Baroness Smith of Basildon (Labour Lords Leader)

Baron Newby (Liberal Democrat Lords Leader)

Lord Judge (Crossbench Convener)

We the undersigned are writing to thank you for the work you have been doing in the House of Lords to ensure the government's Health and Care bill is fit for purpose. 

More specifically, we want to thank you for supporting your peers to put forward amendments to: 

1. ban individuals with a financial interest in private healthcare sitting on the new Integrated Care Boards and, 

2. make NHS Trusts and Foundation Trusts the default providers of all NHS care.

We encourage you to continue to fight for this issue at Report Stage and to push these amendments to a vote. We also encourage you to, where appropriate, whip your benches in support of these votes. 

Whatever a person’s views on the suitability of ICSs as the way to organise our NHS - and many of us believe it is unsuitable - most people of good faith agree that private companies should not get to decide how NHS money is spent and that NHS Trusts and Foundation Trusts should take priority over private companies in the commissioning of NHS services. 

Private companies should not decide how NHS money is spent:

A We Own It/Survation poll from July 2021 found that the majority of people in England opposed allowing private companies to sit on Integrated Care Boards (ICB), with 68% of people saying that allowing them to sit on those boards represents an unmanageable conflict of interest.

Virgin Care (which has recently been rebranded as HCRG Care Group) sits on the shadow, non-statutory Integrated Care Partnership Board of Bath, North East Somerset, Swindon and Wiltshire. After recent pressure, the ICS has pledged that they will not be invited to sit on the statutory ICB.

Similarly, the Buckinghamshire, Oxfordshire and Berkshire West ICS has responded to calls from their local community by pledging that private companies will not receive a seat on their statutory ICB.  

If the very people who will administer this new system already recognise the risks associated with allowing private companies a seat at the decision-making table, the House of Lords has a duty to take heed of this lesson and put a strong ban on the face of the bill.

The government’s amendment in the Commons, which leaves the decision at the discretion of the chair of each ICB is vastly unsatisfactory. It will lead to a lack of consistency in decisions about who sits on ICS boards across the NHS. As Baroness Finlay has pointed out, this opens our NHS to legal squabbles. 

NHS Trusts and Foundation Trusts should be the preferred providers of NHS services:

The Health and Care Bill scraps Section 75 of the 2012 Act, which required that contracts above a set value be put out to a competitive tendering process for all providers including private companies. 

This is a welcome move. But scrapping Section 75 without establishing a presumption in favour of commissioning with NHS Trusts and Foundation Trusts opens the door, as the British Medical Association (BMA) has pointed out, to contracts being handed to private companies without proper scrutiny and transparency.

Here are the reasons we believe that NHS Trusts and Foundation Trusts should be treated as the default providers of ALL care in the NHS:

• Recent examples in Covid contracting (such as the “VIP lane”) have highlighted the potential for abuse and have heightened public distrust around the idea of contracting services with the private sector. 

• NHS Trusts and Foundation Trusts do not typically abandon contracts when things get difficult. They are usually the ones that have to pick up the pieces when private providers bail out on their NHS contracts.

• Doing work within NHS Trusts and Foundation Trusts provides an opportunity to train doctors and nurses, which we don’t have when services are outsourced to private companies. This is especially important in light of the 90,000 staff shortages in the NHS.

• Staff pay and conditions are more secure in NHS Trusts and Foundation Trusts than in outsourced NHS services, which has a knock-on effect on quality.

• Outsourcing is fundamentally wasteful. Over the last decade, at least £96 billion has been paid to private providers for NHS services. In just one of those years for which we have figures, they made £831m in profits, money that should have gone into expanding and improving services for patients at a time of stringent budgets. 

Thank you so much for your time. We look forward to seeing your peers vote to back amendments to ban private companies on NHS boards and to make the NHS the default provider of NHS services.

Kind regards

The undersigned