Allyson Pollock’s motion to BMA Council about the NHS Reinstatement Bill

Professor Allyson Pollock writes

On January 14th 2015 I asked the BMA Council to agree that ‘successive government policies have caused widespread disruption to the English NHS which we would seek to redress’ and examine the provisions of the proposed NHS Reinstatement Bill and also the National Health Service (Amended Duties and Powers) Bill sponsored by Clive Efford MP, to determine which provisions were in line with BMA policy and that might put into practice policies defined by the representative body. The BMA Council has now set up a task and finish group to do this.​

Here is the text of my opening speech at Council:

“I present this motion as a critical step in determining BMA Council’s constitutional role in implementing the BMA Representative Board’s strong policies in support of repealing the Health and Social Care Act 2012, abolishing the internal market, and Foundation Trusts and PFI. The status quo is not an option.

The question for the BMA is – when a new government comes to power what will take the place of the Health and Social Care Act 2012?

The BMA must be ready and prepared to state its vision of health care delivery to its members, to patients and to people and to lobby parliamentarians after the election. However, political pledges will not restore our NHS, only legislation will do this. This is why we need the next parliament to introduce an NHS Reinstatement Bill.

The Health and Social Care Act 2012 abolished the duty to provide core NHS services throughout England, a duty which has been in place for 64 years. It put in place a new system for market contracting, for reducing the current level of NHS services and mechanisms for providers to restrict eligiblity and entitlement to NHS care and to pick and choose the patients they will treat. For the first time in the history of the NHS there is now a legal requirement for providers to set out in their licenses who is and who isn’t eligible for NHS funded services and treatment (Section 103 Health and Social Care Act 2012). Foundation Trusts are also expected to reduce the services they provide. This Act takes the logic of the internal market to its final conclusion, it abolishes the NHS as a public system of health care paving the way for user charges and for other regressive forms of funding. In its place will be privatized health care operated and provided by large corporations.

The Representative Body of the BMA has deplored the market ideology that takes the place of the public-service ideal as wasteful, inefficient and fragmenting care and services.

Council now has the task of translating its policies into a BMA vision for health care.

BMA has strong policy calling for abolition of the internal market and the purchaser-provider split and the repeal of the Health and Social Care Act 2012. It has policy against foundation trusts and policy which is highly critical of commissioning as creating unnecessary costs, fragmenting services and undermining care.

This proposed NHS Reinstatement Bill will reinstate the government’s duty to provide the NHS throughout England and abolish the wasteful internal market and marketised bodies. It will end virtually all commissioning and the market bureaucracy that is required to support it along with FTs and PFI. It will reinstate area based bodies as in Scotland and Wales and restore planning for integrated services on the basis of need and fairer resource allocation flows to primary care and all services.

The opposition to these necessary changes will come from those who will describe our Bill as more top down re-organisation. This is a paralysing term. It is basically an endorsement for the status quo, market prescriptions and denial of care. We have no choice but to put back the duty to provide core services throughout England and the structures that allow this to happen, if we are to restore the NHS and give back to people throughout England what they have lost – and what Scotland and Wales still have – a national health service. Restructuring will save money by eliminating the costs of the internal market, the costs of tendering, commissioning, shareholder returns and consultancy and legal fees. It will minimise waste.

In a brief review of BMA policy it appears that many of the provisions in the Bill are entirely consistent with BMA policy. But others might argue that there may be areas where they are not. In particular some BMA policies call for improvements in the current system and may appear to clash with policies which are critical of the whole system. For this reason today is not the day to ask Council to support the Bill but rather to support the provisions in the proposed Bill that do not contravene BMA policies and would further BMA policies. This complements other work that is ongoing and will provide a legislative framework for doing so. Our objects of association require us to promote the medical and allied sciences, to maintain the honour and interests of the medical profession and promote the achievement of high quality health care.

