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.

Peter Roderick reflects on what happened to the NHS Bill in the Commons on 11 March 2016

It’s exactly one year since the cross party NHS Reinstatement Bill was tabled in the House of Commons. One year in which the initial Bill fell and was re-tabled, in which the privatisation of the NHS in England has proceeded unhindered, and in which the Labour party’s leadership has changed – many hope for the better. One year of campaigning efforts by thousands to get the majority of MPs to wake up to what is happening to the NHS and to pass a law to stop it. And the upshot of all this? 17 minutes of debate in the Commons.

After the spirited proceedings outside the Department of Health and the crowd at the rally outside the Commons, I went inside to listen to the debate. What a difference. The first thing to hit you was the emptiness. Hardly anybody there. Perhaps as many as 40 MPs, certainly fewer than 50. Oh, it’s Friday, say the Westminster cognoscenti, nobody’s there on a Friday. But what about the tens of thousands of people who have asked their MPs to be there? That made no difference to the vast majority of them.

Then there was the filibustering. The “usual suspects” on the Tory backbenches were going on and on about how we need a law to exclude foreigners convicted of crimes to be excluded from the UK. The Deputy Speaker said she couldn’t stop them talking. When they were challenged by Caroline Lucas and the SNP, they feigned offence. 4.5 hours for them, 17 minutes for us. Fair play?

Perhaps the most disappointing impression was the small number of Labour MPs who turned up – perhaps 15, certainly no more than 20 (hard to count with the comings and goings). Full marks to those who did – and to the strong showing from the SNP – but there’s a long way to go.

And finally, the most abiding impression. If enough Labour MPs had turned up, it might have been possible to stop the Tory MPs talking by putting a closure motion. When this was pointed out by Caroline Lucas, the shared smirks on the faces of silent Heidi Alexander, Labour shadow health minister, and the junior health minister Ben Gummer, gave the game way. The Tories didn’t want a proper NHS debate, neither did Labour’s health team and together they made sure it didn’t happen. Body language speaks louder than words.

Filibustering, empty benches, silence, smirks and front bench deals are contemptuous responses to tens of thousands of people. They are also counter-productive.  This second NHS Reinstatement Bill will fall. But the spirit is high and the commitment to bring a third, and a fourth, and a fifth – until a proper public NHS is restored – is stronger than ever.

‘Is that it for the NHS?’

The London Review of Books has published an article titled ‘Is that it for the NHS?’ by Peter Roderick, co-author of the NHS Reinstatement Bill.

The National Health Service in England is being dismantled. But you wouldn’t know it from listening to the radio or reading the newspapers. As so often, you have to look beyond the headlines about pressures on funding and the junior doctors’ dispute to find out what’s really going on. In 1990, Kenneth Clarke introduced an internal market into the NHS, following on from the ‘options for radical reform’ set out by Oliver Letwin and John Redwood in 1988. It had three pillars: GP fund-holding (delegating budgets to individual GP practices); the replacement of health authorities by ‘NHS trusts’ (self-governing accounting centres with borrowing powers, and their own finance, human resources and PR departments) and the splitting of purchasers from providers (the planning and delivery of services was to be undertaken by separate bodies, with the money flowing between them). In its 1997 manifesto, New Labour promised to ‘end the Tory internal market’. It did get rid of GP fund-holding (only to reintroduce it later as Practice Based Commissioning), but otherwise took the Tories’ ideology even further by introducing, in 2003, the market-oriented ‘NHS foundation trusts’ and their regulator, Monitor, as well as scaling up the Private Finance Initiative. Clarke was able to say on the sixtieth birthday of the NHS in 2008 that ‘in the late 1980s I would have said it is politically impossible to do what we are now doing.’

London Review of Books, Vol. 37 No. 23 · 3 December 2015 » » Is that it for the NHS?

For the full text of the article, see the London Review of Books.

If you would like to support the Campaign for the NHS Reinstatement Bill, find out how you can take action.


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 <>

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

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

Promote, Provide – Procrastinate? Beware the Devil in the Detail

Labour’s health manifesto is flawed. With the best of intentions, it misses the point – or rather, doesn’t quite reach it. And it’s all down to understanding what the Secretary of Health MUST provide as well as promote when it comes to health services and the NHS – hence what needs putting right if the NHS is not to continue to wither away.

Page 9 of its Health Manifesto (A Better plan for the NHS, health and care) says they will “restore the Secretary of State’s historic duty to provide a comprehensive health service”, even though the statement does not appear in the actual main Party manifesto.

