Integrated Care Systems

integrated care systems (ics) and the Health and Care Bill 2021-22

Statement by Doctors in Unite

The Health and Care Bill is now in Parliament, and a new Health Secretary in charge. Doctors in Unite branch of Unite the Union opposes the Bill, and calls for MPs and Lords of all parties to vote against it at every opportunity.

The Bill splinters the NHS into 42 separate ‘Integrated Care Systems’ (ICS), each with its own budget set at a level to promote ‘innovation’, and ‘new models of care’ from the US in pursuit of ‘financial sustainability’. This is also known as cuts and rationing, and where they chose to spend will be determined by what they call ‘best value care’ for the system. Local NHS services will be commissioned by, and finances portioned out by, a ‘streamlined’ IC Board, open to the private sector, and committing local authorities to a financial project without real democratic representation, accountability or control.

The Bill will bring the market and marketing, with profits for corporations and investors from ‘the rise of the consumer’ and the ‘certainties of capitated budgets’ in healthcare. Our future healthcare is to be impacted by transnational corporations and banks, and surely it is no accident that a former banker and Chancellor is now Health Secretary, while the Prime Minister’s NHS advisor for integration is the former CEO of Operose (the UK branch of Centene) Samantha Jones. Some 200 companies, at least 30 of them US-owned and prominent in the health
insurance market, are already accredited to help to develop and manage the Integrated Care Systems. They include Operose (which now controls dozens of GP surgeries and community services), Optum (owned by the largest US health insurance firm and previous employer of Simon Stevens- UnitedHealth), IBM, McKinsey, ATOS, Deloitte and Palantir.

Most importantly what will all this mean for patients and for NHS staff, whose wellbeing is essential to provide effective care?

For patients:
● more remote services resulting in fewer face-to face appointments creating a twotier health service, with access tied to an ability to use computers or smart phones

● less contact with GPs with more care given by less skilled and cheaper staff, and with less chance of seeing the same health worker

● growing expectation that patients will ‘self-care’, using phone apps or websites for advice or information

● more risk that services will be cut or rationed, and non-urgent referrals to hospital delayed or refused because of pressure on ICSs to make savings

● faster discharge from hospital without care assessments, and with family carers expected to take on more unpaid care due to lack of community services

● more confidential information being digitised and shared, with no clear protection for patient privacy.

For staff:
● a threat to national agreements on pay, terms and conditions as each IC Board will have their own limited budget and seek to cut costs

● flexible working, with staff redeployed across and even beyond the ICS area, undermining team working, union organisation, continuity of care, and thus creating more ‘work related stress’

● deskilling, as nursing and other jobs are advertised to candidates without the professional qualifications required, but asked to perform using standardised procedures and algorithms

● deregulation, as the Secretary of State will have the power to remove jobs from regulation with an apparent expectation that clinical decisions will be determined by new technology superseding the need for professional judgement and negating the need for staff development.

For democratic accountability and Local Authorities:
● The Secretary of State for Health will assume decision making power to impose local service reconfigurations weakening the power of scrutiny by local authorities

● the right of access by the public to board meetings and papers may also be threatened.

For legal protections:
● Exempting the NHS from the Public Contract Regulations 2015 will remove the associated environmental, social, and labour law protections (ILO conventions guaranteeing Freedom of Association and the Right to Strike). The government plans for the NHS will have reverberations throughout our society. The responsibility for budgetary constraint in our healthcare will be devolved from Government to each ICS, each of their provider Partners and every member of the public for whom they have core responsibility. The threats to staff should ring alarm bells for every trade union with members in the NHS, and the threats to patients should concern everyone.

Let’s stop this Bill now.