Summing up

This is a crucial moment for the BMA. I present this motion as a critical step in determining BMA Council’s constitutional role in implementing Representative Body’s strong policy in support of repealing the Health and Social Care Act 2012, abolishing the internal market, and Foundation Trusts and PFI. The provisions in this proposed Bill have the function of giving legislative weight to BMA policy. The BMA record was tarnished in 1948 with the view that it resisted the NHS. In 1989 it conducted an important and bruising campaign against the internal market in defence of the BMA. And time proved the BMA right, the internal market was the vehicle for the market and the abolition of the NHS in 2012.

The BMA has an opportunity to re-state clearly that it wants to restore the duty to provide and ensure that the policies developed by the Representative Board in support of the NHS are put into action. Today is about agreeing a process for supporting those legislative provisions which will further BMA policy and give hope to BMA members and patients throughout England. It will maintain the honour and interests of the medical profession and promote the achievement of high quality health care. I have no doubt the BMA will do what is needed and support the Motion.

Professor Allyson Pollock on Radio 5 live

Allyson Pollock appeared on Radio 5 live on Saturday 10th January debating the recent news stories about excessive demand on the NHS.

She responded by outlining how the real story is that the 2012 Health and Social Act has resulted in the break up of the NHS, wasting money on commercial interests.

Radio 5 LiveYou can hear the full debate on the Radio 5 live site here. The interview begins at 2:40:18.

Take action by writing to your MP and parliamentary candidates to support the proposed NHS Reinstatement Bill.

Professor Allyson Pollock speaks about the NHS and what you can do to help

Professor Allyson Pollock, one of the co-authors of the NHS Reinstatement Bill, spoke at a public meeting on 25 November 2014.

The meeting was organised by the Oxford Green Party. (The Green Party nationally are supporters of the proposed NHS Reinstatement Bill.)

You can watch Allyson’s presentation below – it is half an hour long – but it’s a great introduction to the issues of marketisation of the NHS, and what you can do to help.

If after watching it, you are inspired to support the campaign – please do take action here.

Response of Peter Roderick and Professor Allyson Pollock to Lord Hunt

Lord Hunt (Labour) wrote an article on the ourNHS website about Clive Efford MP’s NHS (Amended Duties and Powers) Bill.

Peter Roderick and Allyson Pollock, authors of the NHS Reinstatement Bill, respond to his piece below. (This article is also hosted on the ourNHS site.)


Peter Roderick writes: Lord Hunt’s selective quotations from the 1946 Act which founded the NHS, and from the Efford Bill currently before Parliament, do not hit their target.  The actual text of Clause 1 of the Efford Bill that Lord Hunt quotes simply copies and pastes from the 2012 Act.  It’s not restoring any duty.

The Bill puts the Secretary of State back in charge but does not re-establish a duty to provide the listed health services.  I see that the House of Commons library has just amended its briefing in this regard.

Why does Lord Hunt not mention the all-important Clause 3 of the Bill and section 3 of the NHS Act 2006?  Presumably, because he would then have to admit that the Bill’s Clause 3 would transform the 2006 duty to provide listed health services throughout England into a new duty to commission them, and with no geographical stipulation.

There is also a slight concern around the Bill’s approach to the notorious Section 75 regulations which do much to force competition onto local health bodies. The Bill repeals sections 72-80 of the 2012 Health and Social Care Act – some of the key legislation around the regulation of competition to provide NHS services.  This is to be welcomed as a step in the right direction of reducing tendering procedures.  But for the record, the Bill doesn’t actually “repeal… the Section 75 Regulations” – i.e., The National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013.  It repeals rather the power to make more such regulations in the future.  Presumably it is intended that they should be revoked, but this must be clarified.

More worrying, there are concerns about what the Efford Bill would do regarding the EU/US trade deal, which many including the BMA have identified as threatening the NHS.

Lord Hunt says that “TTIP will not be ratified if it: ‘…shall cause any legally enforceable procurement or competition obligations to be imposed on any NHS body …. in any part of the health service.’”

But the Bill doesn’t actually say that.

