Unite members vote to support NHS Reinstatement Bill

We are pleased to announce that the members of Unite have voted unanimously in favour of supporting the NHS Reinstatement Bill.

The vote took place on 23rd November 2015, at the health sector conference at the Unite National Industrial Sector Conference. The motion for support for the NHS Bill was proposed by the National Committee, having already been passed by the West Midlands Regional Health Committee.

It was passed unanimously.

Over a hundred thousand health members were represented by the conference delegates that passed this motion. Unite the union in represents 1.42 million members. That’s a lot of people.

Would your union support the NHS Bill? Keep our NHS Public have a produced a downloadable draft motion – it is the motion that was passed by Unite members – and is available here.

Find out if our local NHS services are at risk – two minute action

A crucial time for one of the main mechanisms to cut NHS services is now upon us.

From April 2016, the ability of NHS Foundation Trusts to stop providing certain NHS services will increase.


Monitor Guidance CoverFrom next April, because of licence changes planned by Monitor, some services that used to be compulsory for Trusts to provide, and have been protected since April 2013, can lose their protection.

The worry is that as pressure on NHS funding increases, unprotected services would be at risk, down the line, if not immediately.


The NHS Bill would stop these changes going ahead, but under a Conservative Government, the Bill is highly unlikely to pass and so will not change the law in time to prevent the changes. More detailed information on the technicalities is available at the end of this page.

But we don’t have to accept this as a fait accompli. We can at least try to find out exactly what’s going on in our local areas and which services are at risk; make our views known and object where necessary.

Below is an example of a letter that, health lawyer Peter Roderick has sent to his clinical commissioning group (CCG) that you can adapt to send to your own CCG.

CCGs have an obligation to respond under the Freedom of Information Act.

Find your Clinical Commissoning Group address here.

Dear Sir/Madam,

Re: Designation of Commissioner Requested Services

As you will be aware, Monitor told CCGs in March 2013 that your responsibilities include “designating a range of services that local commissioners believe should continue to be provided locally if any individual provider is at risk of failing financially. We call these Commissioner Requested Services…”, and issued Guidance and a Designation Framework.

You may also be aware that from April 2013 until April 2016 services that NHS Foundation Trusts were required to provide under their old authorisations were automatically designated as Commissioner Requested Services in their new licences. But Monitor has also said that “[o]ver time, commissioners should review this automatic classification and we expect the number of services that are designated as Commissioner Requested Services to decrease as a result.”

I am concerned about the expected reduction in services and would like to be informed of the progress the CCG has made in the process of reviewing and re-designating services as Commissioner Requested Services from April 2016.

In particular, I would be grateful if you would:

(1) specify which services that are currently provided by each NHS Foundation Trust with whom you contract and which are designated as Commissioner Requested Services at that trust, will not be so designated on completion of that process. (If the process has already been completed, please specify the services that have not been so designated.);

(2) explain why you have decided, or will decide, not to designate those services as Commissioner Requested Services;

(3) inform me where those services will be available in the future. I look forward to hearing from you as soon as possible.

Yours faithfully,


Further Action


Please do let us know how you get on – by emailing <info@nhsbill2015.org>

Cutting NHS services at Foundation Trusts - find out more on the technicalities

Under the Health and Social Care Act 2012, clinical commissioning groups (CCGs) buy services from providers, especially from NHS Foundation Trusts.

Since April 2013, services provided by NHS Foundation Trusts fall basically into two categories: Commissioner Requested Services (CRS), and the rest.

Services that are designated as CRS are subject to “continuity of service” conditions in a trust’s licence – these are typically in section 5 of the licence. The conditions place restrictions on cutting or altering these services – though they do not stop them being cut.

For example, the trust must have an Asset Register that lists the buildings and equipment used to provide CRS, and selling off these needs Monitor’s consent.

Services that are not CRS are not subject to any such restrictions. So the more services that are not designated as CRS, the more freedom an NHS Foundation Trust has to do what it likes – so long as 51% of its income comes from NHS services.

In April 2013, the services that NHS Foundation Trusts had to provide under their old authorisations were automatically designated CRS in their new licences for 3 years.

But Monitor told CCGs in March 2013 that their planning and purchasing responsibilities include “designating a range of services that local commissioners believe should continue to be provided locally if any individual provider is at risk of failing financially. We call these Commissioner Requested Services…”.

