There are times when it is appropriate, even necessary, to be angry and to shout out. I’m presently in a local café trying hard to restrain myself. I have two immediate sources of irritation (and many more lurking around). These are: (1) the reviewers’ reasons for calling for a second set of revisions to our paper on the need for muckraking sociology in relation to the NHS, COVID and health inequalities, a paper that we’d submitted to a leading journal in the field (having already had it rejected – ‘we don’t take polemical pieces’ – by a mainstream journal); and (2) today’s second reading of the new NHS Bill. As for (1), I will constrain myself since I’ve vented before. Benny Goodman, Miranda Scambler and I were asked to provide evidence, for example, that the Tories’ proposed ‘reforms’ will open the door to for-profit providers and that this would be a bad thing. We took the collective decision not to dilute our thesis and have instead made the paper available at https://doi.org/10.31235/osf.io where it can be read and cited. The remainder of this blog is directed at (2).
The NHS Bill gets its second reading today and will, I imagine, have a majority in the House of Commons. It is the discredited Hancock’s Bill, although it will be defended by the new Health Secretary, Sajid Javid. What this Bill will do is initiate yet another major top-down reorganization of the NHS (this time under cover of COVID). In a nutshell:
- It will bolish the 200+ existing Clinical Commissioning Groups (CCGs), which will be replaced by 42 very much larger Integrated Care Systems (ICSs);
- The ICSs are designed to unite hospital, community, GP and mental health services with local authority care and public health (one board, one budget);
- No details about the funding of ICSs have been released but if existing budgets are spread evenly across the regions deprived areas could see significant cuts;
- There will be no automatic places on ICSs for patient representatives, or for mental health providers;
- The Health Secretary (or PM) will gain new powers – with no accountability or transparency – which could see him award lucrative outsourcing contracts to for-profit companies;
- The Health Secretary (or PM) will also control appointments to the 42 ICS boards (so expect an influx of politically obedient sympathizers);
- The Bill allows for for-profit providers to sit on ICSs (which is already underway in East Somerset, where Virgin Care, which delivers local services, has a seat on the shadow ICS established to prepare for the shake-up;
- Javid’s claim that the NHS will be ‘less bureaucratic, more accountable, and more integrated in the wake of Covid-19’ is entirely spurious since comparative studies show for-profit involvement promises more bureaucracy, less accountability and less integration.
It may well be that Hancock wanted Dido Harding – she who failed in relation to test-and-trace at a cost of £37bn – to be the new NHS CEO, although she is no longer in the running. But there is another possible candidate worthy of a mention. Mark Britnell spent 20 years in the NHS, reaching the heights of a director-generalship. But, according to Polly Toynbee, since 2009 he has been KPMG’s senior partner for global healthcare, from where he sat on the board advising Cameron on Lansley’s regressive Health and Social Care Act of 2012. He has been quoted as saying that ‘the NHS will be a state insurance provider not a state deliverer’. Lauding the competitive element in Lansley’s reforms, he opined that ‘the NHS will be shown no mercy and the best time to take advantage of this will be the next couple of years.’ He has not denied saying this. Watch out for his name!
If not angry now, then when FFS! I’m compelled to ask again: what is sociology for if it stands by? The NHS is being sabotaged right now, and chunks of it are due to be handed over to profiteers. It’s not just cronyism, it’s corruption and we are being played for fools.