This shocking NHS bill is without sense or mandate
The Lords should be affronted by the slipshod way our health system is being blown apart, before they can even debate it
Under scrutiny … the health and social care bill reaches the House of Lords next week. Photograph: Christopher Furlong/Getty Images
Westminster Bridge, joining parliament and St Thomas's hospital, will be blocked on Sunday at one o'clock by a UK Uncut sit-down protest against the NHS bill that reaches the House of Lords next week.
The Lords have the last chance to amend the health and social care bill's most egregious clauses. Despite its gigantic size, basic questions remain unanswered. The Tory MP and GP Sarah Wollaston once called it "a hand grenade thrown into the NHS" – and so it is proving. The Lords should be alarmed by the constitutional enormity of this largely unscrutinised bill for which there was no manifesto mandate.
As it levers the NHS open to EU competition law, who is democratically accountable for its £120bn budget? Who is to answer for its quality or failures? Who commands its privatised fragments in times of crisis or pandemic? The Lords have a duty to scrutinise the most contentious parts of a bill railroaded through the Commons in just two days after the "pause", with 1,000 new amendments undebated. "The fundamental principles remain" boasted Andrew Lansley at his party conference: not much changed. Scrutiny of slapdash legislation is what the Lords are for.
They should be constitutionally affronted that this colossal reorganisation is already imposed on the NHS without waiting for their consent. No one can remember a similar case of pre-legislative implementation, as if parliament were irrelevant.
Without waiting for them: 300 clinical commissioning groups are taking over, nominally run by GPs. Private sector involvement is already compulsory: by this month every commissioner must find at least three outside providers for diagnostic tests, audiology, primary care psychological therapies, treatment for back pain, feet and other services.
Department of Health website instructions say: "Commissioners cannot refuse to accept providers once they have qualified." That's what "any qualified provider means" and it's happening now – forget the law. McKinsey and other consultants are already being paid millions by commissioners to work out the payment system.
How do these new providers become "qualified"? They must register with the Care Quality Commission, the regulator whose severe stress was revealed over the Winterbourne View scandal. Created from merging three bodies, plus possibly the human fertilisation authority, this bill gives it the new HealthWatch too. Can they cope? CQC has 30% less cash than the bodies it replaced. Last year it cut inspections by 70%. It has just 900 inspectors to cover 18,000 care homes, 8,000 GP practices, 400 NHS hospital trusts, 9,000 dental practices and now every new "qualified" entrant. Will the Lords really think proliferating providers will be sufficiently inspected?
The British Acupuncture Council was first respondent on the department's site, asking for its members to be registered as qualified to offer back pain treatment. How will the CQC know which pins are qualified pins? Second respondents were audiologists warning that private sector cowboys will "manipulate the facts", pretending they have better hearing aids, and older people will be tricked out of using NHS hi-tech audiology.
GPs will have small say in this market: forget the cosy image of them choosing the best for you. This week's scandal of the Haxby GP practiceshows what Professor Alan Maynard calls the "overwhelming temptations" in the system for GPs to set up their own services and urge patients to use them, even charging them. In the US and New Zealand doctors cannot refer patients to any service in which they have a financial interest: no such caveat is in this bill.
Commissioning services will not be done in your cosy GP surgery: the 300 CCGs will be cut back to many fewer, commissioning from afar and often outsourced to private companies. Professor John Appleby says the Treasury is right to worry about control of the cash. The NHS Confederation warns that finance directors, highly employable elsewhere, have been walking away, unwilling to take financial responsibility for the coming mayhem at a time of the most severe cutbacks ever in the NHS.
The Lords should scrutinise Monitor, the regulator whose first duty is to stop "anti-competitive behaviour". Already competition challenges are filed against GPs for purchasing from familiar NHS hospitals. With more hospitals in financial trouble, losing more funds when services are soon cherry-picked by outsiders, nothing in the bill says what happens when some go bust. Big companies will soon gain monopoly muscle.
NHS community staff are being forced, not invited, into friendly sounding social enterprises, as a fig leaf for privatisation. Central Surrey Health, an enterprise run by nurses, was hailed by Cameron as Big Society Award winners. But they failed to win their first genuinely competitive contract, losing out to private group Assura. Surrey nurses could only raise a £3m bond, while the winners reportedly raised a £10m bond. So much for social enterprise and NHS staff security when up against big capital.
The Lords should be alarmed that no one in parliament will be accountable for the NHS. The NHS Commissioning Board, a gigantic £80bn quango, will run it with the secretary of state forbidden by law from interfering. MPs will be shocked when the Speaker has to rule out of order any questions about hospital scandals, closures, waiting lists and all the imminent NHS crises. Re-imposing some duties on the secretary of state may be conceded in the Lords to Shirley Williams: let's hope she will not be satisfied with that.
Few Lords can explore the thicket of clauses in this vast bill. Lords Owen and Hennessy are bidding for two key sections to go to committee for thorough scrutiny: this is not a wrecking delay, but a chance to examine the bills most alarming aspects.
It's the best to be hoped for, ever since Nick Clegg folded in the Commons. David Owen makes a telling comparison with the privatisation of the railways. There are not, he says, many Tories who are not shamefaced about the slipshod way that was done. Do they really want to do that to the NHS?
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