At the same time Monitor issued a four-stage Designation Framework that CCGs are supposed to use to come up with a new list of CRS by April 2016 on the assumption that the trust would go bust. Monitor said “Over time, commissioners should review this automatic classification and we expect the number of services that are designated as Commissioner Requested Services to decrease as a result.”

In other words, services which were mandatory until April 2013, and which for 3 years afterwards have some protection from “continuity of service” conditions, are expected to decrease.

BMJ Front cover 11 October 2014 copyMore detailed information is provided in the article written by Peter Roderick and Allyson Pollock in the British Medical Journal.

Response to post on Socialist Health Association website

Allyson Pollock and Peter Roderick have written a response to a post on the Socialist Health Association website by Irwin Brown on the NHS Reinstatement Bill.

The full response is available as a pdf here, and also posted below.

Irwin Brown writes: “The NHS Reinstatement Bill is expected to have its second reading in March 2016. It would replace the current NHS architecture with a return to Regional and District Health Authorities.”

Our response: The Bill does not do this. The Bill replaces clinical commissioning groups (CCGs), transforms NHS England into a Special Health Authority, and abolishes the market structures (NHS Trusts, NHS Foundation Trusts and Monitor). The Bill does not return to regional and district authorities (the first consultation draft put out in August 2014 proposed district authorities and regional committees of NHS England). The Bill replaces CCGs with Health Boards (the bodies in Scotland and Wales) approved by the Secretary of State on the basis of bottom-up proposals. The Bill also proposes regional committees of NHS England (as in the first consultation draft).


IB writes: “[The Bill] seeks to address some genuine problems but it is the wrong solution. Nobody believes the Bill can become law but it raises some key issues about the NHS. What is important is that looking at such a narrow and technical issue should not be allowed to drown out more important discussions around social care and funding. There are no solutions any more looking at the NHS in isolation.”

Our response: The Bill is neither narrow nor technical. It is returning the NHS to its founding principles after 25 years of marketisation favoured by Tory and New Labour governments. And it’s not looking at the NHS in isolation; it contains the only specific statutory proposal we are aware of for initiating a systematic integration of health and social care in England, along the lines implemented in Scotland.


IB writes: “Trying to raise public interest in campaigns which deal with NHS structures is unlikely to have any impact. The claim is that the Bill would prevent privatisation and reinstate the NHS; although few believe we have already lost our NHS – the public certainly don’t.”

Our response: Thanks for telling us we’re wasting our time! This isn’t our experience. When people are informed of what market policies have done to the NHS, many are incensed. New Labour denial and Tory stealth reinforce disillusion with politics.


IB writes: “Of course passing legislation cannot prevent anything, any determined administration would just pass its own legislation. The only way to prevent privatisation is to elect a government that is against it.”

Our response: Passing legislation is necessary in order to prevent privatisation. IB seems to be saying something else – about how such legislation could happen. But it’s not an argument against new legislation to say that later legislation can amend it. (It might be an argument for never legislating, but that’s another topic!)


IB writes: “In Scotland and Wales there is no market but also no need for actual legal prohibition on the use of private providers. In the 1980’s when a structure such as that proposed by the Bill was in place the Tory government imposed Compulsory Competitive Tendering on the NHS; although it chose for political reasons not to extend this into clinical services.”

Our response: After three very different points (there are more important issues, public campaigns won’t work, and legislation doesn’t prevent anything) now a change of tack: the Bill won’t do what it is supposed to do. Please identify the provisions of the Bill that allow compulsory competitive tendering, and we’ll plug the hole – this is the last thing we want it to do.


IB writes: “The NHS does not need another redisorganisation. There has been no impact analysis but it appears that implementing the Bill would require the biggest ever top down imposition, far bigger even than the last one or the one in 1990s. Every part of the system would be affected. Over 500 organisations would have to be wound up and the assets (and liabilities) transferred to the new Authorities – that alone would cause enough arguments to remove any focus on delivering care. Then over 1 million staff would have to be transferred into new organisations; tens of thousands of senior staff would have to compete for new jobs in new organisations; tens of thousands of contracts would have to be re-negotiated. Other organisations such as the over 200 local authorities would also be embroiled and an unknown number of private or semi-private providers. Doing this in stages would just make things worse. Every local authority would have to get engaged in lengthy discussions with all the local existing health organisations about how the new structures would be set up – scope for years of argument.”

