Response to NHS England’s consultation on Integrated Care Providers

The national consultation, promised by NHS England after the JR4NHS judicial review, is currently underway. It ends on 26th October 2018.

NHSE has now dropped the term ‘accountable care organisation’, preferring instead ‘integrated care provider’ (ICP). But don’t be fooled by a change of wrapper.

The judicial review succeeded in forcing NHSE to retreat from its original radical intentions but major problems remain with what’s proposed.  NHSE is still pressing ahead without new primary legislation, and without ICPs having to be public NHS bodies.  

The claimants in the judicial review have now sent in their response to the consultation.

It’s necessarily detailed – but in summary it says that the revised proposals are seriously flawed:

  • They are organisationally absurd and bureaucratically wasteful. (paras 7,33)
  • It remains entirely obscure how the proposed contract would achieve integrated services for patients in practice. (15-19)
  • There are major problems in safeguarding public accountability (33-39) and the role of clinical commissioning groups (24-28) in the new arrangements.
  • Patients’ choice of GP is threatened (52,53) and the claimed provisions to ensure general patient choice are seriously deficient. (45-49)
  • The threat of creeping privatisation and charging remains, in spite of protestations to the contrary.  (19 ,58-62).

Responses to the consultation can be posted to The ICP Consultation Team, Area 2D NHS England,  Skipton House, 80 London Road, London SE1 6LH, or via NHSE’s website.


Thank you to all who have supported the campaign to reinstate the NHS through legislation over the last few years.

Thank you to all who have supported the campaign to reinstate the NHS through legislation over the last few years.

On Wednesday 11 July, Eleanor Smith Labour MP for Wolverhampton SW presented her National Health Service Bill in the Commons under the ’10-minute rule’. Campaigners gathered outside Parliament in support of the bill’s public service principles.

The long title (the description) of Eleanor Smith’s bill was in accord with the NHS Reinstatement Bill. The bill’s short title was The National Health Service Bill. The full text will not be known until it is published. In her speech Eleanor Smith said, “The Bill has been created with the Labour Front-Bench leadership team and we will continue to work together on its future development with campaigners, unions, professionals and stakeholders.”

The NHS Reinstatement Bill cannot circumvent Labour’s procedures. Professor Allyson Pollock & Peter Roderick, the Reinstatement Bill’s authors, will not be the authors of this Labour Bill. But they will continue discussions with Eleanor and the Labour party with a view to the party producing a Bill that is as close as possible to the Reinstatement Bill . The Bill Group will be paying close attention to the content of Labour’s bill  – if and when the full text emerges – to ensure it remains true to the principles of a public service NHS.

The Reinstatement Bill itself will not be affected by the Labour Party’s processes. The campaign has always been supported by people who are members of various political parties as well as those who have no party affiliations. NHS Bill Now are especially grateful to Caroline Lucas MP (Green) and Margaret Greenwood MP (Labour) who have previously put the Bill forward in parliament and to the SNP, with special mention to Dr Philippa Whitford MP, who were early supporters.

Many thanks once again from the Bill Group Team. We hope that you will continue to support our campaign for the reinstatement of the NHS as a wholly public service based on Bevan’s principles, not commercial ones.


Re-tabling the NHS Reinstatement Bill 11th July 2018

Professor Allyson Pollock and Peter Roderick have been discussing the re-tabling of the NHS Reinstatement Bill in the House of Commons on 11th July 2018 with Eleanor Smith, MP for Wolverhampton South West. We are delighted that an MP with Eleanor’s experience and commitment wants to do this.

You can find here the proposed Bill that we have sent to Eleanor, which contains a number of changes from the previous Bill as presented by Margaret Greenwood MP, and the Explanatory Notes that we have prepared are here.

A brief overview of the proposed Bill is below.

 

Overview

In short, the Bill proposes to fully restore the NHS in England by 2021 as an accountable public service by reversing nearly 30 years of marketization, by abolishing the purchaser-provider split, ending contracting and re-establishing public bodies which plan and provide integrated services and accountable to local communities.

The Bill gives flexibility in how it would be implemented, led by current bodies, including local authorities.

