Jeremy Hunt must consult properly on Accountable Care Organisations

BMJ analysis – Are radical changes to health and social care paving the way for fewer services and new user charges?

Co-authors of the NHS Reinstatement Bill, Allyson Pollock and Peter Roderick, alongside Shailen Sutaria – a specialty registrar in public health medicine – have published an analysis piece in the BMJ titled ‘Are radical changes to health and social care paving the way for fewer services and new user charges?’.

“Current reforms to health and social care services, and radical redesign of the local government finance system, may signal the end of the NHS and local government in England as we know them, argue Shailen Sutaria, Peter Roderick, and Allyson M Pollock”

Key messages

  • STPs, accountable care organisations, devolution deals, joint commissioning of health and social care services, and redesign of the local government finance system are radically changing the NHS and local government in England.
  • The effect on service provision of the fundamentally different funding bases for health (free at the point of delivery) and social care (means tested) services has been ignored.
  • The changes are likely to lead to reduced services and entitlements, more private provision of publicly funded services, and potentially more user charges.
  • People in poorer areas are likely to lose out as funding will depend more on the wealth of local areas and less on the principles of redistribution and need.
  • The evidence for and effects of these changes on access to care, equity, and widening inequalities must be disclosed and understood.

Read the full article here.

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

BMJ article – Why the Queen’s Speech on 19 May should include a bill to reinstate the NHS in England

Worcestershire Hospital crisis predicted by Allyson Pollock 15 years ago

The current crisis in Worcestershire Hospital Trust where patients have been turned away and experiencing long delays (Disaster doctor sent to under-pressure Worcestershire Royal – BBC News) were all predicted back in 2000 by Allyson Pollock and colleagues in the report into Worcestershire and Kidderminster hospitals ‘Deficits before Patients’.

The report showed that the high costs of PFI could only be met by major bed and hospital closures including the local accident and emergency department in Kidderminster. They predicted that need would not be met as a result of bed and service closures and the bed crisis has continued to this day. It was the reason why Richard Taylor was elected twice as an independent candidate in Wyre Forest, because David Lock (the Labour candidate) did not oppose PFI or service closures.

Meanwhile the exorbitant costs of PFI in Hereford which also resulted in major bed closures has seeen the launch of a new plan to rebuild Hereford County Hosptial reorganisation. (Worcester News – Trust Board backs £40 million plan to “re-build” Hereford County Hospital.)


Interviewed by the BBC for the Today programme an unidentified senior clinical member of staff from the trust said:


“The problem at the moment is that the Worcestershire hospital is far too small. They can’t cope with the number of admissions or the number of walk-in patients that turn up in A&E.
“These things mean we have ended up with a crisis in A&E.

“They have now drawn little rectangles into the corridors to signify that is a corridor bed. It’s incredibly stressful. It becomes a Third World situation where only the very sickest patients can be treated properly.”


Over the past few years patients and staff have been repeatedly drawing attention to the crisis which has spread across the West Midlands to neighbouring hospitals.


Take Action

We need politicians in the next parliament to introduce an NHS Reinstatement Bill.  Please ask your parliamentary candidates for their support.

SNP MPs to vote to restore England’s NHS

17th April 2015 – SNP issued a press release demonstrating their support for a Campaign for the NHS Reinstatement Bill.

The full text of the press release is copied below.

Do you know what the position of your candidates on the NHS Reinstatement Bill?

Responses so far – find out what your candidates think about the Bill

Take Action – Ask your parliamentary candidates to support the Bill

FM – SNP MPs to vote to restore England’s NHS


First Minister Nicola Sturgeon is today reaffirming the SNP’s commitment to voting to restore the NHS in England – on the day that prominent health expert Allyson Pollock backed the SNP’s position.

Campaigning in Central Ayrshire with SNP candidate Philippa Whitford – an NHS consultant breast surgeon – the First Minister will set out how SNP MPs will back a Bill to restore the NHS – ensuring the health service south of the border remains in public hands and protecting Scotland’s health budget in the process.

