MPs urged to reject Health and Care Bill as BMA demands major amendments

BMA leaders have urged MPs to reject the government's Health and Care Bill - warning the plans are poorly timed, increase the risk of NHS privatisation and fail to tackle funding or workforce shortages.

The BMA council voted overwhelmingly against the proposed legislation, calling it 'the wrong bill at the wrong time'. A motion backed by the association's council reads: 'That council calls on the BMA to actively oppose the Health and Care Bill currently before UK parliament.'

Doctors' leaders warned the plans would 'significantly dilute public accountability', while conferring 'wide-ranging, excessive powers' on the health and social care secretary.

The BMA argued that the bill - introduced to parliament earlier this month - came at the wrong time for a health service struggling with the impact of the COVID-19 pandemic.

NHS reform

It said the proposals failed to address 'chronic workforce shortages' - at a time when general practice is currently operating with 10% fewer full-time equivalent GPs per patient than five years ago - and did not address the shortfall in funding facing the NHS and social care.

Plans to scrap current tendering rules around awarding of NHS contracts along with plans to shift power and budgets to integrated care systems (ICSs) have sparked concerns over increased privatisation in the health service - and the BMA warned that the plans failed to protect services from 'further outsourcing and encroachment of large corporate companies in healthcare'.

BMA deputy chair Dr David Wrigley said: 'This is not the right time to be making such widespread changes to our health service. What’s more the bill addresses none of the problems the NHS is currently facing - too few resources, too little funding, a crisis in social care and a huge shortage of staff. It does not address the problem of a workforce that is exhausted and depleted by the pandemic and is now facing yet another wave.

'Healthcare workers have led from the front throughout this pandemic, but the bill in its current form undercuts truly representative clinical leadership. The BMA has consistently called for meaningful clinical leadership, engagement and representation at every level of ICSs, including from primary and secondary care as well as public health doctors to ensure the right voices are heard when it comes to commissioning decisions, but this has not been adequately addressed in the legislation.

Privatisation fears

'The threat of private health providers having a formal seat on new decision making boards, and wielding influence over commissioning decisions, must be ruled out.'

Dr Wrigley added that plans to extend the powers of the health and social care secretary should also have been ruled out as the bill was drawn up. He said: 'Of course, the health secretary should be accountable for the NHS, but it would be totally wrong for government to have the power to abolish arm’s length bodies without due scrutiny, approve or reject ICS chairs, or interfere with local decisions – all of which risk political interference for political gain, and do not have the interests of the NHS, or its patients, at heart.'

Although the BMA has backed removal of 'enforced competition' for NHS contracts as part of a more collaborative approach to provision of healthcare, it warned that the NHS must become the 'default option' to provide any services being commissioned, with contracts only put out to tender where NHS provision was not possible.

Dr Wrigley said: 'This is also vital to avoid the awarding of contracts without scrutiny to private providers at huge expense to the taxpayer, as was seen with the procurement of PPE and Test and Trace during the pandemic.'

NHS workforce

He added: 'Fundamentally, the legislation is a missed opportunity to truly boost the NHS workforce. We entered the pandemic on the back foot, with a historic workforce crisis that has only worsened over the last year. This bill does nothing to address the huge staffing shortages facing the health service.

The NHS is the people who work in it, and having a fully-fledged workforce is vital to safe patient care, which is why government must be accountable for ensuring adequate numbers of staff. The bill must include a responsibility for the secretary of state to produce ongoing accurate and transparent workforce assessments which will directly inform recruitment needs, now and in the future.'

Announcing plans to introduce the bill into parliament earlier this month, health and social care secretary Sajid Javid said: 'To help meet demand, build a better health service and bust the backlog, we need to back the NHS, as it celebrates its 73rd birthday this week, and embed lessons learned from the pandemic. This will support our health and care services to be more integrated and innovative so the NHS can deliver for people in the decades to come.'

NHS chief executive Sir Simon Stevens said at the time: 'This bill contains widely supported proposals for integrated care, which have been developed and consulted on over recent years by the NHS itself. They go with the grain of what our staff and patients can see is needed, by removing outdated and bureaucratic legal barriers to joined-up working between GPs, hospitals, and community services.'

A DHSC spokesperson said: 'The Health and Care Bill builds on the NHS’ own proposals for reform and sets out the next steps in building a health and care system that delivers better care for our communities. It will be less bureaucratic, more accountable, and more integrated in the wake of the pandemic.

'Our proposals will give the NHS more power, not less, and maintain the NHS’s clinical and operational independence while ensuring the secretary of state has appropriate oversight and accountability.'

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