Our response: Now a fifth point. Minimising disruption is very important, but this is an argument for the status quo and ignores the continuing dismantling of the NHS currently underway as Simon Stevens’ Five Year Forward View is implemented. The 2012 Act implemented a marketised system which enables the withdrawal and closure of services, with marketisation and fragmentation of what remains. The challenge is to remove the purchaser-provider split whilst minimising disruption – which Scotland and Wales have done.


IB writes: “In reality across England reorganisation is taking place but through local initiatives not a top down imposition. By 2020 the NHS will have undergone a whole series of localised reorganisations under devolution and through vanguards projects. Some 50 odd schemes are already under way all of which flout the existing competition requirements. There is much to commend and much that causes concern about these schemes – and the risks are well worth a proper policy discussion.”

Our response: Describing devolution and the vanguard projects as bottom up is a novel characterisation. The reported remarks of Stephen Hall, Greater Manchester’s TUC President – that the devolution process is ‘a complete mockery of democracy.’ – make more sense. And flouting legal requirements isn’t a sound foundation for supporting an argument – there should be no competition requirements. Simon Stevens is implementing the insiders’ market consensus. At the same time GP surgeries and hospitals are closing across the country risking leaving patients without easy access to care, as a result of CCGs withdrawing contracts and funding.


IB writes: “There could be some reductions in management and administration running costs from removing the market but the claim that removing the market would reduce NHS expenditure by £10bn pa is not supported by any evidence or by any rational analysis despite thorough work by bodies such as the Kings Fund looking at the impact of commissioning.”

Our response: Accurately quantifying the costs of a market bureaucracy is fraught with difficulty, but there is no doubt that the costs of a market bureaucracy are significantly more than the costs of a public bureaucracy. Professor Calum Paton’s paper in February 2014 gives a good overview analysis. He cites the usually mentioned figures for administrative costs (5% before the 1980s, 14% by 2005), and conservatively estimates that “at least £5 billion of the NHS’s recurrent i.e. continuing, year-on-year running costs relate to the market”.

Quantifying needs collection of data, but this is what in March 2010, after 13 years of New Labour government, the House of Commons Select Committee said:

“Whatever the benefits of the purchaser/provider split, it has led to an increase in transaction costs, notably management and administration costs. Research commissioned by the DH but not published by it estimated these to be as high as 14% of total NHS costs. We are dismayed that the Department has not provided us with clear and consistent data on transaction costs; the suspicion must remain that the DH does not want the full story to be revealed. We were appalled that four of the most senior civil servants in the Department of Health were unable to give us accurate figures for staffing levels and costs dedicated to commissioning and billing in PCTs and provider NHS trusts. We recommend that this deficiency be addressed immediately. The Department must agree definitions of staff, such as management and administrative overheads, and stick to them so that comparisons can be made over time.”

It is also worth noting that in the US, the Institute of Medicine calculated that:

“about 30 per cent of health spending in 2009 – roughly $750 billion – was wasted on unnecessary services, excessive administrative costs, fraud, and other problems”

Certainly, to say that “there could be some reductions in management and administration running cost” from the NHS Bill is far off the mark – it will be billions.

We are not aware of the Kings Fund’s work referred to. But we do recall the promise in the 1997 Labour Party manifesto:

“There can be no return to top-down management, but Labour will end the Conservatives’ internal market in healthcare. The planning and provision of care are necessary and distinct functions, and will remain so. But under the Tories, the administrative costs of purchasing care have undermined provision and the market system has distorted clinical priorities. Labour will cut costs by removing the bureaucratic processes of the internal market.”

In the event, of the three pillars of the Tories’ internal market – GP fund-holding, the creation of NHS trusts and the purchaser/provider split – New Labour only abolished GP fund-holding.


IB writes: “There is also often reference to the experience of Wales and Scotland which have removed the market. In Wales the experience was that the first attempt actually caused much upheaval and increased costs – although the second attempt was far more successful. In both devolved systems the main aim was achieved although so far there is no evidence of major management and administrative cost reductions. But the systems are much smaller and simpler than the fragmented monstrosity that we now have in England.”

Our response: We agree that the NHS in England is fragmented. But the implication that it is some sort of behemoth of gigantic proportions is wrong. Historically, like Scotland and Wales, England’s NHS was heavily decentralised through its regional and area or district structures. This is well described by Charles Webster in his official history and also by Geoffrey Rivett in From Cradle to Grave. Area health authorities had a great deal of autonomy to decide how to meet the needs of their residents and how to provide those services. The internal market and PFI took away a great deal of that autonomy and the ability to plan soundly. Services in Scotland and Wales are not less complex than England, albeit they serve smaller populations, and both have problems of extreme rurality. Scotland has more beds and staff per head of population and lower administrative costs in the hospital sector.

