Letters NHS reforms

Issues MPs and the media have missed in Lansley’s bill

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d3194 (Published 24 May 2011) Cite this as: BMJ 2011;342:d3194
  1. John R W Lister, senior lecturer in health journalism and health policy, Coventry University1
  1. 1Oxford OX4 7UR, UK
  1. john.lister{at}virgin.net

The Commons Public Accounts Committee review makes damning criticisms of Lansley’s deeply flawed Health and Social Care Bill, exposing the shallowness of parliamentary scrutiny.1 But it fails to note that the bill would end the accountability of the secretary of state for the continued provision of health services and ignores the loss of local accountability.2

GP consortiums, the NHS Commissioning Board, and health and wellbeing boards are not required to meet in public, publish board papers, or consult locally on changes. Nor are foundation trusts directly accountable to parliament—parliamentary questions are not answered by ministers but referred to the trust chair.3

Monitor has argued that foundation trusts should focus on services that deliver a surplus and pull out of services that don’t.4 Consortiums do not need to ensure that an appropriate range of services is accessible in each area. Instead “any qualified provider” approved by Monitor can compete to provide services anywhere they choose, regardless of the impact on struggling foundation trusts. Monitor’s primary brief is to maximise competition. GP commissioners would have no say over which companies would be included in the register.

Primary care trusts have drawn up long lists of “low priority” treatments no longer routinely covered by the NHS, including hip and knee replacements.5 Nothing in the bill deals with these gaps in NHS provision, leaving patients confronting a brutal choice: go private or go without.

The bill would also scrap limits on how much foundation trusts can raise from private medicine. Some trusts will focus on commercial services to paying customers, leaving NHS patients—for whom trusts receive declining tariff payments—to wait.

If these questions are not raised, MPs could push the bill through in a haze of public ignorance and misinformation.


Cite this as: BMJ 2011;342:d3194


  • Competing interests: None declared.


View Abstract