Legislation to reorganise the NHS will “institutionalise cronyism”, and could lead to funding cuts of more than £200 a patient in the most deprived areas of England, Labour has claimed.
Sajid Javid, the health secretary, will bring the controversial health and care bill back to the House of Commons on Wednesday for its second reading, which Labour will oppose.
The shadow health secretary, Jonathan Ashworth, told the Guardian it was “the wrong bill at the wrong time”.
“The Conservatives are embarking on a top-down reorganisation when we are still in a pandemic, when admissions are rising, and we are going steeply up the trajectory to 100,000 infections a day; when you’ve got hospitals in Birmingham and Leeds saying they’ve got to cancel cancer surgery because of the pressures they are under; when the waiting list has topped 5.3 million, so big you can see it from outer space,” Ashworth said.
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Under the complex reforms, more than 200 clinical commissioning groups (CCGs) will be replaced by just 42 much larger integrated care systems.
The government has not yet given details of how funding will be allocated to these new commissioning units but Labour analysis suggests that if existing budgets are spread evenly across the new regions, deprived areas could suffer significant cuts.
Blackpool could lose out by £287 a patient by being integrated into the much wider Lancashire and South Cumbria region, for example; Knowsley by £253 a patient as it joins Cheshire and Merseyside; and Salford by £116 a patient as it is swallowed up into the Greater Manchester health and care partnership.
Several Conservative MPs, including former prime minister Theresa May and liaison committee chair Bernard Jenkin, have already raised questions about the impact of the reorganisation on their local areas.
“There are deep concerns about what this bill means for patient care,” Ashworth said. “I do not believe it will improve patient care. I don’t believe it will integrate care: quite the opposite.”
Ashworth also warned that the legislation as drafted does not reserve an automatic place on the new ICS boards for patient representatives, or for mental health providers – though they can be invited to join.
“Once again, we have another reorganisation – and we’ve had 20 in the last 30 years – where patients are sort of left as like a ghost in the machine: they’re not thought about, and their interests are not brought to the fore at all,” he said.
And Labour claims the new powers the health secretary will take on as part of the shake-up could allow him to award lucrative outsourcing contracts to private companies.
“You don’t want the secretary of state given the power whereby they can hand out contracts to the private sector with no accountability, no transparency whatsover,” Ashworth said. “We are concerned that there are elements of this bill that are a privatisers’ charter, and we’ll be seeking to get those elements taken out of the bill.”
There is nothing in the legislation to prevent private healthcare providers sitting on an ICS, he claimed. That is already happening in Bath and North East Somerset, where Virgin Care, which delivers some local services, has a seat on the shadow ICS established to prepare for the shake-up.
The legislation would also scrap section 75 of the Health and Social Care Act 2012, which made it mandatory for all NHS contracts to be put out to competitive tender.
Citing multiple claims of cronyism during the pandemic, including former health secretary Matt Hancock’s local pub landlord receiving a contract to manufacture PPE, Ashworth said: “What this bill is about to do is to institutionalise that cronyism.”
The shake-up was the brainchild of Hancock, who said it built on the lessons learned during the pandemic.
When Javid introduced the legislation to parliament last week, he said it would make the NHS “less bureaucratic, more accountable, and more integrated in the wake of Covid-19”. He added that it would allow “closer collaboration between the NHS, local authorities and care providers to provide more joined-up working”.
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Some reports have suggested Javid was sceptical about the need for pressing ahead with the legislation, but the prime minister had insisted on it.
Ashworth also reiterated his criticism of the government’s decision to lift almost all Covid restrictions on 19 July, calling for mask-wearing to remain mandatory, and improved ventilation to be installed in public buildings.