If there’s a simple way to get rid of the market, then that’s the one to go for – but let’s not be seduced. It was easier to do that in Scotland and Wales, because neither had foundation trusts, Monitor or CCGs, and neither had abolished the government’s ‘duty to provide’.


IB writes: “Labour is committed to a policy to stop the privatisation of care services and where possible to reverse it. That policy was constructed in a way which ensured that decisions about how services were provided could be made without any external interference by procurement or competition law; domestic or EU or beyond. This was set out in the last parliament by Clive Efford’s Bill which relied on expert advice from those actually currently working in the relevant areas. It gave a solution which cost virtually nothing to implement and required little in terms of any reorganisation.”

Our response: It would be good to see Labour saying that they want to stop and reverse privatisation, and to explain where and why reversal is not possible. But to do so means going beyond New Labour’s Efford Bill – not least because its characterisation of the NHS as a “service of general economic interest” appeared to defer unnecessarily to EU competition law. Certainly, copying and pasting the first section of Andrew Lansley’s 2012 Act – which the Efford Bill did – made it very difficult to believe that New Labour really did want to stop and reverse privatisation. See our analysis of that Bill here.


IB writes: “The Efford Bill did not remove the commissioner/provider split, but then it was never intended to do that. It has been rightly said many times that there is always commissioning even in Wales and Scotland; it is how it is done that is important. In the non-market system as proposed by Labour the nature of commissioning in England would change to one that was not driven by competition between providers and by market behaviour, so commissioning becomes more like planning and the internal market is removed.”

Our response: Again, it would be good to see Labour’s proposals for a non-market system. But the reasoning here makes us wary. ‘Commissioning’ as an activity is central to the market and contracting. It was introduced in 1990 in order to separate assessing needs, planning services to meet those needs, setting clinical standards, matching funding to delivery, capturing information to support the various stages of the cycle, and ensuring accountability – necessary tasks that had always been done ‘in house’ – from the new marketised providers, the NHS Trusts. Since then, we have as well NHS Foundation Trusts (now 51% NHS, 49% non-NHS), other private licensed providers, their regulator Monitor and CCGs. Separating ‘commissioning’ from ‘providing’ and so keeping these market structures and the financial flows means keeping the market. So the really interesting question for Labour under Jeremy Corbyn – a supporter of the NHS Reinstatement Bill, with John McDonnell and more than a dozen other Labour MPs at the last count – is whether they will get rid of the purchaser-provider split as Wales and Scotland have done.

Getting rid of the split means keeping the tasks of planning and providing in one body, and that necessarily means getting rid as well of the remaining element of the Tories’ internal market New Labour promised to get rid of in 1997 (NHS Trusts), of New Labour’s 2003 extensions (Foundation Trusts and Monitor) and Lansley’s 2012 abolition of the duty to provide and creation of membership-based not area-based bodies (CCGs).

This isn’t a technical or purely structural issue, it goes to the heart of the founding principles. The NHS is for everybody. Restoring contiguous geographic areas of administration means that services are planned, managed and provided within one body – health boards – that cannot exclude people from services but must plan them to meet needs of all residents in an area. Area-based structures include everyone in their area. This flows from the Secretary of State’s duty to provide “throughout England” (key words missing from the Efford Bill). This is not the case for the 200-odd CCGs who only have to contract for “persons for whom they are responsible” – a new conception, with new powers for the government to make regulations to include and exclude. So instead of covering everybody in its area, whether a given person is entitled to services now depends on whether they qualify as “a person for whom the CCG is responsible”. Despite a CCG having an “area”, its duty to contract for services with providers is not to do so for people in its area, but for people for whom it is responsible. This new idea makes CCGs membership-based organisations drawn basically from GP lists, and the abolition of practice boundaries in January 2015 accelerates this process.

Getting rid of the internal market will also make PFI deals a thing of the past as hospitals would not be able to enter into PFI deals which were a key mechanism for privatising ancillary staff nor would they be able to negotiate different terms and conditions for individual staff and staff groups departing from national terms and conditions.


