The NHS was "liberated" in July 2010. It has been in flux ever since.
The Health and Social Care Bill was first introduced by the government 13 months ago. By April 2011, as opposition amongst health professionals to its measures grew, Andrew Lansley became the first ever Health Secretary to have a vote of no confidence passed against him by the Royal College of Nursing.
The government "paused" the bill soon after, claiming there was a “natural” break in its legislative passage. But despite the government saying it would implement the 16 changes recommended by the future forum, doctors’ unions and health workers still have serious concerns over the bill.
While the phone hacking scandal, public disorder and the fall of Gaddafi dominated the news over the summer, the NHS is re-emerging as the big political issue.
The bill will go back to parliament on September 6 – with Lib Dem MPs reportedly threatening a rebellion, and Labour MPs suggesting amendments, here are the four key contentious issues that remain.
Unison warned last week that despite changes to the bill private patients could still leapfrog to the front of the queue for treatment , as lifting the cap on hospitals treating private patients would mean NHS Trusts under financial pressure would end up treating fewer NHS patients.
Lawyer Peter Roderick, who has been a vocal critic of the NHS Bill and submitted his concerns to the Department of Health, has claimed the Bill could set the “legal stage” for private companies to run “much of the NHS” as well as “for market forces to determine the way many health services are provided.”
The furore over competition – one of the more controversial elements of the very controversial Bill – has not died down in the wake of the Future Forum report. Dr Richard Lewis, a partner at Ernest and Young highlighted how the National Commissioning Board and Monitor would “be responsible for identifying how services should be ‘bundled’ and how tariffs for integrated services might be developed”.
Dr Lewis concludes: “This opens up the prospect of competition between providers of integrated care.”
Doctors’ union the BMA, agree. A spokesperson told Huff Post UK: “The legislation would still accelerate competition in the NHS without making clear what happens when providers fail. There’s not enough clarity around the duty of the Secretary of State to provide comprehensive services, nor around Monitor’s approach to competition and choice.
Andrew Lansley’s position
Independent lawyers have raised questions about if the Bill means the Health Secretary will no longer be responsible for the NHS. The Department of Health have firmly denied this, saying in a statement: “The Secretary of State will continue to be responsible – as now – for promoting a comprehensive health service”. But critics argue that these functions will be “greatly curtailed”.
An analysis by barristers from Harrison Grant solicitors and the specialist barristers Stephen Cragg and Rebecca Haynes for online campaign group 38 degrees indicated it removed his legal “duty” to provide an NHS, instead transferring it to consortia.
“Although some people will see this as a good thing, it is effectively fragmenting a service that currently has the advantage of national oversight and control, and which is politically accountable via the ballot box to the electorate.”
Labour have pointed out the Bill creates five news quangos: Monitor, The NHS Commissioning Board, Healthwatch England, Public Health England and Health Education England.
It also devolves responsibilities currently undertaken by Primary Care Trusts into five bodies; Clinical Commissioning Groups (previously referred to as consortia), PCT clusters, which will help commission primary care and dentistry, Clinical senates, Local authorities which will handle public health and Health and Wellbeing Boards, which will bring together public health and government.
A spokesperson for the BMA said this was excessive: “The changes that have been made in order to counter the lack of proper checks and balances in the original Bill have led to excessive complexity and bureaucracy.”