Intended for healthcare professionals

Observations Health and Social Care Act

Amend or repeal? How New Zealand tackled unpopular healthcare legislation

BMJ 2015; 350 doi: (Published 24 March 2015) Cite this as: BMJ 2015;350:h1502
  1. Ian Powell, executive director, Association of Salaried Medical Specialists, Wellington, New Zealand,
  2. Martin McKee, professor of European public health, London School of Hygiene & Tropical Medicine, UK
  1. ip{at}, Martin.McKee{at}

New Zealand has shown that unsuccessful, competition based health legislation can be repealed

It is now hard to find anyone in England who believes that the 2012 Health and Social Care Act was a good idea, with one senior Conservative politician branding it the greatest mistake of this parliament.1 There is, however, less agreement about what to do about it. The BMA has voted overwhelmingly for its repeal, doctors have formed a pressure group with the same aim,2 and Labour and Green MPs have introduced an NHS Reinstatement Act to repeal it.3

Yet others are more cautious, arguing that, although changes are needed, they should build on rather than tear up the existing legislation.4 They contend, firstly, that no one wants another major reorganisation and, secondly, that it is simply impossible to return to what went before.

Failure of the market model

The first argument has already been disproved, and major legislative change now seems inevitable. The complexities and contradictions of the competition elements of the Health and Social Care Act are seen as unworkable by many, and the roles of regulators such as Monitor and the Care Quality Commission are increasingly unclear. From the outset, general practitioners, seen as leading the new clinical commissioning groups, failed to engage with them.5 The large …

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