IB writes: “So the NHS Bill will not achieve what is claimed, would be very hard (impossible?) to implement and is not really necessary. There are many policy issues to discuss that should get far more attention. But – a change in Government is what is actually required.”

Our response: We agree, a change of Government is required, urgently. But the NHS Bill is supported by over 70 MPs from five parties and the BMA, and is building support amongst local Labour parties (including Clive Efford’s) and trade unions. To say that the NHS Bill is worthy of comparatively little attention is dismissive (though obviously meriting a blog) and – we hope – yet another indicator of the death knell of Blairism.


Allyson Pollock and Peter Roderick, 11th November 2015

BMA position on NHS Reinstatement Bill

Below is BMA position on the NHS Reinstatement Bill.

It is taken from a report that looked both at the proposed NHS Reinstatement Bill, and also the National Health Service (Amended Duties and Powers) Bill (also known at the ‘Efford’ Bill), that was put forward by Labour MP Clive Efford in 2014 but was filibustered out in committee prior to the 2015 General Election.


The BMA has strong policy in nine areas of particular relevance to the issues covered by one or other or by both Bills:

i. Repeal the Health and Social Care Act 2012,
ii. Restore the Secretary of State’s duty to provide,
iii. Limit the Secretary of State’s powers over operational matters and day-to-day running of the health service,
iv. End the purchaser-provider split, the internal and external market and competition,
v. End PFI,
vi. exempt the NHS from TTIP,
vii. Oppose a charging system for asylum seekers and undocumented migrants,
viii. Ensure public accountability, and
ix. Support national terms and conditions of service.

We consider that these areas of policy are the clearest and simplest way of framing the TFG’s work. We therefore adopt this approach below.

(a) and (b) Repeal the Health and Social Care Act 2012, and restore the Secretary of State’s duty to provide

Neither Bill repeals the 2012 Act as such. Both Bills repeal some of it. The Reinstatement Bill repeals more of it than the Amended Duties Bill.

As regards restoration of the duty to provide, paragraphs 15-19 of the final report are almost entirely accurate.

Restoration of the SoS’s duties to provide or secure provision (Clause 1) and to provide listed services throughout England (Clause 3) only appears in the Reinstatement Bill, both of which are in line with BMA policies. Unfortunately, only restoration of the latter duty is recognised in the final report as
being in line with BMA policies.

(c) Limit the Secretary of State’s powers over operational matters and day-to-day running of the health service

The Reinstatement Bill limits the Secretary of State’s powers over operational matters and day-to-day running of the health service by imposing restrictions on the power of issuing directions, based on the general duty of autonomy in the 2012 Act which the Bill would repeal. The Amended Duties Bill does not include express restrictions on the power to issue directions, and does not repeal the duty of autonomy.

Paragraphs 20-26 are incoherent and contain several inaccuracies. They appear to be seeking to fabricate a pretended conflict between BMA policies to restore the duty to provide – the legal foundation of the NHS since 1946 – and generalised ‘political interference policies’ which are not described or synthesised to help the reader understand what they actually say. The text of the relevant policies are more nuanced and specific, namely: they recognise damaging short-term political initiatives, believe that ministers should set policy and not control operational matters; and state that the NHS is far too important to be left in the hands of the politicians (both 2005, PB page 245); and propose an independent board for NHS management with a long-term strategy free of party political interference (2008, page 244).

The legal duty to provide is a quite separate matter from damaging short-term political initiatives, control of operational matters and management, and the desirability of a long-term strategy (which we support).

(d) End the purchaser-provider split, the internal and external market and competition

The BMA has clear, strong and reiterated policies over several years opposing the purchaser-provider split, the internal market and commercialisation. In 2011 it called for market-based policies to be abandoned, and in 2013 called on the BMA to defend the NHS. Some of these policies are accurately identified and synthesised in paragraph 28 of the final report.

The Reinstatement Bill abolishes the purchaser-provider split and is in line with these strong and reiterated policies opposing the market, competition and commercialisation.

The Amended Duties Bill does not abolish the purchaser-provider split, and extends NHS contracts to private providers (Clause 6(5)) but the final report does not mention this. It does abolish the 2012 Act’s main competition provisions,

As stated above, however, rather than evaluating the consistency and strength of BMA policies against the internal and external market, and noting the clear difference between the two Bills, the final report sets up another pretended conflict between these policies, and concerns about the potential
disruption from structural changes – and then fails to mention the provisions in the second version of the Reinstatement Bill which set out a flexible approach and timescale to bottom-up implementation led by local authorities working with current bodies to design the new structures. The TFG should be championing BMA policies against the market loudly and clearly.