It would:

  • reinstate the government’s duty to provide the key NHS services throughout England, including hospitals, medical and nursing services, primary care, mental health and community services,
  • integrate health services under the Secretary of State, whilst allowing delegation of public health services to local authorities, and allowing for integration of social care services following and subject to further legislation,
  • declare the NHS to be a “non-economic service of general interest” and “a service supplied in the exercise of governmental authority” so asserting the full competence of Parliament and the devolved bodies to legislate for the NHS without being trumped by EU competition law (for so long as the UK is an EU Member State) and the World Trade Organization’s General Agreement on Trade in Services,
  • exclude the NHS from international trade deals,
  • require the NHS Commissioning Board (NHS England), clinical commissioning groups (CCGs), NHS trusts, NHS foundation trusts, and local authorities, including combined authorities and elected mayors, to develop a ‘bottom up’ process so that by 2021 services would be planned and provided without contracts through regional and local public bodies – which could cover more than one local authority area if there was local support, and taking into account English devolution – to be known as Strategic Integrated Health Boards and Local Integrated Health Boards,
  • allow Health Boards to employ GPs, end pay beds and private practice in NHS hospitals and end contracts for GP services with commercial companies,    
  • abolish NHS England, CCGs, NHS trusts and NHS foundation trusts, following completion and approval by the Secretary of State of the Health Boards, 
  • repeal the competition and core marketization provisions of the 2012 Act, and abolish Monitor – the regulator of NHS foundation trusts, commercial companies and voluntary organisations,
  • re-establish Community Health Councils to represent the interest of the public in the NHS,
  • stop licence conditions taking effect which have been imposed by Monitor on NHS foundation trusts and that will have the effect of reducing by April 2016 the number of services that they currently have to provide,
  • introduce a system for collective bargaining across the NHS,
  • impose a duty on the Treasury to minimise, and if possible to end, the expenditure of public money on private finance initiatives in the NHS in England, and
  • abolish the legal provisions passed in 2014 requiring certain immigrants to pay for NHS services.

Eleanor Smith will table a 10-Minute Rule Bill for the NHS

Statement from the NHS Bill Now Campaign

We are pleased to hear that Eleanor Smith MP will now be tabling a 10-Minute Rule Bill in the House of Commons on 11 July 2018 to reinstate the NHS in England.

We understand that the Bill will be a Labour Party Bill based on the NHS Reinstatement Bill and We Own It’s #NHSTakeBack pledges.

Next week we will be publishing the version of the proposed Reinstatement Bill that we have provided to Eleanor Smith once we have completed the explanatory notes.


Labour commits to legislation to reinstate the NHS

Campaigners are set to play a leading role in shaping Labour legislation to reverse the 2012 Health and Social Care Act and end the fragmentation and privatisation of the NHS.

That was the positive outcome of a constructive meeting called in Westminster by Labour’s Shadow Health and Social Care Secretary Jonathan Ashworth MP earlier today (June 27).

The meeting brought together representatives and advisors from the shadow health team and Labour Leader’s office and health policy advisors, along with Eleanor Smith MP who had planned to move the NHS Reinstatement Bill as a 10 minute Bill on July 11, Allyson Pollock and Peter Roderick – the authors of the Bill, the Socialist Health Association, Health Campaigns Together, and Keep Our NHS Public.

It was called as an urgent response to the decision last week by the Labour whips’ office not to support Eleanor Smith’s Bill for parliamentary procedural reasons, and to address the subsequent criticism and fears expressed by campaigners in social media that this decision represented a retreat by the Labour leadership from a full commitment to end privatisation in the NHS, reverse the 2012 Act and reinstate the NHS.

Jonathan Ashworth underlined his support for the underlying principles of the NHS Reinstatement Bill, and also stressed the Parliamentary Labour Party’s record of implementing the various commitments for campaigning as set out in last year’s Labour Conference Composite motion 8. He explained that his intention in calling the meeting had been to find ways in which legislation, which all can support, could be developed through a process of collaboration and consultation.

Campaigners were repeatedly assured that Labour’s leadership is committed to proposing its own Bill in the first Queen’s Speech of a Labour government that would embody the principles of the NHS Reinstatement Bill. The explanation of the decision to pull support from Eleanor Smith’s Bill was that the level of detail that it included is too great for tabling at this stage as a 10 minute Bill, with some of it potentially controversial within the Party. In particular significant debates need to be had on how Labour wishes to address the crisis of the heavily privatised social care system currently run through local government, and whether the NHS or local government should take charge of public health.