Backing the SNP’s position, Allyson Pollock – Professor of Public Health Research and Policy at Queen Mary University of London said:

“The NHS in England has been effectively abolished by the Health and Social Care Act 2012 and health services are being broken up and put out to tender in the open market. NHS money is now flowing through commercial contracting bodies, known as Clinical Commissioning Groups, to commercial for profit providers which can pick and choose the services and patients they want to treat. Those NHS hospitals which are foundation trusts have been established as 51% public which means that increasingly half the beds, staff and services can be diverted to private patients i.e. those that can afford to pay. As the NHS withers away and hospitals and beds close people will find it increasingly difficult to get care, patients are already being turned away from some hospitals and services.

“With cross party support, the SNP has backed a Bill to reinstate the NHS south of the border – and this is a hugely significant step demonstrating the impact SNP MPs could have in the next Parliament. Without taking such action, the NHS in England will cease to exist – with catastrophic consequences for people in England and serious implications for the people of Scotland and its NHS. It is important that people consider this before casting their vote in the General Election. The NHS is such a vital service and we need to do everything in our power to reinstate and restore it in England while we still can.”

Welcoming the endorsement, Ms Sturgeon said:

“The NHS is our most precious national resource – yet the current Westminster agenda of austerity, privatisation and patient charging in the NHS is threatening the very foundations of the health service south of the border and is putting funding for the NHS in Scotland at risk.

“That’s why the SNP has been clear that our MPs will vote for a Bill to restore England’s NHS to its founding principles, ensuring it remains the accountable public service it was always meant to be – and protecting Scotland’s health budget in the process. And I’m delighted that our position has been endorsed by someone of the standing of Professor Allyson Pollock today.

“Restoring the NHS in England is just one example of the way SNP MPs can be a strong voice at Westminster for progressive politics which will benefit people in the rest of the UK as much as people in Scotland – compared to a Westminster establishment which has its priorities all wrong.

“A publicly owned, properly funded health service is the hallmark of a decent society – and I will be immensely proud for the SNP to take action in the next Parliament to put an end to Westminster’s privatisation and cuts agenda ensure people across these islands have the top quality healthcare they deserve.”

SNP candidate for Central Ayrshire and NHS consultant breast surgeon Philippa Whitford said:

“As an NHS professional, I know that Professor Pollock is held in the highest esteem by people across the health service – and I am absolutely delighted that she has endorsed the SNP’s plan to restore England’s NHS today.

“Westminster’s cuts and privatisation agenda south of the border is having a devastating impact on England’s NHS – and threatening Scotland’s health budget – and has to be stopped. A strong team of SNP MPs elected next month will stand up for the founding principles of our health service – voting to restore England’s NHS and further protecting and improving Scotland’s NHS budget.”


Professor Allyson Pollock on BBC News

Prof Allyson Pollock on Radio 5 live Breakfast

Will politicians be architects or destroyers of the NHS?

Allyson Pollock has reviewed Lord David Owen’s book ‘The Health of the Nation’ in the Lancet.

This article originally appeared in the Lancet, 28 March 2015.

revolutionary 'B' pb grid.qxdIn the history of the UK’s National Health Service (NHS), the Health and Social Care Act 2012 will go down as the most egregious act of vandalism against the people of England. During its passage through Parliament, David Owen called it the “Secretary of State’s Abdication Bill”, because the legislation removed the Secretary of State for Health’s responsibility for, and duty to provide, an NHS throughout England. The Act’s destructive effect is being felt in all political jurisdictions. But it has fallen to Owen, a peer in the House of Lords who describes himself as an independent social democrat, to take on the mantle of Nye Bevan, the founding father of the NHS. A veteran politician, Owen has served as Labour health minister and foreign secretary, and led the Social Democratic Party in the 1980s.

In The Health of the Nation, Owen returns to grass roots politics in his account of the People’s Commission in Lewisham, south London, and the Save Our Surgeries campaigns to stop NHS hospital and general practice closures in 2013–14. He documents the tenacity of local campaigners and NHS staff and patients to stop closures of their hospital and community services, which were driven by the high costs of servicing private finance initiative (PFI) debt. The fight went to the High Court where the people won; they won again when the UK Government appealed against the decision. Owen explains how the costs of the PFI debt repayments combined with budget cuts are the engine for NHS hospital, general practice, and community closures across the country. He outlines how privatisation is opening up health services to international markets and making public services vulnerable to trade treaties and legal challenges from multinational investors. As a former doctor, he fears the dismantling of the NHS will see a return to public health tragedies on a scale not seen since before World War 2.

