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Health and Social Care Act

The background

The Health and Social Care Act 2012 provided for a reorganisation of the structure of the NHS in England.

Specifically the Act removed responsibility for the health of citizens from the Secretary of State for Health, abolished NHS primary care trusts (PCTs) and Strategic Health Authorities (SHAs) and transferred commissioning funds from the abolished PCTs to clinical commissioning groups. The Act also established the creation of Public Health England.


The HCSA is not working - but why?

The NHS is not a bank

There is no place for the Competition and Markets Authority (formerly known as the OFT) in the NHS: public medical services are not the same as banks. The CMA must have no place in governing the NHS and overturning decisions by doctors.


Integration before competition

Integration of services must always trump competition. Yet the Act gives them equal prominence, creating the risk of confusion among commissioners who can feel pressurised to put all services out to competitive tender.

The Act must prioritise integration over competition.

Commissioners must be supported to plan integrated services and create seamless patient pathways.


Seamless, not fragmented care

An increase in the number of health providers increases the risk of fragmentation. The NHS should always be the preferred provider of patient care. And where alternative providers are already delivering services to patients, commissioners must ensure these services are integrated with GPs and hospitals.

There should be more robust safeguards to address concerns about providers only choosing to provide more profitable services.

Read the BMA chair's letter to MPs about the impact of the HSCA.

Read about the launch of the campaign.


Only 5% believe HSCA has improved the quality of services for patients

More than a year on from the introduction of the Health and Social Care Act, a survey of doctors by the BMA has found that only one in twenty doctors (5%) believe it has improved the quality of services for patients.

While half of doctors (51%) surveyed reported a change in how they plan and deliver care following the introduction of the Act, almost a third of this group (28%) believe it was having a negative impact on patient care, and almost three quarters (73.6%) believed the Act - which increases the role of private providers in the NHS through the roll-out of competitive tendering for services - had led to a fragmentation of care.


It's not too late to change

"While everyone else in the NHS has been working to make it better for patients, the government, through its misguided legislation, has been doing the exact opposite.

"How can we ever achieve whole and seamless care when so many services have to be touted to private bidders?

"How will these services work together for the good of patients when they are constantly eyeing up each other’s business?

"How can services improve when the law can impose competitive tendering but cannot be used to protect or prefer publicly-run services?

"The possible benefits – which certainly didn’t need this piece of legislation to make them happen – have been weakened."

BMA Chair of Council Mark Porter, speaking at the ARM 2014


  • A system that puts profits before patients

    A BMA tracker survey found that just five percent of doctors believe the Health and Social Care Act has improved the quality of care for patients.

    Dr Kailash Chand, BMA Deputy Chair, comments:

    The test for any government health policy should be whether it delivers for patients, and by almost every measure the current system is failing. It’s extremely concerning that, a year on from the Health and Social Care Act coming into force, doctors believe patient care is being compromised rather than improved. 

    The government was repeatedly warned that opening the NHS to the private sector would lead to a fragmentation of services at a time when more joined up care is needed, and this is exactly what we’re now seeing.

    As the dust settles on the Health and Social Care Act, it’s clear that we’ve been left with a system which puts profits before patients, competition before co-operation and has failed utterly to deliver improved patient care.

    What’s worse is that, at a cost of billions, it’s taken vital funding away from frontline services while doing nothing to address the crippling £30bn black hole facing the NHS, or rising workloads which affect the quality of patient care.

    The damage being done to the NHS is profound, which is why doctors are calling for the Health and Social Care Act to be scrapped, and for an honest and frank debate about how we can put right what has gone wrong without further top-down reorganisation.

  • Case study

    Bedfordshire and Milton Keynes

    In his speech to the BMA annual representative meeting, BMA Chair of Council Mark Porter gave the example of Bedfordshire and Milton Keynes CCGs (clinical commissioning groups) review of healthcare services, which saw almost 500 potential providers contacted.

    A letter sent out last month says the CCGs and NHS England are considering ‘what best practice means for different services’. The £3.2m review is being funded by Monitor and advised by the management consultants McKinsey. It says all providers who expressed an interest would be invited to take part in discussions.

    But there were suggestions of a scattergun approach when it emerged the commissioners had written to a trust that had already been dissolved (South London Healthcare NHS Trust), one about to be dissolved (Mid Staffordshire NHS Foundation Trust) and all 14 of those investigated last year by NHS medical director Professor Sir Bruce Keogh for higher-than-expected mortality.

    Doctors distracted

    Dr Porter told the ARM in Harrogate that commissioners were being ‘driven to distraction’ by a culture, fuelled by the requirements of the Health and Social Care Act, that encouraged them to put resources into inviting interest from the widest possible range of sources.

    In addition, the CCGs wrote to a number of private healthcare providers, such as Virgin, Spire and Bupa, and six international providers which they said they had chosen ‘at random’ from a list of 200. Five out of six of the ‘random’ providers were German, the other Indian.

    An earlier provider list supplied by Bedfordshire CCG also listed a large number of American organisations ‘we have approached’ but the CCG later said the list was revised before letters were sent.