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NHS Bill and the Labour Party

nhs bill 11.2.16 (71)
In the week prior to the 2nd reading of the Bill in the House of Commons several campaigners, including our Chair Louise Irvine, who had written to our local MP Vicky Foxcroft, received a standardised letter from her saying she could not be present at the debate because of duties in her constituency and that while in support of the overall objectives of the Bill, she did not support the  another ‘wholesale top down reorganisation’ of the NHS.

Our Campaign Steering Committee discussed this and agreed to write a statement in reply.

Letter from Vicky Foxcroft, Lewisham Deptford MP
Thank you for your recent email asking me to be in the House of Commons for the second reading of the NHS Bill 2015 on Friday 11 March.

I’m afraid that I am unable to be present on Friday due to several constituency commitments, but I thought it would be helpful if I set out my views on the Bill.

As you may know, this Bill was introduced as a Private Member’s Bill last summer and as such, it is subject to the constraints associated with the parliamentary timetable. Even if the Bill were to receive its second reading this week (and there is no guarantee that it will even be debated), there is little prospect of the Bill becoming law in this session due to a lack of parliamentary time.

I have personally experienced the same frustrations at this system. I introduced a Private Member’s Bill to allow votes at 16. The Government never allowed us time to have a full debate and, along with all other Private Member’s Bills, is due to come off the books next week. Sadly, that’s just how the system works.

I am supportive of the overall objectives of the Bill. In particular, the principles behind duties outlined in Clause 1 of the proposed Bill – which would restore accountability to the Secretary of State for the delivery of the health service. It would also require that a comprehensive health service continues to be provided free of charge.

Labour also believes that the encroaching privatisation of the NHS must be halted and that decisions about NHS services should never be called into question by any international treaties or agreements, such as the Transatlantic Trade and Investment Partnership (TTIP).

However there are concerns that some of the other parts of this Bill would require another wholesale reorganisation of the health service.

The recent top-down reorganisation of the NHS, brought about by the Coalition’s Health and Social Care Act 2012, threw the system into turmoil, cost over £3bn and eroded staff morale.

So whilst I support the broad objectives which lie behind this Bill, I am concerned about the scale of structural change and costs associated with any further major reorganisation of the NHS.

If the Bill were to proceed, Labour would seek to amend it so that it avoids the problems of a further reorganisation but implements the key principles of the Bill.

In line with our manifesto commitment at the last election, Labour is committed to repealing the competition elements of the Health and Social Care Act 2012, and ensuring that patient care is always put before profits, and collaboration before competition.

Thank you for taking the time to contact me about this matter.
Kind regards, 
Vicky Foxcroft MP
Member of Parliament for Lewisham Deptford 

Statement from the Save Lewisham Hospital Campaign

Louise Irvine, Chair, Save Lewisham Hospital Campaign, 24.03.16

The Save Lewisham Hospital Campaign was extremely disappointed that the majority of Labour MPs did not attend the debate on the NHS Bill on 11 March and that the Labour Party did not support it.

 The Campaign supported the Bill because we believe that such legislation is necessary in order to protect the wider NHS, and our local hospital and NHS services, from the damaging effects of competition and the marketised system of health care that we currently have, with all the attendant risks, costs, fragmentation and waste.

Growing support for the NHS Bill
There was support for the Bill from the British Medical Association, Unite the Union including its medical branch “Doctors in Unite” and the Socialist Health Association. The chair of the Royal College of Paediatrics & Child Health supported it in a personal capacity. Within the Labour Party many CLPs passed resolutions supporting the bill and 20 Labour MPs support it. However the Labour Party did not support the Bill and the vast majority of Labour MPs failed to attend the debate thus enabling it to be filibustered by the Tories, leaving just 17 minutes for debate and no time for a vote.

Addressing Labour’s reasons for failing to support the NHS Bill
Labour Party MPs, including Lewisham Deptford MP Vicky Foxcroft, issued a standard letter, explaining Labour Party reasons for neither supporting the Bill nor attending the debate.

 The Labour Party letter claims to be supportive of the overall objectives and key principles of the Bill but did not support it because it would “require another wholesale reorganisation of the health service” and it was concerned about the “scale of structural change and costs associated with any further major reorganisation of the NHS.”

Labour refers to the “recent top-down reorganisation of the NHS, brought about by the Coalition’s Health and Social Care Act 2012” and talks about this in the past tense as something that “threw the system into turmoil, cost over £3bn and eroded staff morale”.

