MPs call on government to halt NHS reorganisation plan over concerns of conflict of interest and postcode lottery

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28 Apr 2021

A group of MPs and peers have written to Prime Minister Boris Johnson calling on him to pause the government’s planned reorganisation of the NHS and social care until after all Covid-19 restrictions are lifted and to then carry out a full public consultation so that patients, NHS staff, care workers and unpaid carers can have their say.

The letter, which was organised by Margaret Greenwood, the Member of Parliament for Wirral West, has been signed by 27 politicians.

It follows the publication of the government’s white paper Integration and Innovation: working together to improve health and social care for all and comes before the government is expected to announce plans for a related bill in next month’s Queens Speech.

Among the concerns highlighted in the letter are that the government’s proposals would:

- create the potential for conflicts for interest by opening up the opportunity for private companies to have a say in what health and social care services are provided in an area

- embed a postcode lottery, with the health and social care services that people can access varying depending on where they live

- allow hospitals to discharge vulnerable patients before they have been assessed for NHS Continuing Healthcare (CHC) and NHS Funded Nursing Care (FNC), risking leaving families to pick up the pieces bring uncertainty to the future of the NHS workforce

- leave the issue of access to and funding of social care unaddressed yet again

The MPs and peers warn the white paper does not set out clearly how budgets are going to be allocated to local Integrated Care Systems (ICSs) and asks if NHS and social care providers will find themselves competing for resources at local level.

The politicians have also hit out at the timing of the proposals and argue that, with more than 4.5 million people in England waiting for hospital treatment, and with NHS and care staff exhausted, this is no time to carry out a major reorganisation of the NHS.

Margaret Greenwood MP, who organised the letter, said:

"It is a matter of extreme concern that the government is planning a major reorganisation of the NHS and social care while we are in the middle of a pandemic and public health crisis and when there is a huge backlog in the NHS. 

"The proposals, if implemented, would have profound implications for patients, NHS staff, care workers and unpaid carers across England.

"The government should pause the whole process until all Covid-19 restrictions are lifted and then set out its plans clearly at a time when people are able to meet, talk and discuss their implications.

"There must be a widespread consultation with the public so that so that patients, NHS staff, care workers and unpaid carers can have their say."

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The full text of the letter

The Rt Hon Boris Johnson MP
Prime Minister
10 Downing Street
London
SW1A 2AA

28 April 2021

Dear Prime Minister,

We are writing to you about the government’s plans for the future of health and social care as set out in the recently published white paper?Integration and innovation:?working together to improve health and social care for all.

The plans have massive implications for patients, NHS staff, care workers and unpaid carers. By putting Integrated Care Systems (ICSs) on a statutory footing, the proposals represent a major reorganisation of the NHS as we know it.

We have a number of serious concerns about the proposals contained in the white paper which include, but are not limited to, the fact that the government's plans would:

- embed a postcode lottery, with the health and social care services that people can access varying depending on where they live. There have been numerous reports in recent years highlighting the prevalence of a postcode lottery for NHS patients. These proposals would embed a postcode lottery, with ICSs making decisions about which services to prioritise and which services to reduce within their areas.

- open up the opportunity for private companies to have a say in what health and social care services are provided in an area. The white paper sets out that each ICS will have an ICS Health and Care Partnership which 'will bring together systems to support integration and develop a plan to address the systems' health, public health, and social care needs'; it also states that members of the ICS Health and Care Partnership could be drawn from a number of sources, including 'independent sector partners'. This raises concerns that representatives of private companies could take key roles in developing plans for how public money will be spent. Not only that, the very same organisations could well be providers of health and care services in the area, so there is huge potential for conflicts of interest.

- allow hospitals to discharge vulnerable patients before they have been assessed for NHS Continuing Healthcare (CHC) and NHS Funded Nursing Care (FNC), leaving families to pick up the pieces, and leaving those without family potentially at risk of isolation and lack of care. The white paper proposes putting in place a legal framework for a ‘Discharge to Assess’ model, which would allow assessments to take place after an individual has been discharged from acute care. It explains: 'This will replace the existing legal requirement for all assessments to take place prior to discharge'. This could have serious implications for the wellbeing of patients and for many of the millions of unpaid carers who may well feel that they may be left to pick up the pieces and take over the care of their loved one once they have been discharged from hospital, regardless of any continuing health and care needs that the person who has been discharged may have.