David Lock, QC – former Labour MP and widely said to be the drafter of the National Health Service (Amended Duties and Powers) Bill presented in 2014 to the House of Commons by Clive Efford MP (the ‘Efford Bill’, filibustered to death in Committee by whipped Tories just before the last Parliament was dissolved) – says in a piece on Clive Efford’s website:

“Since the creation of the NHS in April 1948 the Secretary of State has always had the duty to promote a comprehensive health service but has never had a duty to provide a comprehensive health service”

The thing is, Mr Lock’s statement is actually correct. But it misses the critical point.

In 1946, Parliament formulated a clear framing ministerial duty in section 1 of the founding NHS Act, continued in later Acts, though slightly diluted in 2006. The most recent version – before the Health and Social Care Act 2012 – was in s.1(2) of the NHS Act 2006: to provide or secure the provision of services in accordance with the Act for the purposes of a comprehensive health service that it was also the duty of the Secretary of State to promote. In section 3, the Act gave him or her the specific duty to provide hospital and specialist services throughout England and Wales. This duty was later extended under the Heath government to medical, dental, nursing and ambulance services, and to certain community care services that had previously been placed on local authorities.

Sections 1 and 3 are to be read together: as Lord Woolf said in 2001, the Secretary of State in section 1 “has the duty to continue to promote a comprehensive free health service and he must never, in making a decision under section 3, disregard that duty”.

Why then is Labour saying they will restore a historic duty that never existed?

What needs restoring is the duty to provide or secure the provision of services in accordance with the Act for the purposes of a comprehensive health service that it is also the duty of the Secretary of State to promote; and his or her duty under section 3 to provide hospitals, medical, dental, nursing and ambulance services, and community care services. The NHS Bill would do both. The Efford Bill would do neither.

More information

Our previous news stories on the National Health Service (Amended Duties and Powers) Bill

2nd Committee Debate 10 Feb 2014 - 4 Clive EffordEfford Bill Filibustering Blunders On
10 February 2015


Empty Select CommitteeTory MPs filibuster to block Efford Bill
4th February 2015


Hunt_wide2_400x400Response of Peter Roderick and Professor Allyson Pollock to Lord Hunt
26th November 2014


Big BenHouse of Commons Library briefing amended – no longer any mention of re-establishing or reinstating a legal duty to provide
25th November 2014


Peter Roderick speaking in Committee Room 9 at the House of Commons on the Efford BillResponse to Clive Efford MP’s legal advice on Secretary of State’s ‘duty to provide’
24th November 2014


Peter Roderick speaking in Committee Room 9 at the House of Commons on the Efford BillA day in the Commons for the Efford Bill – a personal view
22nd November 2014


21st November 2014


Big BenDuty to provide throughout England? Request for correction of House of Commons Library Briefing
20th November 2014


Clive Efford NHS BillEfford Bill 2nd Reading – Friday 21st November
20th November 2014


Clive Efford Private Members Bill copyResponse to Clive Efford MP’s Bill
19th November 2014

In pictures: Presentation of the NHS Bill in parliament 11 March 2015

The NHS Bill was presented in Parliament on 11 March 2015.

Thank you to all the campaign groups and individuals that came to the House of Commons to support the NHS Bill: Keep Our NHS Public, Save Lewisham Hospital, Greenwich Keep Our NHS Public, 999 Call for the NHS, Keep our St Helier Hospital, Save our NHS – from Barts and Queen Mary’s medical school, Save our Hospitals (Ealing, Charing Cross, Hammersmith, Central Middlesex) and the National Health Action Party.

And thank you to all the MPs that supported the presentation of the Bill (and the additional MPs who attended the rally outside parliament): Caroline Lucas from the Green Party; Andrew George and John Pugh from the Liberal Democrats; Labour’s Katy Clark, Jeremy Corbyn, Roger Godsiff, Kelvin Hopkins, John McDonnell, Michael Meacher and Chris Williamson; SNP’s Stewart Hosie, Angus MacNeil, Mike Weir and Eilidh Whiteford; and Plaid Cymru’s Hywel Williams.

Co-author of the Bill, Peter Roderick answers questions about what the presentation of the NHS Bill means here but below are some pictures from the day.


1- Campaign group banners for NHS Bill


2- Photo Call for the NHS Bill


3 - Student nurses with Andrew George Caroline Lucas and Peter Roderick


4 Jeremy Corbyn Peter Roderick


5 London NHS Campaigners


6 Photographers with Peter Roderick and Caroline Lucas


7 Andrew George Caroline Lucas Peter Roderick and Tony O'Sullivan


You can support the campaign by asking your MP and prospective parliamentary candidates whether they would back an NHS Reinstatement Bill to be in the next Queen’s Speech.