(e) End PFI

Seven strong and clear policies opposing PFI have been identified. Most recently in 2014, the ARM demanded legislation to rescind all NHS PFI debt and demanded that government does not enter into any new PFI scheme. The Reinstatement Bill would centralize PFI debts in the Treasury and require the Treasury to report to Parliament on its proposals for reducing them.

(f) Exempt the NHS from TTIP

In 2014, the ARM demanded that the NHS is exempted from TTIP, believing that the treaty will tip the balance of power further towards private corporations and away from the public sector. Both Bills are in line with this policy.

However, it is not accurate to state in paragraph 92 that the Amended Duties Bill specifically exempts the NHS from TTIP – Clause 14(1) only applies to procurement and competition obligations, and so would not extend, for example, to dispute-settlement procedures or advance notice to the US
government of proposed regulatory measures.

Neither is it accurate to state paragraph 94 that the Reinstatement Bill seeks to require parliamentary approval of any international treaty that has an impact on the NHS in terms of procurement or competition regulations – its impacts are not so limited.

TTIP is subject to the EU common commercial policy, and the UK does not currently have formal legal competence in this regard.

(g) Oppose a charging system for asylum seekers and undocumented migrants

We agree with paragraphs 107 and 108 of the final report on this matter: the Amended Duties Bill is silent on this issue, and the Reinstatement Bill is in line with BMA policy opposing a charging system for asylum seekers and undocumented migrants.

(h) Ensure public accountability

The BMA has policy in support of the public accountability of senior executives in the NHS and of the health service as a whole; neither Bill focuses on this explicitly. The Reinstatement Bill addresses this in clause 17 by re-establishing CHCs, with the purpose of representing the interests of the public within the health service.

(j) Support national terms and conditions of service

Unfortunately BMA policies on this vitally important issue were not synthesised and added to the final report. It is important that any statutory provision relating to that matter furthers BMA policies, the Reinstatement Bill does this clearly, but this matter has been blown up out of all proportion in the summary in an attempt to undermine the Reinstatement Bill. A constructive approach would be for BMA council to specify clearly the legal provisions it wishes to see on terms and conditions of service.


Junior Doctors are now paying the high costs of the market in health care

Junior doctors have now agreed to ballot for industrial action. If they go on strike it will be for the first time in 40 years. Negotiations between the BMA and the body known as NHS Employers have broken down because NHS Employers want to extend routine working hours from 60 per week to 90, remove safeguards which protect both patient and doctor safety and reduce junior doctors pay. Junior doctors will work longer more antisocial hours for less money and with fewer breaks.

But the real reasons for the squeeze on staff and junior doctors pay and terms and conditions are not being explained to them or to the public. At the root of these negotiations is a cost-cutting exercise which will do nothing to enhance patient safety. Expenditure on the NHS is falling as a percentage of GDP from 6.5% in 2012-13 to 6.2% in 2015-16. Outgoing NHS chief executive David Nicholson told everyone that these cuts would mean the NHS would need to find 20 billion pounds in efficiency savings by 2015. Against this background of cuts in total health expenditure come three main pressures – the private finance initiative, escalating drug budgets, and the costs of marketisation and privatisation of clinical services.

Annual payments for PFI hospitals are ring-fenced and must be paid before any money can be allocated for staff or patient care. However, PFI payments are linked to the retail price index and hence the cost rises year on year while the NHS budget is falling. Some PFI hospitals may be paying as much as 30% of their annual income out on PFI charges. The NHS may pay more than ten times the original construction costs over the life of the contract.

Meanwhile the cost of medicines is rising and takes a bigger share of the NHS budget year on year. In 2013-14 the drugs budget increased by 7.6% from the previous year – to 14.4 billion pounds. The costs of medicines rose by 15% in hospitals and 3.4% in primary care in 2013-14 compared with the year before. The pharmaceutical industry makes between 20% and 40% profit on the medicines it sells to the NHS. Last year, US giant Pfizer, which supplies the NHS with drugs and is the world’s largest drug company by pharmaceutical revenue, made a 42% profit margin. This means that up to 6 or 7 billion pounds is likely to be flowing out of the NHS and into pharmaceutical company profit each year.

