Why UNISON needs to campaign on Integrated Care Proposals

On the face of it ICPs or Integrated Care Partnerships (or Services) proposed for England make a lot of sense. Anyone who has looked after an elderly relative or been in a carer role will know the frustrations of care falling between two stools. ‘Who does what?’ is often the question, and beneath a shallow surface, ‘who pays for what?’. But the model is flawed and lacks scrutiny. Like most ‘good ideas’ it has fallen into a bureaucratic framework which means ‘form’ is taking precedence over function.

The form in this case is the Health and Care Bill currently at Committee stage in Parliament. Whilst there are always concerns about the role of private companies in NHS provision some have sought to argue that the Bill in fact rolls back some of the damaging privatisation provisions from the 2012 reorganisation of the NHS.

A lot will depend on the new bodies who will inherit commissioning from the clinical commissioning groups, but there are few safeguards to prevent increased private sector involvement in NHS service delivery – though CCGs have hardly been the bastions of supporting in-house NHS or local authority services either.

At best the Bill is Janus faced. On the one hand it arguably removes some tendering requirements from NHS commissioners – something they have protested has been a costly waste of time – but on the other it could lead to unregulated procurement without tenders. Contracts for Cronies anyone?
It also reserves huge powers of intervention to the Secretary of State for Health – this is becoming something of a trade mark in Conservative Government legislation. Think the Localism Act of 2011, which reserved over 150 powers to the Secretary of State for Communities, in an Act that was supposed to devolve more powers to local councils and communities. So, assurances from Government that the Secretary of State would only use the Health and Care Bill powers sparingly, and if absolutely necessary, seems therefore somewhat obtuse. It begs the question why are these reserve powers to the Secretary of State needed?

There is also a question about how ‘National’ the NHS will be with over 40 new and very powerful regional bodies; which will involve the grouping up of existing NHS trusts. These new powerhouses of ‘Integrated Care Systems’ or ICSs will undoubtedly hold the keys to the cash tin for providers; and the private sector providers could have a seat at the table. This is likely to make contract awards opaque, with no separation between the judgement of what is ‘best value’ in awarding public money for the performance of a service contract.

And where do local councils sit in all of this? Although councils have a seat on these new Boards, they are set up to have only a minor role. Local authorities that ought to have a far greater role in ill-health prevention measures through physical activity programmes, better social care, child support, and other services like housing provisions, parks and local environmental quality - will be very much the junior partners around the table.  

They have already been told that any new cash for social care is in fact illusory as the new National Insurance increases - dressed up as a hypothecated tax for social care - is in fact nothing of the sort; it is simply a further tax to allow the NHS to catch up on its covid-created backlog. So once again the idea that this great new idea will support social care services – that are already on their knees both financially, and in terms of the human resources needed in the service, is a fundamentally weak assertion.

With the narrative around the Bill being ‘this is a good idea’ it will be hard for UNISON to punch through the fluffy language of integration. The big question yet to be answered is how will a Bill that of itself is unable to address the root causes of health inequality – poverty, education, even your post code – change outcomes for those in need of care. The simple answer to that is it probably will not!

Anna Rose