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Feature NHS Reforms

The Health and Social Care Bill: 10 things for the Lords to consider

BMJ 2011; 343 doi: (Published 28 September 2011) Cite this as: BMJ 2011;343:d6082
  1. Edward Davies, editor
  1. 1BMJ Careers, London WC1H 9 JR, UK
  1. edavies{at}

Although the NHS bill has passed the first hurdle, the House of Lords could still force further changes. Edward Davies highlights some of the remaining controversies

After a third reading and heated debate in the House of Commons, the Health and Social Care Bill was passed by 316 votes to 251 on 7 September. It received its first reading in the House of Lords, little more than a formality, the next day but will be subject to far more rigorous debate at its second reading in October. Despite more than 1000 amendments in its near 600 pages, many individuals, groups, and organisations still harbour grave concerns. Here we look at 10 of the outstanding questions that the Lords will want to consider.

1. Privatisation

“Privatisation” has become the central battle ground of the reforms. The bill is unashamedly supportive of markets and competition, with the government believing that this is the best way to improve the quality of NHS services. But the word “privatisation” has been interpreted and objected to in many ways.

Some health unions vociferously opposed the bill on the basis that it is the first step down a road to a fully private insurance system like that in the United States.1 Others do not believe this will happen but are still forcefully arguing that the bill amounts to privatisation. Writing in the BMJ, Clive Peedell, co-chairman of the NHS Consultants’ Association, claimed that “the World Health Organization has defined privatisation in healthcare as “a process in which non-governmental actors become increasingly involved in the financing and/or provision of healthcare services” and as such the bill was clearly a move in this direction.2

Although amendments to the bill have softened the language, much of the central drive remains the same. However, both Conservative and Liberal Democrat ministers …

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