Intended for healthcare professionals

Observations Health and Social Care Act

The future of England’s healthcare lies in the hands of competition lawyers

BMJ 2013; 346 doi: (Published 15 March 2013) Cite this as: BMJ 2013;346:f1733
  1. Martin McKee, professor of European public health, London School of Hygiene and Tropical Medicine
  1. martin.mckee{at}

The government’s revised regulations on competition in the NHS have removed much of the initial clarity and are ambiguous in several places

The Health and Social Care Bill that the government sprung on an unsuspecting electorate in January 2011 attracted much criticism but had the advantage of clarity of purpose. It envisaged a competitive market in which healthcare would be purchased from any willing provider, regardless of the provider’s experience.

Faced with widespread criticism that it could lead to privatisation of most healthcare, fragmentation, and huge administrative costs that would suck resources from the care of patients, the government paused to engage in a “listening exercise.” Many words were changed in the revised bill; any “willing” provider became any “qualified” provider, albeit unspecified. New lines of accountability were introduced but confounded those seeking to represent them on paper. A widespread view was that the revisions had created confusion rather than clarity. The critics maintained that the bill’s fundamental goal of privatisation remained and predicted that this would become apparent when the government published the regulations needed to implement it.

In February 2013, only a few weeks before the act was due to come into force, …

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