It was agreed that while this work needed to be done, in the short term, as Eleanor Smith and others argued strongly, a declaration of intent and principle is needed from Labour in this 70th anniversary year of the NHS.

With this in mind the meeting agreed:

  • Jonathan Ashworth and Eleanor Smith would publicly sign up to show their support for the ‘NHS Takeback’ pledges, based on the Reinstatement Bill, that is promoted by the We Own It campaign https://weownit.org.uk/nhstakeback.
  • Labour will seek the earliest opportunity – if possible before the summer recess – to table a shorter version of the Reinstatement Bill as a 10 minute Bill, to be moved by Eleanor Smith. This would echo the Takeback pledges and the NHS Reinstatement Bill as previously tabled.
  • Further detailed meetings will take place beginning immediately – between the Leader’s office, the shadow health team and the drafters of the Reinstatement Bill, but also on a wider level to draw in and engage with campaigners, trade unions and other significant stakeholders – to draw up more detailed Labour legislation based on the Reinstatement Bill. Meetings will also take place with other committees as appropriate with the aim of developing an agreed draft Bill by the end of 2018 suitable for inclusion in a Queen’s Speech.
  • Campaigners will continue to work with and advise Jon Ashworth and the shadow health team in responding to any NHS England proposals for new legislation or amendments to the Health & Social Care Act that might be tabled by the current government. Joint efforts to expose and challenge privatisation and encourage those such as the Wigan strikers who are actively fighting it will continue.

The unique and historic nature of this meeting and these agreed proposals was stressed by Jonathan Ashworth and recognised by the meeting. This unprecedented level of collaboration is a result of years of hard work on the ground by campaigners.

The result will be a stronger and broader campaign in Parliament and across the country for legislation that will restore and improve the NHS as a publicly owned, publicly funded, publicly provided and publicly accountable service.


Statement from Eleanor Smith MP on the withdrawal of the Bill reading

Statement from Eleanor Smith, Member of Parliament for Wolverhampton South West:

“Following the withdrawal of the NHS Bill on Wednesday I have now received clarification from the Health Policy team as to where the resistance to the Bill came from.

In view of this I want to reassure supporters of the Bill that the main thrust of its content will be maintained; we are going to try and work through and resolve the issues; meetings are being arranged for next week- and I expect to be invited to take part in them.

I know that passions are running high, and no-one is more disappointed than I am but please can I ask supporters to keep their passion but also remain patient.

The fact is, in the 70th anniversary year of the NHS, we desperately need a Bill that we can all support and rally behind. We must preserve the NHS before it is completely destroyed by this Tory government.”


Campaign update for the NHS Bill 11 July reading

The best birthday present the NHS could have had this year is the NHS Bill, written by Professor Allyson Pollock and Peter Roderick, to restore it to a full public service, after 30 years of incremental steps to privatisation.

The NHS Reinstatement Bill Group were expecting Eleanor Smith, MP for Wolverhampton South West to table the Bill in the House of Commons on 11th July 2018. Eleanor Smith, an NHS nurse for 40 years before she became an MP in 2017, is passionate about this issue.

Yesterday morning she informed us that this will not now happen. We understand that this was the result of the shadow health team vetoing it.

Chair of the Group and co-author of the Bill, Professor Allyson Pollock said:

“We are deeply disappointed and somewhat shocked that the shadow health team is not backing the bill. It was voted for unanimously as policy by Labour Conference in 2017 and has been supported for a number of years by Jeremy Corbyn and John McDonnell. The Health Select Committee has suggested that primary legislation is needed for the NHS, so surely this is the moment for Labour to be championing a public service bill. Otherwise we are at risk of government legislation bringing in the US-style organisational structure of Integrated Care, which NHS campaigners are vigorously opposing.”

 


Campaigners have won an important concession: a national public consultation on ACOs

Positive news from Peter Roderick, co-author of the NHS Bill and campaigner with #JR4NHS:

“Thanks to the fantastic, far-reaching and committed campaign involving thousands of people, and our brilliant legal team, the government and NHS England have now accepted that there must be a national public consultation on ACOs, and that no ACO contract will be signed until that’s happened. This is great news, and a clear concession in response to our seeking a judicial review.

