away from the government, is essentially a growing privatisation of services without full and frank debate of whether this is good for public healthcare or is something that there is a public mandate for. It also allows the government to distance itself from the NHS and attack it for not being good enough, even if some of the reasons for failures in meeting patient needs are due to cuts and underfunding imposed by the government.
The NHS bill is being proposed by Caroline Lucas MP (Brighton Pavillion) who says: "This Bill would reverse the creeping marketisation of the health service and reinstate the NHS based on its founding principles... In practical terms that means simplifying the health service and removing the unnecessary complication introduced in 1991 (and reinforced in recent years) which fragmented the NHS by forcing services to go into competition with each other to win contracts."
Lucas explains further: "The Bill would bring back health boards who would look at what services are needed in each local area and then provide them. The Bill also reinstates the Health Secretary's duty to provide services throughout England - which was severed in the 2012 Health and Social Care Act."
The bill needs 100 MPs present in order to be read. Lucas hopes enough will be there: "I hope all MPs who feel even slightly uncomfortable about the impact of the market and the private sector in the NHS will stay in Parliament this Friday for a real debate over the future of our health service," she said. "By voting for the NHS Reinstatement Bill MPs will be backing the workers in our health service, challenging the perpetual crises we're facing and helping to rebuild an NHS we can be proud of, safe from the privateers."
In the run up to the reading, activists nationwide have been busy. Junior doctor strikes on Wednesday and Thursday protest against contracts which are seen as unsafe and unfair. Nurses, whose bursaries have already been cut, have been speaking out at rallies across the country, and last weekend saw protest marches in Bristol and Brighton.
Madeleine, NHS activist from Brighton, said "This government is pulling the biggest confidence trick imaginable on the British public. They are dismantling our NHS and trying to undermine and fragment it beyond repair all while telling the public it is business as usual." Madeleine sees the NHS bill as promoting a positive alternative vision and being "...our best chance to shout loudly and clearly about what the government is doing."
Many people have emailed their MPs to request that they attend. On Friday we'll see how many do. The NHS bill is one way of prompting that full and frank discussion about how we want the public health service to be run. We should be bothered about the NHS bill, and so should our MPs.