NHS Winter Crisis

Part of the debate – in the House of Commons at 3:21 pm on 10th January 2018.

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Photo of Margaret Greenwood Margaret Greenwood Shadow Minister (Work and Pensions) 3:21 pm, 10th January 2018

The crisis in the national health service this winter is real, and patients and NHS staff are feeling its effects. Thousands of operations have been cancelled, and ambulance crews and patients are waiting in A&E. On one day at Arrowe Park Hospital in my constituency, 26 ambulances, with patients and paramedics, were forced to wait more than an hour just to hand over patients. For 21 days in the period between 20 November and 31 December, we had a bed occupancy rate of over 99%, which is not safe or acceptable. Nineteen per cent. of ambulances that arrived had their handover delayed for over 30 minutes in that period, and 8% were delayed for more than an hour. We have heard of the terrible ordeals suffered throughout the country by patients and NHS staff stretched to the limit. Cancer operations have been cancelled and less serious elective surgery has been postponed until the end of January.

It is estimated that 55,000 operations will be delayed, but there is another crisis in the NHS this winter that deserves parliamentary attention: the Government’s plan to make regulatory changes to facilitate the introduction of accountable care organisations. The Government have failed to provide any time for parliamentary scrutiny of that plan on the Floor of the House. Accountable care organisations and accountable care systems are ideas that have been imported from America. In the US, Government and private insurers award large contracts to commercial bodies to run and provide services. We all know the horror stories of how expensive healthcare is in the US and how people with complex conditions find it difficult to obtain insurance. We hear stories of people with cancer who are forced to sell their home to pay for care. Those horror stories are real, so we all have a responsibility to guard against any introduction of private health insurance models in the UK, which is why we must scrutinise ACOs.

ACOs bring together health and social care so that there is a single finite budget to provide for a specific population. Once that budget has been spent, there is no extra money. ACOs are being developed for delivery in 44 STP areas rather than the country as a whole. It follows that if there is an increase in demand for healthcare in one of those areas—because of an epidemic or a serious accident, for example—the money that is taken out for that squeezes the rest of the system for health and social care.

A great strength of the NHS is that it provides a large risk pool for everyone in England so that they can be supported. Why would a Government who are committed to a national health service choose to replace a large risk pool with 44 little risk pools? It does not make any sense. At the heart of the issue is the serious fact that ACOs are non-NHS entities, so we need clarity from the Secretary of State. We need him to answer serious questions on the Floor of the House. Will ACOs be private companies? It seems logical that they might be, given that the idea has come from America and the Secretary of State considers that the American healthcare company, Kaiser Permanente, provides one of the best examples of practice in integrated care.

If ACOs are allowed to operate, they will be given multi-billion-pound health and social care budgets for 10 years or more. They will blur the boundaries between health and social care, and there is real concern that there will be an increase in the types of things for which people will be asked to pay. An ACO, once established, would have control of a huge budget for an area’s entire health and social care needs, so it would have a huge amount of power to determine what it does and, crucially, what it does not commission.

I have received a lot of correspondence from constituents who are very concerned that the introduction of ACOs is yet another major step towards the wholesale privatisation of the national health service. They have expressed real concern that ACOs could be a means to introduce private health insurance models area by area. That could not be done on a national basis because it would be politically unacceptable. Let us have no more talk about taking the politics out of the NHS. The NHS is a political entity. People need to take responsibility for their decisions around the Health and Social Care Act 2012.