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The Health and Care Bill Hollows Out the NHS As We Know It

The Health and Care Bill Hollows Out the NHS As We Know It

On Monday evening, Unite were joined by NHS campaigners and workers, representatives from the BMA Council, and Members of Parliament, as we rallied against the Conservative’s latest wheeze – the Health and Care Bill for England. Those that joined us on that dark and cold evening outside of Parliament added their names to over 300,000 people that have signed the petition against the Bill, including stars such as Stephen Fry, Jo Brand, David Tennant, Vicky McClure, Shaparak Khorsandi, Romesh Ranganathan and Frankie Boyle, who have also spoken out. 

On Tuesday evening, the Bill was voted through the Commons third reading, moving the fight for the future of our NHS to the next stage. The Government faced a rebellion and backlash over their social care cap, which discounts local council contributions towards the £86,000 cap on social care costs. Not only is the cap deeply regressive, but it fails to grapple with the present funding and staffing crisis, with nothing to address poor pay terms and conditions, huge workforce shortages, or the massive overall shortfall in funding of our social care. 

As well as this, Unite and our 100,000 health sector members have been clear since it was published that the Bill as a whole is the wrong prescription for our NHS. Our members have huge concerns about its impact on services, accountability, funding, professional standards, privatisation, safety, and terms and conditions. 

The Covid-19 pandemic has been one of the biggest and ongoing crises the NHS has ever faced. Yet it entered that crisis having undergone 10 years of cuts and underfunding, with the Conservative government since 2010 providing the worst funding settlements in our NHS’ history. Understaffing and waves of privatisation meant services were in critical condition from before the pandemic, and as we go into our second winter of the pandemic, the situation becomes more desperate. The NHS waiting list in England hit a record 5.45 million in August and social care is at breaking point, as local authorities have been left on the verge of bankruptcy after deep funding cuts.

In February of this year, the King’s Fund reported that the major shortage of nearly 84,000 full-time equivalent staff included 37,000 nurses (1 in 10 of all nurse roles), driven by multiple factors including under-investment in training, low pay and stress. With 28 percent of nurses and health visitors leaving the NHS within the first three years of their service, evidence suggests that recruitment is only part of the solution, and more must be done to retain staff. Despite this, and the distressing experience of the pandemic following a decade of real cuts, the government instead offered staff another year of real pay cuts with a grossly inadequate 3% offer. 

As well as failing to give staff the pay they deserve, the government is pursuing this Health and Care Bill which completely fails to grapple with the workforce shortages we face now and fails to build the workforce of the future. Instead of legal obligations on safe staffing levels, the protection and enforcement of professional standards, and maintenance of national terms and conditions of employment, the Secretary of State would be given powers to deregulate clinical professions. 

Local areas would also potentially be able to vary pay, terms and conditions of staff, undermining national terms and leading to serious issues that would make staffing shortages worse, with poorly-funded areas seeing this as an easy way to cut costs, and more affluent areas being able to poach staff. 

Under this Conservative government, which has demonstrated its passion for awarding large sums of money to the private sector and its friends time and again, there is also a very clear and present danger of further waves of privatisation being hardwired into our health system and hollowing out the NHS as we know it. 

By June of this year, the government had awarded £37.9 billion worth of contracts related to the coronavirus crisis to private companies, the vast majority without a competitive tender. As the backlog from the pandemic continues to grow, under current government plans the NHS will remain hobbled by lack of capacity and chronically dependent on private hospitals and contractors. The Health and Care Bill will lead to local contracts being awarded with even less scrutiny and oversight than at present.

This Bill also does not place an obligation on the government or Secretary of State to ensure the provision of a universal and comprehensive health care service or to ensure its funding. Instead, the Bill retains the ‘marketplace’ of NHS services, and provides the Secretary of State sweeping new powers of control, restructure and decision-making, eliminating the need for legislation if the government chooses to undertake further reforms. 

Through the Health and Care Bill, our NHS in England will be split into 42 different areas, run ‘independently’ by newly created boards appointed by this government. The Bill allows for the appointment of private providers - but not public oversight or accountability - as these boards will be able to operate like commercial entities, maximising budgets over care and allowing profits through the denial of care, along the lines of the American health insurance industry. 

The pandemic has demonstrated, yet again, how valuable free, universal health care is to us as a society, and that access to good, free health care is a human right. Sustainable public funding, well-trained and rewarded staff providing quality care, and a publicly owned NHS are not a tax burden or problems to be solved, but an investment in all of our futures. The coming generations deserve for the NHS to care for them, as it has done for us since 1948. That is why Unite is committed to continuing the campaign to fight for our members’ jobs, terms and conditions, and our NHS, for all of us. 

You can keep up to date with the campaign at and add your name to the petition against the Health and Care Bill at

PHOTO: Photo © Jim Osley (cc-by-sa/2.0)