The hon. Lady makes an incredibly important point. There can be no more poignant and devastating example of what this crisis is leading to.
The Health and Care Act is a privatising piece of legislation that opens the door to private companies having a greater say in the delivery of health care. Guidance by NHS England, while the Act was going through Parliament, stated that it would enable integrated care boards to delegate functions to providers, including devolving budgets to provider collaboratives. Provider collaboratives are partnership arrangements involving at least two trusts, and they can include representation from the private or independent sector.
As we now know, the delegation of commissioning from ICBs to provider collaboratives will definitely go ahead. That represents not only the opportunity for the privatisation of the NHS, but clearly has implications for NHS staff. I am concerned that a situation may well arise where a provider collaborative decides to commission services from the private sector, instead of from the NHS provider that is currently delivering the service. In that instance, NHS staff may well find that their jobs are lost from the NHS, and that equivalent work is available only in the private sector, on poorer pay and conditions of service.
The Health and Care Act, which was passed by the Conservative Government earlier this year, has the potential to undermine national collective bargaining, and the pay and terms and conditions of NHS staff. It also undermines the concept of the NHS as a publicly owned organisation that has served us so well since 1948. The Act prohibits the chair of an ICB from approving or appointing someone as a member of any committee or sub-committee that exercises commissioning functions, if the chair considers that the appointment could reasonably be regarded as undermining the independence of the health service, because of the candidate’s involvement with the private healthcare sector or otherwise. However, that is clearly open to interpretation. It by no means rules out people with interests in private healthcare from sitting on those sub-committees.
If we are serious about providing governance that rules out the possibility of the private sector influencing the expenditure of public money, an organisation carrying out the functions of an ICB on its behalf should be a statutory NHS body. It is a great pity that the Government did not legislate for that, despite an amendment in my name calling for it, which had cross-party support.
Private companies can also have influence through integrated care partnerships, which are required to prepare a strategy setting out how the assessed needs of its area are to be met. ICBs must have regard to a strategy drawn up by an ICP, which I am concerned might be influenced by private companies. Of course, the responsibility of a private company is to make money for shareholders; it is not to support a publicly owned, publicly run national health service.
Other provisions in the Act also have serious implications for staff. The Act allows for a profession that is currently regulated to be removed from statutory regulation. That is deeply concerning. Once a profession is deregulated, we can expect the level of expertise in that field to decline over time, alongside the status and pay of those carrying out those important roles. Deregulation also brings with it serious long-term implications for the health and safety of patients.
The Act also provides for the revoking of the national tariff and its replacement with a new NHS payment scheme. Engagement on the NHS payment scheme is still under way, with a statutory consultation due to begin shortly. I have long been concerned that, given the requirement in the Act for NHS England to consult with each relevant provider before publishing the NHS payment scheme, including private providers, this may well be a mechanism through which the Government will give private health companies the opportunity to undercut the NHS. If that happens, I believe that one of the inevitable outcomes would be an erosion of the scope of “Agenda for Change”, as healthcare that should be provided by the NHS is increasingly delivered by the private sector.
In that event, NHS staff may then find themselves forced out of jobs that are currently on “Agenda for Change” rates of pay, pensions and other terms and conditions, with only private-sector jobs with potentially lesser pay and conditions available for them to apply for if they wish to continue working in the health service. Just like the provision around provider collaboratives, that would appear to hold risk for NHS staff and their pay and conditions. As such, I would be grateful if the Minister will guarantee that the pay rates of “Agenda for Change”, pensions, and other terms and conditions of all eligible current NHS staff will not be undermined as a result of the adoption of the NHS payment scheme. Can he also confirm that trade unions, staff representative bodies and all the royal colleges will be consulted before the NHS payment scheme is published, as Ministers in the other place assured us during the passage of the Act?
I understand that the Government are to publish a comprehensive NHS workforce plan next year, including independently verified workforce forecasts of the number of doctors, nurses and other professionals we will need in five, 10 and 15 years’ time. Such a plan is long overdue, so can the Minister provide some further details about when we will see it? Will that plan also include details of the numbers of staff we will need in the social care sector, where there is also a workforce crisis that is intricately linked to that in the NHS? Will the Minister set out what measures he is taking to address the staffing crisis this winter?