The NHS bill: a briefing

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The government's Health and Social Care Bill will spell the end of the NHS as we know it

The National Health Service has a constitution which sets out the framework of principles within which healthcare is provided in England. The government's Health and Social Care Bill, which is currently being considered in the House of Lords, has caused widespread alarm among health workers, patients and the public. The perception is that this bill forces the NHS to privatise - and this perception is correct.

When compared with the principles set out in the constitution, it becomes clear that the bill is intended to destroy the NHS as we know it.
Here's why:


The NHS provides a comprehensive service, available to all

The bill abolishes the duty of the Secretary of State for Health to provide a health service for all.


The NHS is accountable to the public, communities and patients that it serves

In fact there is currently very little democratic control over the NHS, except for the responsibilities of the health secretary. What accountability that does exist will be fatally undermined by the bill.

A new body, the National Commissioning Board (NCB), will be responsible for healthcare provision. It will work in conjunction with groups of GP commissioners, known as Clinical Care Groups (CCGs). Under present plans, the NCB will not be democratically accountable to health workers, patients or the public. Indeed, the health secretary will be disbarred from "interfering" with the actions of the NCB.

The NCB will have no obligations to distribute funding in socially beneficial ways - such as targeting its money to curb health inequality, for example. CCGs will merely be charged with "having regard to" health inequality. Their primary task will be to ensure "choice" - ie competition. EU competition law may become a further lever in promoting competition within this new healthcare marketplace.

The current regulator, Monitor, will also play a role in rooting out "anti-competitive" behaviour. In February this year Monitor's chair, David Bennett, predicted the NHS would become just like other privatised utilities such as gas and telecoms. Monitor will act like regulators such as Ofgem or Ofcom, whose primary task is to promote competition. Democratic accountability will be stripped away at every level. By contrast, the bill it makes clear that private companies have the right to contest commissioning decisions in court, exposing NHS commissioners to costly litigation if they don't bend to the needs of businesses.


Access to NHS services is based on clinical need, not an individual's ability to pay

Hospitals will be run as autonomous businesses and expected to operate a budget surplus. They will be able to borrow cash secured against their "assets" - such as hospital buildings.

There will be no limit on the number or proportion of beds taken by private patients in hospitals. There will be a big incentive to chase private patients as they will boost the cash flowing into hospitals. Hospitals that seek to serve more NHS patients or address health inequality will be likely to go bust. In fact, it is explicitly intended that some "surplus" hospitals will "fail" in this way. They may then be bought up by private consortiums. Foundation Trusts will be allowed to go bankrupt.

A central plank of the bill is to involve "any willing provider" in the provision of healthcare. Private companies will have an incentive to "cherry pick" cheap procedures. This will undermine the ability of the NHS to heal people with complex, costly and long-term conditions. Fixed personal budgets will be introduced for many chronic conditions. This will create a two-tier system, where those who can afford to do so will "top up" their treatment privately, leaving the rest to make do with an increasingly limited "basic" level of provision.


The NHS is committed to providing best value for taxpayers' money and the most cost-effective, fair and sustainable use of finite resources

The NHS is presently one of the most efficient health services in the world, according to a recent report by the Journal of the Royal Society of Medicine. It has saved more lives for every pound spent than any other country in the world, except Ireland, over the past 25 years. The largely privatised system in the US is among the least efficient.

This is in part due to what the report calls the "relatively huge bureaucratic burden needed to monitor the costs, behaviour and risks of customers, as well as the immense legal costs required to control payment". Such additional costs would be a likely consequence of the imposition of profit-seeking companies on the NHS. The situation will be worsened by the £20 billion of cuts currently being made to the NHS budget under the guise of "efficiency savings".

As appalling as this bill is, it is still some way from becoming a reality. It may be that the battle for the NHS comes to the boil when these changes actually start to be implemented. The core principles quoted here reflect the demands for decent healthcare made by working class people when the NHS was first set up. The tortured progress of this bill so far reflects the fact that these demands still hold sway with the vast majority of people in Britain. This means that there is a broad well of support for those health workers and others who want to take serious action to defend our NHS.