This health bill will 'abolish' the NHS

Public satisfaction with the NHS has never been higher yet it is going to be changed root and branch - that is the paradox captured in the British Medical Journal online today.

The latest British Social Attitudes (BSA) survey reports that 64% of the British public are either very or quite satisfied with the NHS - the highest level of satisfaction since the survey began in 1983, nearly double what it was in 1997 and part of a continuous upward trend since 2002. Why change a winning formula? But that is exactly what the government plans to do.

Professor Allyson Pollock and David Price from the Centre for Health Sciences are far from convinced. In a comment piece, they examine health secretary Andrew Lansley's proposed changes and conclude that the Health and Social Care Bill amounts to the abolition of the English NHS as a universal, comprehensive, publicly accountable, tax funded service, free at the point of delivery.

They say that freedoms created under the new bill will allow corporate commissioners and investors to contract out all NHS services to a range of private providers and redefine the range of NHS services available. They will also be free to charge for some elements that are currently NHS services and to create surpluses for staff and shareholders by under-spending the patient care budget, the authors say.

International competition laws may also be used to challenge public policies that impair their profitability and freedom to operate, they warn.

Duty to provide 'comprehensive care' abolished

In order to create a commercial market, they argue that 'the government has repealed the health secretary’s duty to provide or secure the provision of comprehensive care and has abolished the structures and mechanisms which follow from this duty.'

However, they point out that 'government belief that cost efficiency, improved quality, and greater equity flow from competition in healthcare markets is not supported by evidence, the Office of Fair Trading, the government’s impact assessment, or its experience of independent treatment centres and private finance initiatives.'

They call for several key amendments 'to ensure continuation of NHS comprehensive healthcare throughout England.'

These include restoring the duty of the secretary of state for health to provide comprehensive healthcare throughout England, imposing a duty on commissioning consortiums to provide comprehensive healthcare to all residents on the basis of need, and withdrawing the power granted to commissioners to charge for healthcare services.

Unless these amendments are made, the bill as drafted 'amounts to the abolition of the English NHS as a universal, comprehensive, publicly accountable, tax funded service, free at the point of delivery,' they conclude.

• BMJ article in full: How the secretary of state for health proposes to abolish the NHS in England