Dr. John Lister of Coventry University details the changes in public policy concerning England's public health system. (May 2013)

1. England’s NHS in 2013
John Lister May 2013

2. Disunited Kingdom
Since 1999, devolved government in Wales and
Scotland and later Northern Ireland have meant
diverging health care systems
England: testing ground for experimental market-
style reforms
Fragmentation, competition, privatisation
Wales & Scotland: moving back towards
integration – market model rejected, services
brought back ‘in house’
Free prescriptions
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3. Since 2000
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Labour govt’s NHS Plan starting point for 10
years of major increases in funding
More staff – nurses doctors, professionals
More beds
Reduced waits to maximum 18 weeks
New hospitals (privately financed through PFI)
New structures for commissioners and
providers
2008: hit the wall with banking crash

4. 2008 to 2013
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2009 McKinsey report – target of £20bn savings
by 2014 to bridge gap between needs & resources
2010 last year of above inflation increases
2010 onwards: Tory coalition govt. New drive for
cuts and closures (“reconfiguration”)
A&E under pressure: failure of primary and
community health care services & social care
Beds and jobs cut
Mental health budget cut

5. High profile cuts
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3 year pay freeze for 1 million+ NHS staff
Attempts to break up national pay agreement
South London Healthcare bankrupt:
“unsustainable provider regime” invoked
Mid Staffordshire hospitals – scandal followed by
administration & cuts. But 55,000 protest
NW London hospitals, etc
Social care cuts (local government cutbacks)
Pressure for mergers/ impeded by “reforms”

6. The meanest of financial times
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7. Moving towards a market model
Under Tony Blair, Labour combined increased
spending with market-style “reforms”:
PFI to finance new hospitals & health centres
Foundation Trusts
Payment by Results
Independent Sector Treatment Centres
“World Class Commissioning” – break up
community services for private, social enterprise,
“any willing provider”
Increasing bureaucratic costs of market
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8. Tories crank up the pace
Health & Social Care Bill/Act: Far-reaching change
Massive Bill (400 pages), Complex
Removes duty of Secretary of State to provide services
Confusing language (e.g. amendment from “Any Willing
Provider” to “Any Qualified Provider” – but no definition
of “qualified”.
New structure: NHS England leading 200+ Clinical
Commissioning Groups ostensibly “led by GPs” but
steered by Commissioning Support Services
National Commissioning Board (NHS England) with
sweeping powers & Local Area Teams
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9. Creating a competitive market
NHS Trusts to become Foundations (pressure
towards takeovers/mergers etc: BUT OFT
intervention creates problems)
Foundation Trusts free to make up to 49% of
revenue from private medicine & deals with
private sector
Regulator and “Cooperation & Competition
Panel” to enforce competition (+ integration!)
Regulations to compel CCGs to open up
services to competitive tender/AQP
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10. Regulation and Competition
Care Quality Commission
Monitor
NICE
Professional bodies (NMC, GMC etc)
Cooperation & Competition Panel (Monitor)
Office of Fair Trading
Competition Commission
EU Competition Law – “right to provide”
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11. It’s as simple as this!
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12. What about accountability of
non-NHS providers (AQP)?
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13. Plans to go much further
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Cameron’s new health advisor Nick Seddon is leading
neoliberal from ‘Reform’ group, on record as wanting to
hand over NHS budgets to private insurance
Plans to enforce charges for “immigrants” using
accident & emergency and other health services open
way for wider imposition of charges
Personal health budgets and budgets for social care in
mental health and elderly care open way to top-up fees
– and health insurance
NHS beds filled with emergencies, now delaying
elective treatment: will increase use of private care
How long will NHS remain “free at point of use?”