My Lords, the NHS was founded on the principle of not for profit and serving all people equally, with dignity and respect for patients and staff. This Bill violates those principles. It accelerates privatisation of the NHS. At my local hospital many services, such as physiotherapy, have already been privatised, and employees had to reapply for their jobs on inferior terms. The Bill neither protects employees nor prioritises patient care. It enables private companies to secure NHS contracts even though they do not deliver value for money. A typical cataract operation is 50% to 100% more costly in the private sector than on the NHS. It is the same story for knee and hip replacements.
Around 11% of the annual NHS budget goes to private companies, which have shareholders and overpaid executives to appease. Up to 25% of the amounts paid to the private sector disappear in dividends, interest
payments, lease payments, rents and other intragroup transactions, often to an offshore affiliate. This leaves very little for front-line NHS services, and the waiting lists inevitably grow. The likes of Virgin healthcare have milked the system and pay little or no corporation tax. This Bill will facilitate even more of the same and rob the NHS.
The 42 independently run integrated care systems would be responsible for commissioning and delivering services to a group of people on a geographical basis. This heralds further fragmentation of the NHS and will create another postcode lottery.
The Minister, like many others, has mentioned integrating the health and care services, but the issue of merging the budgets is highly problematic. Take the NHS: it is free at the point of delivery, but social care is not—it is means tested. The Bill offers absolutely no clarity about how the budgets are to be merged, and there is nothing in it to prevent some NHS treatments or services being reclassified as social care and thus force people to pay more for the services. Social care budgets are fixed and capitated; overspends are not allowed. If the same was to be applied to the NHS, many people would simply not receive the treatment to which they are entitled. I hope that the Minister will clarify these issues.
Of course, we could eliminate lots of problems simply by accepting the principle that social care must be free at the point of delivery and paid for through taxation. However, I fear that a party or Government addicted to hurting the poor will somehow not accept that new policy, so we have a problem.
The Government have made some cosmetic adjustments to the Bill, but employees or personnel from private healthcare companies can still sit on the boards of the 42 ICSs and influence NHS commissioning decisions. This creates conflict of interest and must be absolutely banned. I do not recall any public marches or petitions urging the Government to ensure that individuals from Centene, UnitedHealth, Bupa, Spire and other private companies must somehow make NHS decisions. This is an ideological decision by the Government; there is no other explanation. I hope the Minister will explain the ideological basis of this meddling by the private sector.
It is also a matter of concern that the Bill gives the Secretary of State numerous powers and that he is accountable to nobody, least of all Parliament. There is no real public accountability. Should we really be trusting things to Ministers? We have already seen how they have abused their position in awarding lots of Covid-related contracts to cronies and party donors, without any public accountability. We are still awaiting details of those. What is there to prevent the Minister abusing his or her power in the future? There are absolutely no guarantees in this Bill.
8.11 pm