Health Minister Edward Argar has agreed to table a government amendment to the Health and Care Bill that would prevent private interests from being on any Integrated Care Board. This has now been confirmed in the published report of the First Sitting of the Bill Committee on September 7.
Responding to opposition amendments seeking to exclude private companies, Argar said:
“We recognise that the involvement of the private sector, in all its forms, in ICBs is a matter of significant concern to Members in the House, and we are keen to put the point beyond doubt.
“However, having taken appropriate advice, I am afraid that that these amendments would not cover a number of scenarios—for example, lobbyists for private providers, or those with a strong ideological commitment to the private sector—and they would therefore not be watertight.
“As it stands, these amendments may well not offer the robust assurance that perhaps hon. Members intended. Therefore—this is where I may surprise the hon. Member for Ellesmere Port and Neston—to put this matter beyond doubt, we propose to bring forward a Government amendment on Report to protect the independence of ICBs by preventing individuals with significant interests in private healthcare from sitting on them.” (p143)
This is an important step forward for the MPs fighting for amendments to limit the damage the Bill could do.
The Bill would establish ICBs as the main ‘local’ decision-making bodies of the NHS, and its ambiguous wording appeared to be opening the door, at least in some areas, to extended private sector influence over decision-making.
Many of the greatest fears over the implications of the Bill have been based on the assumption that private corporations and management consultants might play a leading role in shaping and deciding policies within the ICBs.
Ministers had given verbal assurances that this was not their intention, but their decision now to include an explicit amendment along these lines will encourage the opposition team seeking to amend the many other controversial sections of the Bill.
Widening participation in ICBs to include patient and public representation, and ensure involvement of mental health, community health and public health professionals also requires amendments, but may well draw in support from some Tory MPs – or result in concessions by ministers to minimise delays in progressing the Bill.
However the promised new amendment applies only to ICBs: the Bill still explicitly provides for private sector participation in the advisory Integrated Care Partnerships – which are not, under the Bill’s provisions, required to meet in public or publish their minutes and papers. Argar’s response to proposals to exclude private sector involvement on ICPs emphasises their entirely peripheral and advisory role, with no powers to spend money or make policy.
As the Bill stands, however, continued or increased penetration of the private sector into the NHS will also continue on other fronts. The Committee discussions in the Commons have not yet got to the question of regulations governing procurement, or opposition amendments proposing that the NHS should become the default provider whenever contracts come to an end, with a rigorous process required to justify seeking to outsource to a private provider.
The Bill repeals parts of Section 75 of Andrew Lansley’s 2012 Health and Social Care Act, which requires Clinical Commissioning Groups to put clinical services out to competitive tender: but campaigners and unions are also keen to see amendments that would extend the repeal to cover non-clinical support services.
They also want an amendment to ban trusts or ICBs from creating subsidiary companies, whether this be to dodge taxes, evade scrutiny or undermine terms and conditions of staff.
With the clock still ticking on the timescale to force through the legislation in time to establish Integrated Care Boards by next April, who knows what more may yet be won against the odds?
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