Intended for healthcare professionals


BMA calls for repeal of “intensely damaging” health act

BMJ 2014; 348 doi: (Published 01 April 2014) Cite this as: BMJ 2014;348:g2532
  1. Zosia Kmietowicz
  1. 1BMJ

The BMA has renewed its call for the Health and Social Care Act 2012 to be repealed, saying that the changes imposed on the NHS in England were needless and expensive and have failed to deliver any improvements for patients.

A year after the act was introduced the BMA has questioned whether it is working. It is also calling on doctors to report their experiences of the changes brought by the act and asking them what more needs to be done to allow them to deliver optimal care to patients.

The campaign follows pressure from some doctors, who have been calling for a national strategy to repeal the act since it was passed in March 2012.1 2 Implementing the changes is thought to have cost the NHS between £1.5bn (€1.8bn; 2.4bn) and £1.6bn.3

Mark Porter, the BMA’s chairman of council, said, “The damage done to the NHS has been profound and intense. Consequently, the BMA has taken the concerns expressed by doctors, among others, and calls for the repeal of this act. What we need now is an honest and frank debate over how we can put right what has gone wrong without further top-down reorganisation.”

The campaign, called “Health and Social Care Act—is it working?” highlights three chief areas of concern. It says that competitive tendering is creating significant and unnecessary work for commissioners; that the dual role of the regulator Monitor to drive integration and competition is failing to improve care; and that the Office of Fair Trading is not an appropriate body to make decisions about mergers within the healthcare sector.

Porter said, “For a government that campaigned on cutting bureaucracy and red tape, the introduction of the Health and Social Care Act achieved the very opposite. With costs running into the billions, it needlessly shook up the fabric of the NHS with very little gain at the end of it.

“The test for any government health policy should be whether it benefits patients, and while no one wants to see another wholesale reorganisation of the NHS, doctors remain concerned that key aspects of the act and how they are being implemented could threaten patient safety—nothing more so than the emphasis on competition over integration and its failure to improve patient care, a concern echoed by Sir David Nicholson, the outgoing head of NHS England, and the millions already wasted on lawyers as commissioners struggle with the changes.”

Porter said that the Office of Fair Trading, whose expertise lies in ensuring consumer choice in private markets, has no place in the NHS. Decisions about how services were organised should be led by clinicians and not the OFT, which overturned the proposed merger between hospitals in Bournemouth and Poole last October despite support from the local community, healthcare commissioners, and clinicians.4 A BMJ investigation showed that the case cost the NHS almost £2m (€2.4m; $3.2m) in legal and consultancy fees.5

Porter added, “All of this comes as the NHS continues to be used as a political football despite the government’s assurances that it wants to ‘free NHS staff from political micromanagement.’ We have seen doctors openly criticised by ministers, attempts to force through change such as in Lewisham made for political expediency, and even claims that there are attempts to manipulate NHS England for political purposes.”

The BMA was due to hold a meeting on 1 April, the day the BMJ went to press, with three former health secretaries, Andy Burnham, Stephen Dorrell, and Frank Dobson, along with the former health minister Paul Burstow, to discuss the impact of the act so far.


Cite this as: BMJ 2014;348:g2532


View Abstract