The letter states that Labour wants to halt NHS privatisation, protect it from international trade treaties like TTIP and ensure patient care is always put before profits, and collaboration before competition. However the letter does not explain how Labour will achieve this apart from commitment to legislation to “reverse the competition elements of the Health an Social Care Act 2012”.

Hiding behind an invented fear of further reorganisation
There is much flawed thinking in these arguments.  It is very worrying that Labour does not seem to understand the current threats to the NHS, the degree to which it has already been damaged and the kind of legislation will be needed to reinstate it and protect it as a public service.

The principle objection to the Health and Social Care Act 2012 from  defenders of the NHS was not the top down reorganisation itself but its damaging effects on the NHS, effects which are ongoing and escalating.

Referring to the Health and Social Care Act 2012 as a past reorganisation, completely misses the point that the destructive disorganisation of the NHS is an ongoing and damaging process.

The effect of the Health and Social Care Act 2012 was to accelerate the transformation of the NHS from a public service into a market based service, based on competition, and subject to competition law. It has unleashed a torrent of bidding, tendering, contracting, legal challenges and restructuring of services that are part of the everyday reality of the NHS now.  This is currently costing £billions per year and is far more than the original costs of implementing the reforms.

Ongoing and damaging reorganisation in England
Dr Phillipa Whitford, SNP MP said in the NHS Bill debate:

The NHS is being reorganised on a daily, weekly and monthly basis. Every time a service is outsourced, it is completely reorganised. By being taken over, people’s contracts are altered, and the shape of the service changes.”

The NHS is currently being subjected to several further “reorganisations”.  The NHS Chief Executive Simon Stevens’ Five Year Forward View envisages major reorganisation with new models of care; NHS devolution plans involve a radical change in the way that health services are organized at regional and local level; and the recent announcement by NHS England divides England into 44 “Sustainability and Transformation footprints” – with demands for large scale changes, financial cuts and closures dictated to all trusts and commissioning areas. They must produce initial plans to radically reorganise local health services by June. All of these changes show that the current government has no hesitation in endlessly reorganising the NHS to promote its objectives.

Freeing the NHS from the wastefulness of marketisation and damaging privatisation
The objective of the NHS Bill 2015 was not just to repeal the Health and Social Care Act 2015 but to remove all the other elements of the market in the NHS that are the product of three decades of pro-market legislation and reorganisations. It seeks to remove the “purchaser-provider split” and reinstate the NHS as a full public service based on public provision and collaborative planning around people’s health needs.

The Labour Party has to recognize that marketisation and privatisation did not begin or end with the Health and Social Care Act.  The NHS needs to be reinstated as a public service, publicly provided, publicly funded and based on its founding principles. This would also protect the NHS from EU competition law and TTIP, something that the Labour Party position of simply repealing the competition elements of the Health and Social Care Act 2012 would not achieve, because that would still leave sufficient marketised elements in the NHS to make it subject to EU and international treaty laws.

 This taking back of the NHS into public control will not be achieved without a degree of reorganisation. Labour, if it agrees with the objectives and principles of the NHS Bill, must accept this necessity and be prepared to defend it.

There is a difference between a damaging reorganisation and one that would stabilize and support the NHS.

Minimising the disruption of reorganisation
The NHS Bill set out ways to minimize the upheaval of any reorganization. Yes, there will be a cost, but nothing like the cost of the wasteful market system we have now. The costs of the market have been estimated as £4.5 billion annually. And its important to think of the “opportunity” costs of the market in terms of clinical and management time, energy and expertise that would be liberated if instead of being tied up in the bureaucracy of tendering and bidding they could actually devote themselves to planning and delivering good health care. It’s been done before.  As Dr Philippa Whitford said in the NHS Bill debate: “In Scotland, we reversed the purchaser-provider split in 2004, and it was relatively painless. What we need is simply a decision not to outsource further and gradually to move back to geographical health planning instead of the fragmentation of clinical commissioning groups at a time when we need integration.”

Why is it only Labour that is afraid of reorganizing the NHS, if that is what is needed to protect it and defend it from further damage?

Labour must act now and build a cross-party alliance to defend the NHS
If Labour really does agree with the broad objectives and principles of the NHS Bill 2015 as it says it does, then it should bring forward its own legislation to achieve those. Waiting until 2020 and a possible Labour Government will be too late. The damage to the NHS is going on at a relentless pace. Labour should introduce legislation during the course of this government and seek all party support for it. We think the best available starting point to draft this is the NHS Bill. Even if this does not pass it will show the necessary leadership in challenging what the Tories are doing to the NHS and would help transform the balance of forces on the state of our NHS. In so doing this could lead the fight against the Conservative Government and its ideological assault on our public services.