Values of social solidarity led to the creation of the NHS in 1948. At a time when the country was bankrupted by war, the nation decided to build a welfare state of which the NHS was a part. Moral values translated into a legal duty on the Secretary of State for Health to provide an NHS throughout the UK. It would be afforded because it was what the people wanted and voted for. The NHS was not a romantic aspiration.

The NHS survived in England until 2012. Since then, the NHS in England has been reduced to uncoordinated, fragmented services, disconnected from local communities and resident areas. The NHS is still in place in Scotland, Wales, and Northern Ireland, and for the people of the UK it remains the most popular of all the welfare institutions.

Owen sets out starkly how the NHS in England is withering away. By abolishing the legal duty to provide an NHS and entrenching market contracting and competition, the Coalition Government has reduced the NHS to little more than a public funding stream. In its place are market bodies, known as NHS England, Monitor, Care Quality Commission, and Clinical Commissioning Groups. Health services in England are moving to a US model in which increasingly access will not be through automatic entitlement but through local eligibility criteria as commissioners decide what services will be funded by the NHS and what will be paid for. For the first time since the NHS began, legislation requires health-care providers to draw up eligibility criteria as part of their licence conditions. In this system patient choice does not mean patients having choice of providers, but rather providers being able to choose their patients and treatments on the basis of ability to pay. Patients can and are being turned away and denied care.

The NHS had solid foundations. Its system was based on fairness of funding through income taxes and designed to maximise redistribution of resources and services. An efficient public bureaucracy ensured that administration costs were no more than 5% of the total budget and health expenditure didn’t rise much above 4% of GDP. However, since 1990, under Conservative and Labour administrations, market incrementalism has been a hallmark of NHS legislation with the introduction of the purchaser-provider split, use of private finance for new capital projects, and greater use of the private sector and market contracting. The incoming Labour Government in 1997 accelerated market-driven measures giving powers to Trusts to raise capital, use their financial freedoms to generate private income, and enter into exorbitant PFI debt obligations and commercial contracts. The link between planned services and the needs of the local population was being broken. And now, under the Health and Social Care Act 2012, all NHS Trusts must become NHS Foundation Trusts and legislation sets out that it expects these, in turn, to be 51% NHS and 49% private in terms of the income and services provided.

The destructive disorganisation that has resulted from the 2012 Act has led to enormous fragmentation and cost as general practice, hospital, and mental health services are broken up in piecemeal fashion and put out to tender with no regard to planning for need. Commercial contracting is expensive and reduces integration as providers are risk averse and cherry pick the best services and patients. Risk selection is accelerated by the carve up of many public health functions and transfer of some services, including children’s services, sexual health services, and district nursing, to cash-strapped local authorities that will in the future contract them out further fragmenting services. The UK Government is already being subject to challenges from the private sector when they perceive EU competition and procurement rules are not being followed. As Owen so passionately argues, abolishing the purchaser-provider split and the market in the NHS and returning services to public control and direct provision would protect the NHS from challenges from investors under TTIP and other trade treaties; it will also enable greater integration of health and social care and ensure equity of access and quality.

Owen warns us that we have little time left to reinstate the NHS—if we don’t, by 2020 the NHS as we know it will have disappeared not with a bang but with a whimper. Political pledges and manifestos cannot be trusted, solutions are required. Only legislation can reinstate the NHS. The UK election in May could well see a hung Parliament in which minority parties, such as the Scottish National Party, determine the balance of power. If this should happen the electorate will need to know that legislation to reinstate the NHS is not negotiable when deals are being struck.

On March 11, 2015, a Bill to reinstate the NHS in England was tabled in Parliament with cross-party support. The NHS Bill 2015 will abolish market and NHS contracting and the expensive market bureaucracy, make the Treasury responsible for resolving the high cost of private finance, and restore the duty of the Secretary of State to provide listed health services to meet the needs of people throughout England. Prospective parliamentary candidates are being asked to declare their support for this Bill before the election.

Politicians declare we can no longer afford universal health care, although the cost of the NHS per person is far less than any country with marketised health systems. The UK certainly cannot afford a market—the US experience tells us what is in store with health-care costs in excess of 17% of GDP. Owen calls on us to ask our prospective parliamentary candidates to support legislation to restore and reinstate the English NHS in the next Parliament, in return for their votes. If they do not the NHS will wither away as large for-profit multinational corporations take over patient services and determine what will be paid for and what services will be provided. Inequity and denial of care will become the new hallmark of health services in England.

