In a paper published on bmj.com, Professor Allyson Pollock and David Price examine the proposed changes and argue that the government’s duty to provide a comprehensive health service in England is abolished. 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. International competition laws may also be used to challenge public policies that impair their profitability and freedom to operate, they warn. In order to create a commercial market, they argue that “the government has repealed the health secretary’s duty to provide or secure the provision of comprehensive care and has abolished the structures and mechanisms which follow from this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.
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