Health and Care Bill

Debbie Abrahams Excerpts

2nd reading
Wednesday 14th July 2021 Commons Chamber

[Debbie Abrahams (Oldham East and Saddleworth) (Lab) [V]]

This is the wrong Bill at the wrong time. To introduce a Bill like this when the covid pandemic is far from over and staff are on their knees shows a lack of understanding of what is needed.

I am concerned that this reorganisation of the NHS is being used as an opportunity to extend the involvement of UK and international private healthcare companies. The Bill proposes that private healthcare companies can become members of the integrated care boards, potentially meaning they will be able to procure health services from their own companies. Under the Bill, ICBs will have only a “core responsibility” for a “group of people”, in accordance with enrolment rules made by NHS England. There are concerns that this evokes the US definition of a health maintenance organisation, which provides

“basic and supplemental health services to its members”.

What is included in the core responsibilities?

Why is there no longer a duty but only a power for ICBs to provide hospital services? What does that mean for the thousands waiting for elective surgery? What about those waiting for cancer and other therapies? For those who say, “What does it matter who provides our healthcare as long as it meets the NHS principles of being universal, comprehensive and free at the point of need?” I say that not only is the Bill a clear risk to those founding NHS principles but there is strong evidence that equity in access to healthcare, equity in health outcomes and healthcare quality are all compromised in health systems that are either privatised or marketised, as the NHS has increasingly become.

That brings me to my third area of concern: health inequalities. It is notable that the Bill places the duties for the reduction of health inequalities with ICBs. The 2012 duty on the Secretary of State and NHS England to reduce inequalities is repealed, showing the clear lack of commitment to levelling up and the reduction of the structural inequalities that have been laid bare by this pandemic and contributed to the UK’s high and unequal covid death toll. With this change, the Secretary of State is ignoring not only decades of overwhelming evidence that clearly shows that health inequalities are driven at national policy level, but the Prime Minister’s commitment to implement the recommendations that Professor Sir Michael Marmot made in his covid review last December to tackle inequalities and build back fairer.

My final point is on social care. As chair of the all-party parliamentary group on dementia, I express my profound disappointment that, 19 months since the Prime Minister pledged to fix the broken care system, it still has not been fixed. The Bill is a missed opportunity to set out the framework for social care reform in the context of an integrated health and social care system. For people with dementia and their family carers, who have suffered disproportionately from covid, this is a real blow. They deserve better. For me, the principle of health and social care—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Sorry, but we have to go on.