Intended for healthcare professionals

Head To Head

Will 1 April mark the beginning of the end of England’s NHS? Yes

BMJ 2013; 346 doi: (Published 26 March 2013) Cite this as: BMJ 2013;346:f1951
  1. David J Hunter, professor of health policy and management
  1. 1School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University, Durham, UK
  1. d.j.hunter{at}

You do not need to be a conspiracy theorist to conclude that from 1 April the NHS in England will never be the same again. The changes ushered in by the Health and Social Care Act 2012 are different in both scope and intent from anything to which the NHS has previously been subjected. The politics of reform and the desire among many influential government figures, notably the policy minister Oliver Letwin, to dismantle the NHS, should not be underestimated.1 What other reason can there be to explain the government’s stubborn resolve to railroad its proposals through a largely supine parliament? But, as Lucy Reynolds from the London School of Hygiene and Tropical Medicine puts it, this will be a quiet rather than a big bang, and for a time few using the NHS will probably notice any difference.2 If her analysis is correct, and it is well grounded in evidence, this is all part of the plan or, to be more accurate, plot.3

Gradual unravelling

Behind the NHS brand and logo a gradual and insidious hollowing out of what has up until now been a largely publicly provided service will get underway …

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