Instead it says ‘No ratification…shall’ have that effect. In other words, the Efford Bill presumes ratification by the UK government, and then seeks to limit its effect.

Ratification of a treaty follows signature.  It is a step required for a treaty to become binding in international law. Once ratification has occurred, the obligations referred to would become binding in international law. So the TTIP Clause seems to set up a potential conflict between the UK’s international obligations and domestic law.

The TTIP clause is also only a partial exclusion.  So it also needs to be clarified why all NHS-relevant obligations under TTIP are not excluded – whether they affect the UK government, NHS bodies (which are undefined here) and non-NHS bodies, commissioners and providers alike.  And why does it not extend to other obligations, such as (for example) the ousting of the jurisdiction of the UK courts, or to the rights of private companies to bid for contracts?

There are two other, potentially more effective choices for Parliament here. It can either legislate to restrict the Crown prerogative by stipulating that the NHS cannot be included in TTIP. Or it can require the approval of Parliament (and the devolved legislatures) before ratification – as proposed by Clause 22 of the NHS Reinstatement Bill.

Professor Pollock adds: Lord Hunt makes several implied references to the NHS Reinstatement Bill without actually mentioning it.  Our NHS Reinstatement Bill would abolish the purchaser-provider split. Lord Hunt argues against it because he says it would mean “another total top-down reorganisation of the NHS” and “staff that we meet the length and breadth of the country plead with us to avoid another reorganisation.  The NHS would simply collapse under the strain having been so weakened and demoralised by this Government”.

The NHS Reinstatement Bill would not be a total top-down reorganisation.  If it makes it to the Queen’s Speech in May 2015, that’ll be because voters – including staff and patients – will have put pressure on Labour and other parties to do so.  That’s not top-down.  That’s democracy.  There are plenty of NHS staff supporting the Reinstatement Bill and who oppose the continuing inefficient and expensive market structures and mechanisms that are undermining the NHS and equal access to healthcare.

A reorganisation is necessary so that we all know who has the duty to provide and to ensure access to services.

The 2012 Act has resulted in chaos and fragmentation and the emergence of a large market bureaucracy which has seen money diverted from patient care to accountants, lawyers, management consultants and shareholders.

We need to return the health system to a state where it is coherent, organised, effective and efficient. This will inevitably require some structural changes, but it will establish a system that is more functional and will remove those elements of the current structure that are unnecessary and wasteful.

Efford rightly describes the 2012 Act as “hated”. It is dissolving the NHS as staff leave in droves. The NHS needs restoring and strengthening. Demoralised staff need to be trusted and paid properly. And we all need to know the NHS will be there for us when we need it. The Reinstatement Bill seeks to do just that.



Response to Clive Efford MP’s NHS Bill

On Friday 21st November 2014, the House of Commons will debate a Private Member’s Bill introduced by Labour MP Clive Efford.

The National Health Service (Amended Duties and Powers) Bill 2014 would repeal the ‘Competition’ sections of the 2012 Health and Social Care Act. This is to be welcomed as a step in the right direction of reducing procurement and tendering procedures, subject to clarification that the National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013 would also be revoked. These are the Regulations that require commissioners to advertise new NHS contracts unless the services are only capable of being provided by a single provider.

The Bill, however, would not re-establish the Secretary of State’s duty to provide the NHS, despite the long title of the Bill saying that it would. Neither would it abolish the commissioner-provider split, as proposed by the NHS Reinstatement Bill.

Other points of concern are that it would for example:

  • appear to defer unnecessarily to EU competition law;
  • not reverse the 2012 Act’s prospective abolition of NHS trusts, and their transformation into NHS foundation trusts or take over by private companies; and
  • leave Monitor in place with the same main duty, without a statutory purpose and continuing to licence private providers.

Further clarification is also required as regards the provisions covering the Transatlantic Trade and Investment Partnership Treaty and use of the term ‘‘service of general economic interest”.