And now to cap it all, since the Health and Social Care Act 2012, the government has embarked on the break-up of the NHS and privatisation of clinical and non clinical services, wasting billions of pounds on commercial contracts, legal fees and management consultants. In all instances money is diverted to shareholders rather than patient care. In the US, 30% of the health care dollar is spent on market administration. The NHS used to spend less than 6% but it is likely to be approaching 30% now. Once services are in the market, the NHS has no direct control over any of these costs. PFI is a good example where the contracts are signed for 30 to 60 years. The only costs the NHS can control are the staff it employs. Since staff costs are the biggest element of the NHS budget, NHS Employers which represent all the NHS Trusts have responded by cutting the terms and conditions of staff.

It’s the patients, staff and taxpayers who lose out from the marketisation of the NHS. It’s the patients and doctors who lose out when they cannot provide safe and high quality care.

This is why in supporting the junior doctors strike we must also call for the market to be taken out of the NHS. The NHS Bill 2015 currently in parliament – cosponsored by Caroline Lucas, Jeremy Corby and John McDonnell (amongst others) – and which has the support of the BMA would do just that.

Read more on this issue on the BMA site.

Take it to your union

Are you a union member? Would you be prepared to put forward a motion calling for support for the NHS Bill?

Keep Our NHS Public have drafted a model motion that can be adapted by any union branch, local party or association to be used to make the NHS Bill law.

Please download the motion, and help build the momentum behind the NHS Bill.


NHS Bill tabled in parliament – 1st July 2015

On Wednesday 1st July the NHS Reinstatement Bill was presented to the House of Commons by Caroline Lucas of the Green Party supported by a cross party group of MPs representing Labour, SNP, the Liberal Democracts and Plaid Cymru.

The Bill has been published under the name of the ‘National Health Service Bill’ and is publically available on the parliament website. It is scheduled for a second reading on 11 March 2016.

12 MPs is the maximum number that can add their names to a private members bill when it is presented in parliament. The 12 MPs who are named as supporters of the NHS Bill are:

Caroline Lucas (Green, Brighton Pavilion)

Philippa Whitford (Scottish National Party – Health Spokesperson, Central Ayrshire)

Cat Smith (Labour, Lancaster and Fleetwood)

John Pugh (Liberal Democrat, Southport)

Hywel Williams (Plaid Cymru, Arfon)

Jeremy Corbyn (Labour, Islington North)

Michael Meacher (Labour, Oldham West) (sadly Michael passed away on 20th October 2015)

Eilidh Whiteford (Scottish National Party, Banff and Buchan)

Rob Marris (Labour, Wolverhampton South West)

Kelvin Hopkins (Labour, Luton North)

John McDonnell (Labour, Hayes and Harlington)

Roger Godsiff (Labour, Birmingham Hall Green)

Two more Labour MPs also offered to add their name to the Bill, but were unable to be added because of the 12 MP limit:

Margaret Greenwood (Labour, Wirral West)

Richard Burgon (Labour, Leeds East)



2015 MPs – Who supports the NHS Reinstatement Bill?

78 MPs, representing five different political parties, have stated their support for the NHS Reinstatement Bill. They are listed below.

If you think names should be added (or removed) from this list, please email us: info@nhsbill2015.org

