The Bill opens the NHS up to big business, allowing private companies a say in the care that patients receive. The Government’s amendment to the make-up of integrated care boards is weak and it fails to rule out the possibility of people with an interest in private health sitting on them. For that reason I tabled amendment 101, which seeks to ensure that ICBs are made up wholly of representatives from public sector organisations and that private companies, their employees and representatives, and those with financial interests in them, are not represented on them. Surely, that is what the public expect from a body that will be responsible for spending huge amounts of public money?
However, the influence of private companies is not just an issue with ICBs. The Bill allows for private companies to play parts in other ways, for example at sub-system level via place-based partnerships and provider collaboratives—they are not actually stated in the Bill, but that is what it means. Guidance by NHS England states very clearly that the Health and Care Bill will enable ICBs to delegate functions to providers, including, for example, devolving budgets to provider collaboratives. There is nothing to stop such partnerships from being open to big business, so the Government’s rhetoric around protecting the independence of ICBs is, frankly, quite meaningless. For all their talk of recognising
“that the involvement of the private sector, in all its forms, in ICBs is a matter of significant concern to Members in the House,”
they have not taken the action needed to stop private companies from influencing decision making. That is why I have put forward amendment 58, which is designed to ensure that any organisation carrying out the functions of an ICB on its behalf is a statutory NHS body.
Although the Government have made some noise about private membership of integrated care boards, they have said with respect to integrated care partnerships that they
“want local areas to be able to appoint members as they think appropriate.”––[Official Report, Health and Care Public Bill Committee, 14 September 2021; c. 258-259.]
That is a matter of great concern. ICPs are required to
“prepare a strategy…setting out how the assessed needs in relation to its area are to be met”.
Integrated care boards must have regard to a strategy drawn up by the ICP, which may well be influenced by private companies that do not have the same objectives as the NHS. I have therefore tabled amendment 100, which would do for ICPs what my amendment 101 would do for ICBs: seek to ensure that they are made up wholly of representatives from public sector organisations, and that private companies are not represented on them.
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The Bill will break up the NHS into 42 integrated care systems. My amendment 59 would ensure that any provider of health services could not withhold provision of those services from any individual because of the integrated care board to which they were allocated. In other words, wherever in England someone falls ill, they could get treated. There have been alarming recent reports of people in need of urgent care being turned away from A&E because they did not present at the A&E centre closest to where they live. That is
extraordinary—it is not what we expect of the national health service. One recent report told of a woman who suffered burns and attended A&E, only to be told that the hospital did not treat people from Rochdale. There is nothing in the Bill to ensure that people in the country can go to any A&E in the country if they need to. My amendment is designed to address that shortcoming.
As we know, the Bill is also about enabling privatisation—and when we look at the procurement reforms in it, we can see why. They will enable the removal of the current procurement rules that apply to NHS and public health service commissioners arranging clinical healthcare services. The Bill will provide a power to create a separate procurement regime for those services, including removing
“the procurement…of…health care services for the purposes of the health service”
from the scope of the Public Contracts Regulations 2015.