Professor Allyson Pollock, Peter Roderick and David Price have prepared a response to the Bill, which includes their provisional views as to whether some of the key provisions deserve to be supported or opposed and where clarification is needed.  That response is here:

Response to the National Health Service (Amended Duties and Powers) Bill 2014, published on 7th November 2014 (“the Efford Bill”)

Allyson Pollock explains how our NHS is being abolished

Allyson Pollock explains how our NHS is being abolished in a local TEDx event, produced independently of the TED Conferences.

The 1948 Act establishing the NHS gave the Secretary of State for Health the duty to provide universal health care.  The Health and Social Care Act 2012 removed this duty and introduces a market. Allyson Pollock describes why we need to worry.

If after watching it, you would like to do something, please contact your local MP and prospective parliamentary candidates to ask if they support the NHS Reinstatement Bill.


Will NHS England be whittled down to a core service?

BMJ Front cover 11 October 2014 copyProfessor Allyson Pollock, a public health doctor based at Queen Mary, University of London, and Peter Roderick, barrister and senior research fellow also at Queen Marys, are the driving force behind the proposed NHS Reinstatement Bill.

In the BMJ (11 October 2014) they have published their paper ‘A Wolf in Sheep’s Clothing – Is Monitor reducing hospital and Community services in England under the guise of continuity?’

They outline how market forces and budget cuts are challenging the financial viability of hospitals in England, with NHS beds and other services continuing to close as thousands of staff are laid off.

TBMJ Monitor Article p15 11 October 2014 copyhe proposed NHS Reinstatement Bill would abolish Monitor and prevent the reduction of Foundation Trust services from proceeding.

You can read the rapid responses to the article at the BMJ site here.

If you would like to see the proposed Bill become law, then please ask your local MP and prospective parliamentary candidates to ask if they support the NHS Reinstatement Bill.

Below you can listen to Allyson Pollock and Peter Roderick discuss the issue in ‘Is NHS England being whittled down to a core service’ from BMJ talk Medicine. (They discuss the proposed NHS Reinstatement Bill from 15.04 onwards.)



Images © the BMJ

Official Launch of the Campaign for the NHS Reinstatement Bill 2015

Saturday 4th October marks the official launch of the Campaign for the NHS Reinstatement Bill.

Our aim is to reverse the failings of the Health and Social Care Act 2012 and fully restore the National Health Service in England as an accountable public service. We will be encouraging voters to ask candidates in the general election to support including a Bill that would do just that in the first Queen’s Speech after the election.

Professor Allyson Pollock launched the campaign at a special meeting at the Liberal Democrat Annual Conference in Glasgow, whilst Peter Roderick also launched the campaign at the Annual General Meeting of the NHS Consultants’ Association in London.

 “This Bill is a vital public health measure. It will both restore the NHS in England and reverse more than two decades of policies which have been intent upon privatising NHS services and funding, ultimately to its demise.” Professor Allyson Pollock

Underpinning the campaign is a proposed NHS Reinstatement Bill, co-authored by Professor Allyson Pollock and Peter Roderick. The proposed Bill would abolish competition and the purchaser-provider split, re-establish public bodies and public accountability, and restrict the role of commercial companies. It draws on some of the best examples of NHS administration over its history, retains some features of the reforms laid out in the Health and Social Care Act 2012 and would be implemented on a timescale determined by the Secretary of State. More details of the Bill are available here.

“The proposed NHS Reinstatement Bill is a necessary legal measure to prevent the NHS in England becoming simply a memory, something that we had once upon a time. We need to put pressure on those wanting our votes in the general election to restore its founding vision.” – Peter Roderick

“As the failures of the 2012 Act become daily evermore obvious, this Bill provides a template for very necessary reinstatement and reform. The Secretary of State will decide the manner and the pace of implementation – except for section 1, which would restore his or her legal duty to provide the NHS with immediate effect.” – Lord David Owen CH FRCP

If you agree please contact your local MP and prospective parliamentary candidates to ask if they support the NHS Reinstatement Bill.