- bring uncertainty to the future of the NHS workforce. The proposals may lead to restructuring within the NHS. The white paper explains that the government is 'giving ICS NHS bodies and ICS Health and Care Partnership the flexibility to develop processes and structures which work most effectively for them'. It goes on to explain: '...we need to support staff during organisational change by minimising uncertainty and limiting employment changes. We are therefore seeking to provide stability of employment and will work with NHSE and staff representatives to manage this process.' However, the white paper fails to set out any precise limits to the scale or scope of any such restructuring.

- enable joint appointments of senior staff between NHS bodies and local authorities. There are concerns that provisions to 'enable joint appointments across different organisations’, specifically 'joint appointments between NHS Bodies; NHS Bodies and local authorities; and NHS Bodies and Combined Authorities' could make it easy for one individual to decide on parts of the NHS and social care in a local area to retain and develop, and other parts to diminish as they pursue efficiencies to fulfil the duty to meet the 'system' financial objectives.

- leave the issue of access to and funding of social care unaddressed yet again. There are many references in the white paper to how the government will bring forward separate proposals on social care later in the year. The government has been promising to take action on social care for years now and nothing has been done. Yet again, the government has failed to address the crisis in social care.

Furthermore, the white paper does not set out clearly how ICS budgets are going to be allocated. Given that the 'system' has to achieve financial balance, the question arises: will NHS and social care providers find themselves competing for resources at local level? For all the talk of joint working and the ‘duty to collaborate’ which the government intends to place on NHS organisations and local authorities, once ICSs are placed on a statutory footing, existing working arrangements between local NHS and social care providers will change.

There are many other concerns, not least the timing of these proposals. It is extraordinary that the government has chosen to bring them forward at a time when we are in the middle of a pandemic and public health crisis. Furthermore, the backlog of unmet health needs is at an unprecedented level due to the pandemic, with more than 4.5 million people in England waiting for hospital treatment – a figure that, it has been warned, could rise to nearly 7 million by the end of the year. This is no time to carry out a major reorganisation of the NHS.

We believe it is wrong for the government to be rushing ahead with major changes which have the potential to do so much damage to patient care and stability in the NHS when NHS and care staff are exhausted. Sir David Nicholson, former Chief Executive of NHS England, warned recently that the government’s impending shake-up of the NHS could prompt a lot of staff who are already exhausted by Covid-19 to quit.

The government's proposals would, if implemented, have profound implications for patients, NHS staff, care workers and unpaid carers across England. People have a right to know what the proposals contained in the white paper would mean for them. They deserve to understand how NHS and social care services would be impacted.

With the above in mind, we are calling on you to personally intervene and pause the whole process until all Covid-19 restrictions are lifted, and to then carry out a full public consultation on the proposals so that patients, NHS staff, care workers and unpaid carers can have their say.

We look forward to your response.

Yours sincerely,

Margaret Greenwood MP

Rt Hon Diane Abbott MP                                                  Debbie Abrahams MP
Paula Barker MP                                                               Apsana Begum MP
Richard Burgon MP                                                          Ian Byrne MP
Dan Carden MP                                                                Baroness Chakrabarti
Sarah Champion MP                                                        Janet Daby MP
Andrew Gwynne MP                                                         Lord Hendy
Rachel Hopkins MP                                                          Rt Hon Sir George Howarth MP
Kim Johnson MP                                                               Ian Lavery MP
Emma Lewell-Buck MP                                                    Caroline Lucas MP
Ian Mearns MP                                                                  Grahame Morris MP
Kate Osborne MP                                                             Bell Ribeiro-Addy MP
Zarah Sultana MP                                                             Claudia Webbe MP
Mick Whitley MP                                                               Mohammad Yasin MP


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