Name Party Constituency
Caroline Lucas Green Brighton, Pavilion
David Anderson Labour Blaydon
Richard Burgon Labour Leeds East
Ronnie Campbell Labour Blyth Valley
Jeremy Corbyn Labour Islington North
Nicholas Dakin Labour Scunthorpe
Peter Dowd Labour Bootle
Roger Godsiff Labour Birmingham, Hall Green
Margaret Greenwood Labour Wirral West
Kelvin Hopkins Labour Luton North
Ian Lavery Labour Wansbeck
Clive Lewis Labour Norwich South
Rob Marris Labour Wolverhampton South West
Rachael Maskell Labour York Central
John McDonnell Labour Hayes and Harlington
Ian Mearns Labour Gateshead
Steve Pound Labour Ealing North
Cat Smith Labour Lancaster and Fleetwood
Keir Starmer Labour Holborn and St Pancras
Catherine West Labour Hornsey and Wood Green
John Pugh Liberal Democrat Southport
Hywel Williams Plaid Cymru Arfon
Richard Arkless Scottish National Party Dumfries and Galloway
Hannah Bardell Scottish National Party Livingston
Mhairi Black Scottish National Party Paisley and Renfrewshire South
Ian Blackford Scottish National Party Skye and Lochaber
Kirsty Blackman Scottish National Party Aberdeen North
Phil Boswell Scottish National Party Coatbridge, Chryston and Bellshill
Deidre Brock Scottish National Party Edinburgh North and Leith
Alan Brown Scottish National Party Kilmarnock and Loudoun
Lisa Cameron Scottish National Party East Kilbride, Strathaven and Lesmahagow
Douglas Chapman Scottish National Party Dunfermline and West Fife
Joanna Cherry Scottish National Party Edinburgh South West
Ronnie Cowan Scottish National Party Inverclyde
Angela Crawley Scottish National Party Lanark and Hamilton East
Martyn Day Scottish National Party Linlithgow and East Falkirk
Martin Docherty Scottish National Party West Dunbartonshire
Stuart Donaldson Scottish National Party West Aberdeenshire and Kincardine
Marion Fellows Scottish National Party Motherwell and Wishaw
Margaret Ferrier Scottish National Party Rutherglen and Hamilton West
Stephen Gethins Scottish National Party North East Fife
Patricia Gibson Scottish National Party North Ayrshire and Arran
Patrick Grady Scottish National Party Glasgow North
Peter Grant Scottish National Party Glenrothes
Neil Gray Scottish National Party Airdrie and Shotts
Drew Hendry Scottish National Party Inverness, Nairn, Badenoch and Strathspey
Stewart Hosie Scottish National Party Dundee East
George Kerevan Scottish National Party East Lothian
Calum Kerr Scottish National Party Berwickshire, Roxburgh and Selkirk
Chris Law Scottish National Party Dundee West
Angus MacNeil Scottish National Party Na h-Eileanan an Iar
Callum McCaig Scottish National Party Aberdeen South
Stuart McDonald Scottish National Party Cumbernauld, Kilsyth and Kirkintilloch East
Stewart McDonald Scottish National Party Glasgow South
Natalie McGarry Scottish National Party Glasgow East
Anne McLaughlin Scottish National Party Glasgow North East
John McNally Scottish National Party Falkirk
Paul Monaghan Scottish National Party Caithness, Sutherland and Easter Ross
Carol Monaghan Scottish National Party Glasgow North West
Roger Mullin Scottish National Party Kirkcaldy and Cowdenbeath
Gavin Newlands Scottish National Party Paisley and Renfrewshire North
John Nicolson Scottish National Party East Dunbartonshire
Brendan O’Hara Scottish National Party Argyll and Bute
Kirsten Oswald Scottish National Party East Renfrewshire
Steven Paterson Scottish National Party Stirling
Angus Robertson Scottish National Party Moray
Alex Salmond Scottish National Party Gordon
Tasmina Sheikh Scottish National Party Ochil and South Perthshire
Tommy Sheppard Scottish National Party Edinburgh East
Chris Stephens Scottish National Party Glasgow South West
Alison Thewliss Scottish National Party Glasgow Central
Owen Thompson Scottish National Party Midlothian
Michael Weir Scottish National Party Angus
Corri Wilson Scottish National Party Ayr, Carrick and Cumnock
Eilidh Whiteford Scottish National Party Banff and Buchan
Philippa Whitford Scottish National Party Ayrshire
Pete Wishart Scottish National Party Perth and North Perthshire
Michelle Thomson Independent (resigned SNP whip in Sept 2015) Edinburgh West

7 May 2015 – Think NHS when you vote

We have now arrived at the time for the General Election. Think NHS when you vote.

You can check what candidates from your constituency have said about the NHS Reinstatement Bill here.

You can see also check by party which candidates support the Bill:

We need an NHS Reinstatement Bill to be in the Queen’s Speech on 27th May 2015. Please think NHS when you vote.

National Treasures support the National Health Service

2 May 2015 – Joan Bakewell, Melvin Bragg, Alan Bennett, Ken Loach, Sienna Miller, Michael Morpurgo, Peter Pinkney, Jonathan Pryce, Steve Redgrave and over 70 more individuals have signed a letter published in the Guardian calling for a bill to reinstate the NHS.

Guardian Letters 2 May 2015


There is also an open letter on the 999 Call for the NHS website – signed by over 1000 individuals many of whom are NHS workers. You can add your name too.

Have you written to your electoral candidates asking for them to support a bill to reinstate the NHS? A suggested email is online, but please personalise it.