My Lords, I am going to structure this speech untraditionally, beginning with a short list of some of the issues that I expect to pick up in Committee and adding to the list already laid out by my noble friend Lady Jones of Moulsecoomb as her agenda. The British Association of Social Workers is concerned about the dilution of local authority responsibilities. The Institute of Alcohol Studies points out the failure to address the harm done by advertising for alcoholic products. The Venice Commission concludes that it undermines trust in the Parliamentary and Health Service Ombudsman. Unpaid carers are deeply concerned about Clause 80, as the noble Baroness, Lady Pitkeathley, outlined, and, of course, multiple organisations and Peers are gravely concerned about the lack of workforce planning.
I want to spend most of my time looking at the big structural changes introduced by this Bill—astonishingly, as many noble Lords have noted, at a time of tremendous pressure and struggle for our health service. The warning from the British Medical Association that the Bill will
“do more harm than good”
in this context must be noted. I want to engage particularly with two speeches, starting with that from the noble Lord, Lord Lansley. He raised the way the kind of structures created by the Bill reflect those that
“JP Morgan and Rockefeller used when creating vast monopolies.”
Those noble Lords, among them the noble Lord, Lord Stevens of Birmingham, insisting very vigorously that the Bill is not about privatisation—really, really it is not—might like to reflect on that analogy.
The noble Lords, Lord Lansley and Lord Adebowale, noted that integrated care systems have been around in one form or another for six years already. They were brought in de facto into the NHS, without parliamentary oversight, and now we are being asked to approve that model. Somehow, that makes me think of the Henry VIII powers that, rightly, so exercise many of the legal experts in your Lordships’ House. I do not believe anyone disagrees with the idea of integration. Regarding each individual engaged with the system as a person needing a mixture of medical and other care, not as a set of conditions, is obviously essential and all too rare. But the big question is, how? There is an important question to ask about models: what are their origins?
The origins of so much thinking about healthcare systems in the UK come from the United States—as do many of the personnel, who come from giant American healthcare companies. I am talking, of course, about the top of management. That is astonishing, when you think that the world’s richest country can reasonably be classed as having the world’s worst health system. It is a system that absorbs enormous resources—financial, physical and human—to produce astonishingly bad outcomes, whether measured by mortality, morbidity, the actual volume of care provided or inequality. Yet we seem to draw most of our thinking, and many of our senior personnel, from the US.
Maybe I am wrong that this is a failure; maybe the issue is the purpose of the system. If you acknowledge that the purpose of the US healthcare system is to be a cash cow, not a care provider, then on that measure it is a raging success—one that is already consuming about 8% of England’s NHS spending and providing a quarter of our mental health in-patient beds.
It has not always been so. Think back to 2015, when Hinchingbrooke Hospital was briefly in the hands of the healthcare company Circle. Soon, care was rated “inadequate”; the company complained that it was not making any money and handed it back to the Government. Multinationals have found it hard to make money from operating some elements of our current health system but now, potentially, they will have a new way of taking over.
The integrated care board model is closely based on health maintenance organisations, also known as managed care organisations. These are responsible for providing only limited free services to an identified group of people. In the US, they are like customers, but very constrained ones. The sad reality of where we are now in the UK is that, with our level of spending on health significantly below that of nations of comparable wealth, we are already heading towards this. A survey by openDemocracy found that one in five people had had a doctor or other health professional suggest that they needed to go private to get the care that they needed. Nine out of 10 patient-facing staff said that they had been unable to give a patient treatment or a procedure that they would benefit from. With a block of patients and a fixed budget, how much further might this Bill take us down that road?
Lest noble Lords think I am going out on a limb here, I point out that the BMA has noted that the Bill
“risks making it easier for private companies to win NHS contracts without proper scrutiny.”
We have already seen this in action in our social care system over decades under successive Governments. The Bill does nothing to tackle the predatory financing that has consumed our care homes sector, with 84% of beds provided by for-profit companies, and one-sixth of the fee for a bed in financialised homes going towards interest payments.
If this brief outline has left noble Lords wondering or puzzled about the apparent lack of resistance from the Front Bench on this side to the basic structural changes here, where should they go? I suggest they read the work of Professor Allyson Pollock, Peter Roderick
and Caroline Molloy on openDemocracy and, on social care in particular, the work of the APPG on Limits to Growth.
9.57 pm