The Health of the Nation is a clarion call from an experienced statesman to aspiring politicians across the political spectrum. Owen is writing for posterity. The question on May 7 is how do the politicians want to be remembered, as the architects or destroyers of the NHS?

NHS Reinstatement Bill – new version published

The story so far

The NHS was set up by a law – the NHS Act 1946. Since then, there have been dozens of Acts affecting it – especially over the last 25 years or so.

The most radical of these laws was the Health and Social Care Act 2012, because it abolished the legal duty on the government to provide key NHS services in England, and took marketisation to a new level.

We need a law to reinstate that legal duty, to stop marketisation, and to re-establish public bodies. Without a law, the process now rapidly underway will continue.

This is why Peter Roderick and Professor Allyson Pollock drafted a NHS Reinstatement Bill in August 2014. This Bill was put out for consultation, and dozens of responses from individuals and organisations were received. The consultation on the proposed NHS Reinstatement Bill ended in December 2014.

NHS Reinstatement Bill – February 2015

NHS Reinstatement BillPeter Roderick and Allyson Pollock have since drafted a new version of the Bill, finalised on 21 February 2015.

The new version of the NHS Reinstatement Bill is available here.

The explanatory notes are available here.

The comparison between the previous and current version of the Bill is available here.


Brief summary of the NHS Reinstatement Bill, February 2015

In short, the Bill proposes to fully restore the NHS as an accountable public service by reversing 25 years of marketization in the NHS, by abolishing the purchaser-provider split, ending contracting and re-establishing public bodies and public services accountable to local communities.

This is necessary to stop the dismantling of the NHS under the Health and Social Care Act 2012. It is driven by the needs of local communities. Scotland and Wales have already reversed marketization and restored their NHS without massive upheaval. England can too.

The Bill gives flexibility in how it would be implemented, led by local authorities and current bodies.

It would:

  • reinstate the government’s duty to provide the key NHS services throughout England, including hospitals, medical and nursing services, primary care, mental health and community services,
  • integrate health and social care services,
  • declare the NHS to be a “non-economic service of general interest”, asserting the full competence of Parliament and the devolved bodies to legislate for the NHS,
  • abolish the NHS Commissioning Board (NHS England) and re-establish it as a Special Health Authority with regional committees,
  • plan and provide services without contracts through Health Boards, which could cover more than one local authority area if there was local support,
  • allow local authorities to lead a ‘bottom up’ process with the assistance of clinical commissioning groups (CCGs), NHS trusts, NHS foundation trusts and NHS England to transfer functions to Health Boards,
  • abolish NHS trusts, NHS foundation trusts and CCGs after the transfer by 1st January 2018,
  • abolish Monitor – the regulator of NHS foundation trusts, commercial companies and voluntary organisations – and repeal the competition and core marketization provisions of the 2012 Act,
  • integrate public health services, and the duty to reduce inequalities, into the NHS,
  • re-establish Community Health Councils to represent the interest of the public in the NHS,
  • stop licence conditions taking effect which have been imposed by Monitor on NHS foundation trusts and that will have the effect of reducing by April 2016 the number of services that they currently have to provide,
  • require national terms and conditions under the NHS Staff Council and Agenda for Change system for relevant NHS staff,
  • centralise NHS debts under the Private Finance Initiative in the Treasury, and require the Treasury to report to Parliament on reducing them,
  • abolish the legal provisions passed in 2014 requiring certain immigrants to pay for NHS services
  • prohibit ratification of the Transatlantic Trade and Investment Partnership and other international treaties without the approval of Parliament and the devolved legislatures if they would cover the NHS,
  • require the government to report annually to Parliament on the effect of treaties on the NHS.

Further and consequential amendments would also be necessary and these would be contained in a simultaneous NHS (Consequential Provisions) Act.

Take Action

We need MPs in the next session of parliament to commit to backing an NHS Reinstatement Bill.

Please help by contacting your MP and prospective parliamentary candidates in the run up to the election on May 7, asking them to state their support for an NHS Reinstatement Bill.

Please let us know their response, by emailing <>.

You can see whether your MP and candidates have already replied here.