I am now retired, but I worked in the NHS (as a nurse, then a health visitor) for 28 years, then for a further 20 years in an NHS-funded post in a university, in teaching and research. I have, therefore, seen and worked through very many changes and reorganisations in the NHS: often old ideas are reinvented, with a different name and some things get better whilst others get worse. I am, however, very seriously worried about the NHS and Care Bill (NHSCB) in its current format and hope you will not support it in its current form. I have many concerns about the Bill, but these are my top three priorities.
First, NHSCB would remove the statutory duty to provide hospital care, which is neither justified, nor safe. I worked for many years in primary care and welcome developments such as day case and ambulatory care, as people usually benefit from being at home as far as possible. Despite appreciating these beneficial changes in the location of health care, taking away the certainty that secondary care must be provided is potentially very worrying. I appreciate that local Integrated Care Systems (ICSs) will continue to have the power to do so, but making it optional means at least some will, indeed, opt out. One of the reasons the Covid pandemic has led to such a huge backlog in routine care and unprecedented waiting lists, is because the existing NHS capacity is very low, compared with almost all other OECD countries. We have 2.45 hospital beds per 1000 population, compared, for example, with Germany 7.91, Norway 3.47 and United States 2.88. Removing the legal requirement to provide any hospital beds at all, is hardly likely to protect this precious resource.
Second, the NHSCB would allow ministers to circumvent normal procurement rules. This is being suggested at exactly the same time as the scandal of the ‘VIP lane’, is coming to light, showing very clearly that bypassing the standard checks and care allows corruption to flourish and leads to an enormous waste of public money being spent on defective materials. By all means improve procurement practice, but requiring a limit on – or even an absence of – profit on NHS contracts would be a far better way to ensure goods were purchased at the best possible price.
Third, patient data is potentially immensely valuable for health-enhancing research, for planning local and national services and for public health. Most people, if asked, are very happy for their information to be used for these purposes, provided there are very strong privacy safeguards. The large NHS datasets are currently well guarded, but concerns earlier this year, they might be put up for sale led to huge numbers of people opting out of the GP health database. Selling off private information, with or without individuals’ explicit consent, in order to cash in on illness is simply wrong. Why is it even being proposed?
There is so much else that is wrong with the NHS and the Care Bill, but these are my top three concerns. Please, Tobias, do all you can to ensure the NHS continues in its current form, being free for all at the point of delivery (despite being dangerously underfunded and apparently lacking in government support). The Bill comes back to the Commons next week: please do not just wave it through, whatever your whips tell you to do.