Take action here.

What happened on March 11th? Peter Roderick answers

Peter Roderick11th March 2015 was a milestone for the campaign.
But what happened and why was it important?
We put some questions to the co-author of the NHS Reinstatement Bill, barrister Peter Roderick.


What happened today?
12 MPs from 5 political parties tabled the National Health Service Bill in the House Commons, based on the second version of the NHS Reinstatement Bill.

Why is that important?
It’s important because we’ve now got the Bill into Parliament with cross-party support, so it can’t be easily dismissed.

A Bill was the start of the law-making process to create the NHS, and we won’t get it back without starting that process again.


We can see you had fun standing around in the sunshine talking to MPs, but what was the point?
Yes it was fun and sunny, but the point was to let people see and know what was going on and to take heart that there are a lot of people who don’t accept the dismantling of the NHS and who are working seriously to reverse it.

What is the point in doing this at this stage in the parliamentary cycle, isn’t it all too late?
True, the Bill will fall at the end of March when Parliament closes down for the election campaign. But it’s a serious piece of proposed legislation which candidates can support during the election campaign – and as a marker for after the election against which to test government proposals.

MPs supporting the presentation of the NHS Bill

L to R: Eilidh Whiteford MP, Mike Weir MP, Jeremy Corbyn MP, Stewart Hosie MP, Andrew George MP, Angus MacNeil MP, Caroline Lucas MP, Peter Roderick and Chris Williamson MP (hidden). Pictured with campaigners and student nurses.

Which MPs were supporting you today?
The Bill was presented by Caroline Lucas, the Green MP for Brighton Pavilion, and supported by 11 other MPs – the maximum number allowed – here’s the list:

Andrew George, Lib Dem, St Ives
John Pugh, Lib Dem, Southport
Katy Clark, Labour, North Ayrshire and Arran
Jeremy Corbyn, Labour, Islington North
Roger Godsiff, Labour, Birmingham Sparkbrook
Kelvin Hopkins, Labour, Luton North
John McDonnell, Labour, Hayes and Harlington
Michael Meacher, Labour, Oldham West and Royton
Chris Williamson, Labour, Derby North
Eilidh Whiteford, SNP, Banff and Buchan
Hywel Williams, Plaid Cymru, Arfon

That’s just a smattering of MPs, if the mainstream Labour MPs aren’t yet backing it, what chance has the Bill got?
True, but Labour’s not monolithic, there’s an election about to happen, and mainstream today is not necessarily mainstream tomorrow – its centre of gravity won’t shift if we give a depressed shrug.

Doesn’t this Bill promote another top down re-organisation?
I am sensitive to these genuine concerns, but the 2012 Act was a dismantling, not a reorganisation. The evidence of disorganisation, fragmentation and incoherence is already mounting. We want to put the NHS back together again based on its founding principles, and we’re proposing to do it with a new locally-led, bottom-up approach with the Secretary of State’s oversight to make sure it works throughout England.

You can support the campaign by asking your MP and prospective parliamentary candidates whether they would back an NHS Reinstatement Bill to be in the next Queen’s Speech.

Take action here.

Andrew George MP backs the NHS Bill

Andrew George, the Liberal Democrat MP for St Ives, has been a key supporter of the NHS Reinstatement Bill.

On 11th March 2015, Andrew George MP and Green Party MP Caroline Lucas co-sponsored the National Health Service Bill – the NHS Bill – when it was tabled in the House of Commons. The NHS Bill was based on the second version of the NHS Reinstatement Bill.

“There are many risks which need to be dealt with. The public sector ethos of the NHS is at risk. The current dynamics and structures within the NHS means that the risk of fragmentation has been heightened. The private sector is camped on the front lawn of core NHS services, preying on the NHS and cherry picking its easiest and most profitable services.

“The last thing the NHS needs now is yet another top down reorganisation. The NHS Reinstatement Bill provides a good basis for a better direction of travel for the NHS.”

Andrew George MP, 11 March 2015

3 - Student nurses with Andrew George Caroline Lucas and Peter Roderick

Andrew George MP, alongside Caroline Lucas MP, and barrister Peter Roderick (co-author of the NHS Reinstatement Bill), talking to student nurses on the day the NHS Bill was presented to parliament.


You can support the campaign by asking your MP and prospective parliamentary candidates whether they would back an NHS Reinstatement Bill to be in the next Queen’s Speech.

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