The document discusses the evolution of England's NHS since 1999, highlighting the diverging healthcare systems among the UK nations and the shift towards market-style reforms in England. Key points include increased funding and staffing during the Labour government, followed by austerity measures under the Tory coalition, leading to cuts, closures, and pressures on emergency services. The future of the NHS is questioned, particularly concerning potential privatization and the imposition of charges for certain services.

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?”