While there are currently 42 ICSs in England, the health and care bill proposes to establish ICSs as statutory bodies, meaning they would have the power to authorise legislation.
That means these ICSs would be responsible for commissioning and delivering services to patients within their geographical area, rather than one central NHS body, which has been the system since the founding of the NHS in 1948.
The bill also increases powers for the health secretary to intervene on the configuration of services.
At present, controversial changes to NHS services can be referred to the government. But under the proposed Bill, the Health Secretary would be able to intervene in minor local plans at any time.
Why did Sajid Javid propose the bill?
The health secretary inherited the bill from his predecessor, Matt Hancock, when he took over in June.
Three days after being appointed, Javid urged the prime minister to delay the reforms planned by his predecessor because “significant areas of contention” had yet to be resolved, The Times reported.
Boris Johnson overruled Javid, though, and insisted that he press ahead with the “huge” NHS reorganisation.
“The fundamental aim of this legislation is to put into statute the requests the NHS made of government in 2019, while making a number of other changes to support improvement across the health and care system,” wrote Javid to the Health and Social Care Committee ahead of its second reading in July.
Javid added that the bill would “empower local health and care leaders to pursue new and innovative ways of delivering for people and communities.
Who is opposing the health and care bill?
Union Unite is one of the loudest and fiercest critics of the proposed bill they have called the “NHS privatisation bill”. The union’s members have voiced concerns about its impact on services, accountability, funding, professional standards, privatisation, safety, and terms and conditions.
“The government’s new Health and Care Bill is a Trojan horse for more cuts and cronyism and is a licence for politicians to run down and sell off our NHS,” said Jacalyn Williams, Unite’s national officer for health.
“Attempting to drive this through while we are still in the middle of a pandemic and without a care for patients, or staff already stretched beyond their limits, is a disgrace.
Doctor-led campaign organisation EveryDoctor points out that up to 11 per cent of the NHS’s budget already goes to private companies.
“This Bill will embed private companies in the NHS in England, and give them the power to decide who gets what treatment when. No one should be profiting from public healthcare, it’s as black and white as that,” the organisation said.
Multiple Labour MPs have also thrown their weight behind the campaign to #ScrapNHSBill, including Rebecca Long-Bailey, John McDonnell and Barry Gardiner.
Bell Ribeiro-Addy has labeled the bill “an attempt to carve up more of our NHS for privatisation and pave the way for more dodgy contracts.”
Dubbing the bill “the corporate takeover bill,” Labour MP for Norwich South, Clive Lewis wrote in The Independent; “these reforms will usher in a huge transfer of decision-making power to private companies and democratically unaccountable third parties through innocuous sounding “Integrated Care Systems”, which will not guarantee my constituent’s right to access the healthcare they need, when they need it.
How are people protesting against the health and care bill?
Unite has planned a day of action in protest of the bill on Saturday February 26, alongside SOS:NHS and Your NHS Needs You.
Members of Unite are planning rallies and stalls in high streets and outside hospitals in cities and towns in England to encourage people to engage with the Bill and speak to the MP on opposing privatisation of the NHS.
The group says that action will be targeted at Tory MPs who voted in favour of the bill when it passed the House of Commons last November. If the Lords add any amendments to the bill, it will return to the Commons, giving MPs a second shot at voting for or against it.
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“Our NHS is under threat and time is running out. The Health and Care Bill will cut medical and emergency services, force more people to pay for their health care and let more private companies take over services and make decisions on budgets,” said Liane Groves, head of Unite Community.
“That is why Community members will be out on the streets on Saturday, highlighting the tsunami of attacks our health service is facing and asking local people to tell their MPs they must vote against the Health and Care Bill to save our NHS.”
Protest events are planned for Liverpool, Manchester, Preston, Crewe and Chester.
Will the bill privatise the NHS?
The bill will bring about a “complete break up of the NHS as we know it,” a Unite spokesperson told The Big Issue, by breaking up the single, central and public NHS into 42 parts.
These 42 parts will have space for private companies to sit on their boards, who will then be able to influence the running of ICS – including who receives contracts, the services it provides and at what cost.
Private representatives including business owners, will be able to sit on these boards and influence the decisions made over services and care available to patients.
Unite fears that some boards might decide not to offer certain procedures or treatments labelling them as not cost effective. These boards could operate like commercial entities, maximising budgets over patients’ health.
This could create a postcode lottery that sees people in different parts of England get faster access to medical help than people in other areas.
While it is unclear what the funding streams will be for the ICSs, the union fears that instead of sharing one national budget among the NHS trusts, as is the current model, the model proposed by the health and care bill will create local pots of money, exacerbating regional inequalities.
And finally, Unite warns that dividing up power to 42 different ICS could lead to different pay for NHS workers across the country, with a nurse in a more wealthy area earning more than a nurse in a poorer one.
What’s it got to do with the America healthcare system?
Opponents of the bill are warning that it will pave the way for the English NHS to be replaced by a profit-driven American-style system, which would incentivise private health providers to cut and deny care to increase profits.
“It’s modelled on the US healthcare system,” claims Unite, meaning that it makes more likely a situation which could see patients encouraged to go private for services that their local NHS body doesn’t offer, and then receiving a bill in the post.
Actor and broadcaster Stephen Fry has lent his support to the yournhsneedsyou.com campaign, by drawing on his own experience of the American healthcare system.
“I’ve seen what a nightmare healthcare is – if you can call it that – in America. A real nightmare! And the idea of that infecting our NHS is like the idea of a new pandemic, frankly,” he said.
“Research shows that American corporations are already embedding themselves in our NHS. And this is a really dangerous, and a very, very worrying turn of events.”
What amendments are being called for?
Unite is calling for the bill to be scrapped entirely, but others are seeking amendments.
More than 60 health and social care organisations including the British Medial Association and Royal College of Nursing, are supporting an amendment, tabled by former health secretary Jeremy Hunt – now chair ofthe Health and Social Care Committee – which calls for the bill to address the staffing shortages crippling the NHS.
In a letter published by The Times, the group is calling for the bill to improve the way the NHS plans how many staff the health and care systems will need in the long term.
“There can be no doubt that the staffing crisis is the single biggest challenge facing our health and care services. Despite this, the proposals for workforce planning in the bill fall woefully short of providing any long-term solutions,” the letter reads.
Staff shortages have affected almost all sectors of the NHS, causing severe delays in treatment including ambulances facing queues of up to 14 hours outside hospitals.
“When vacancy levels are so high, the move is short-sighted at best and wilfully reckless at worst.”
There are around 100,000 NHS staffing vacancies advertised in England, reports The Mirror.
Hours after the amendment was rejected, parliament’s Health and Social Care Committee made up of cross-party MPS launched an inquiry into the NHS staffing crisis. It will look at why staff are leaving and what can be done to attract new doctors and nurses.