Questions and Answers

We have produced four factsheets to answer commonly asked questions:

 

These are available on our resources page.

What next for the campaign now we have a Conservative Government?

With a Conservative Government now in power, there are unlikely to be legislative changes on the Health and Social Care Act in the near future.

But it is vital that we keep the option of legislative change alive, and we will continue to highlight the importance of an NHS Reinstatement Bill.

On 13th July 2016, the NHS Reinstatement Bill was successfully presented in the House of Commons, by Margaret Greenwood, Labour MP for Wirral West.

The postponed second reading is scheduled for 24th March 2017.

Why do we need new legislation?

The NHS was set up by a law – the NHS Act 1946. Since then, there have been dozens of Acts affecting it – especially over the last 25 years or so.

The most radical of these laws was the Health and Social Care Act 2012, because it abolished the legal duty on the government to provide key NHS services in England, and took marketisation to a new level.

We need a law to reinstate that legal duty, to stop marketisation, and to re-establish public bodies. Without a law, the process now rapidly underway will continue.

Promises by politicians, statements in manifestoes, policy documents and the like are all very well. But they are not laws, and it’s law that will guarantee our NHS.

What does the bill say?

Brief summary of the NHS Bill

In short, the Bill proposes to fully restore the NHS as an accountable public service by reversing 25 years of marketization in the NHS, by abolishing the purchaser-provider split, ending contracting and re-establishing public bodies and public services accountable to local communities.

This is necessary to stop the dismantling of the NHS under the Health and Social Care Act 2012. It is driven by the needs of local communities. Scotland and Wales have already reversed marketization and restored their NHS without massive upheaval. England can too.

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

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 and social care services,
  • 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 and the World Trade Organization’s General Agreement on Trade in Services,
  • abolish the NHS Commissioning Board (NHS England) and re-establish it as a Special Health Authority with regional committees,
  • plan and provide services without contracts through Health Boards, which could cover more than one local authority area if there was local support,
  • allow local authorities to lead a ‘bottom up’ process with the assistance of clinical commissioning groups (CCGs), NHS trusts, NHS foundation trusts and NHS England to transfer functions to Health Boards,
  • abolish NHS trusts, NHS foundation trusts and CCGs after the transfer by 1st January 2018,
  • abolish Monitor – the regulator of NHS foundation trusts, commercial companies and voluntary organisations – and repeal the competition and core marketization provisions of the 2012 Act,
  • integrate public health services, and the duty to reduce inequalities, into the NHS,
  • 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,
  • require national terms and conditions under the NHS Staff Council and Agenda for Change system for relevant NHS staff,
  • centralise NHS debts under the Private Finance Initiative (PFI) in the Treasury, require publication of PFI contracts and also require the Treasury to report to Parliament on reducing NHS PFI debts,
  • abolish the legal provisions passed in 2014 requiring certain immigrants to pay for NHS services
  • declare the UK’s agreement to the proposed Transatlantic Trade and Investment Partnership and other international treaties affecting the NHS to require the prior approval of Parliament and the devolved legislatures,
  • require the government to report annually to Parliament on the effect of treaties on the NHS.

Will this mean a major reorganisation?

It will mean an end to the current chaos and prevent it from getting worse. The main purpose of the 2012 Health and Social Care Act was to replace an organised system with one that was market driven. Not changing that back ensures this will continue. The Bill to reinstate the NHS is not about structural reorganisation: it is about stopping the current levels of disorganisation from getting worse. Which they will unless the law is changed.

The massive changes to the NHS caused by the Health and Social Care Act consumed huge amounts of energy, time and money. It diverted attention away from effective health care planning; and delivering on improvements in the efficiency and quality of care. Managers and clinicians were taken away from the job of providing care and services; and forced to spend endless hours on setting up new bodies and layers of bureaucracy; whilst abolishing old ones, creating new ones.

There is a real danger that a new Bill would result in another round of wasteful reorganisation and unnecessary disruption. But the Bill to Reinstate the NHS is not primarily about structural reorganisation. Rather, it is about addressing the current levels of disorganisation and fragmentation within the health sector; and it is about altering the functions of many existing organisations.

It’s important to recognise that although the 2012 Health and Social Care Act has been described as a massive ‘reorganisation’ of the NHS, its main purpose was to replace an organised system with one that was market-driven, fragmented and privatised. The result has been chaos and the emergence of a large market bureaucracy which has seen money diverted from patient care to accountants, lawyers and managers.

We need to return the health system to a state where it is coherent, organised, effective and efficient. This will inevitably require some structural changes, but will establish a system that is more functional; and to remove those elements of the current structure that are unnecessary and wasteful.  These changes will be welcomed by the vast majority of clinicians and managers alike.

Any concern that a NHS Reinstatement Bill would create more upheaval and demoralisation amongst NHS staff should be allayed by the fact that staff (clinicians and managers) are calling for an end to the chaos, fragmentation and competition; and a return to a more coherent and integrated planning structure and system.

Isn't the NHS unaffordable because of our ageing population?

How many times have you heard it? ‘People are living longer and the NHS can’t afford to look after them.’

Or perhaps – ‘Services won’t cope for much longer because the population is ageing; we have to come up with different solutions.’

These are myths. They are used to cover up the real reason for services being cut, which have nothing to do with the fact that people are living for longer. Our fact sheet explains why. Myth of Ageing fact sheet.

 

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