NHS England’s lawyers promised this to our lawyers on Monday evening, and Jeremy Hunt confirmed this at the Health Select Committee yesterday.

But don’t be fooled into thinking they’ve given up. Despite repeated questioning from Sarah Wollaston MP, the Committee chair, Hunt refused to delay the ACO regulations that he’s still planning for February, which are intended to facilitate the ACO contract – even though there’s no longer an urgent need for them – and he has still not accepted the need for an Act of Parliament before ACOs can operate lawfully.

This is very important because the government has said they will change the definition of ACOs with input from NHS England, but we have absolutely no idea what the new definition will be.

We still remain very concerned about the lack of transparency and the need for primary legislation on ACOs, and so we have told the court this afternoon that we want to press ahead with these points.

Private companies lack transparency and accountability, the opposite of what we want for our public NHS.

This is why we want to make absolutely sure of the definition of “Accountable Care Organisations” in any consultation. We think there is no point in a consultation if the ACOs they consult on are unlawful.

We have been told by the court that we can expect a decision on permission tomorrow, or very early next week.

Thanks once again for all your incredible support.

Peter

PS. You can watch Jeremy Hunt giving evidence about ACOs to the Health Select Committee yesterday from about 16.50 in this video – near the end:
http://www.parliamentlive.tv/Event/Index/70452f3d-4f8b-4db0-9177-fd8e7fda9343

You can also read the letters between him and Sarah Wollaston MP here:
http://www.parliament.uk/documents/commons-committees/Health/Correspondence/2017-19/Correspondence-with-the-Secretary-of%20State-regarding-Accountable-Care-Organisations.pdf


Stephen Hawking joins lawsuit on Accountable Care Organisations

Stephen Hawking has joined the lawsuit seeking to stop the introduction of the first accountable care organisations (ACOs) into the NHS in England in April without proper public consultation and without full Parliamentary scrutiny.

Read the full Guardian article from Friday 8th December 2017.

 

If possible, please do support the crowdjustice funding appeal for the judicial review.

The Judicial Review is against the Secretary of State for Health Jeremy Hunt and NHS England to stop them introducing new commercial, non-NHS bodies to run health and social services without proper public consultation and without full Parliamentary scrutiny – ACOs.

ACOs would be governed by company and contract law and can be given “full responsibility” for NHS and adult social services. They were conceived in the US about 12 years ago, and are now being imported into England although they are not recognised in any Act of Parliament. They would be able to decide on the boundary of what care is free and what has to be paid for. They will be paid more if they save money.

They can include private companies (e.g. Virgin in Frimley, Circle in Nottinghamshire), including private insurance and property companies, which will make money from charging. They could also include GP practices, in which case people on their lists will automatically transfer to the ACO in order to be entitled to services – new patients will also have to register with the ACO. They will be allowed to sub-contract all “their” services.

Such commercial ACOs would fundamentally change the NHS and could profit from a radical reorganisation of health and social services. They would have control over the allocation of NHS and taxpayers’ money. Their accountability for spending it and their obligations to the public would be under commercial contracts, not statutes.

It is also against the public interest that they are being introduced by stealth, without proper public consultation and without full Parliamentary scrutiny.

 Integration of health and care services is a desirable aim, but not whilst their funding and population bases are so different and without new primary legislation. This affects everyone in England.

The Secretary of State for Health has carried out a consultation on technical changes to regulations in order to facilitate ACOs. But he did this without providing meaningful information about ACOs themselves and without consulting the public or Parliament about what his plans entail.

The technical changes include suspending GP contracts so that GPs – and their patients – can transfer to the ACO.  They also provide, for the first time, a definition of an “ACO” which confirms that they could be private companies.

The correspondence makes clear that the Secretary of State and NHS England intend that the first ACOs should come into being as soon as the regulations are passed and before there has been public consultation.

The claimants say that the Secretary of State and NHS England are obliged to consult and that ACOs lie outside the framework of the current legislation.

The claimants also say that the decision to introduce them in this way is contrary to their duty of transparency in decision making in the NHS.

The lawyers have studied the replies received to the first letter before action and have sent a further letter to both the Secretary of State and NHS England.

The claimants intend to file proceedings in the court shortly, in time to stop the introduction of any ACO.


Jeremy Hunt must consult properly on Accountable Care Organisations