Letters The three crises facing the NHS in England

Abolishing the internal market to save NHS costs

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5990 (Published 11 November 2015) Cite this as: BMJ 2015;351:h5990
  1. Nigel Speight, paediatrician1
  1. 1Durham, UK
  1. speight{at}doctors.org.uk

Ham clearly describes the scale of the financial crisis facing the NHS and rightly points out that a greater proportion of Gross Domestic Product could easily be justified in helping to resolve some of these problems.1

However, one easy solution is already available, and this is to abolish the internal market once and for all.

In 2010 the Select Committee on Health divulged that even under the Labour government the cost of administering the purchaser-provider split was 14% of all NHS spending (speech by Dr Richard Taylor MP, who served on the select committee, to the NHS Consultants Association’s annual general meeting). The current cost must have risen to around 25% with all the costs of commissioning and tendering. The only purpose of the internal market was to soften up the NHS for privatisation, and it should now be abolished. Scotland and Wales have already successfully abolished the market and have diverted the funds saved to patient care.

To this end, the profession should be putting its weight behind the NHS Reinstatement Bill, which includes the above measures as a key element. It comes up for its second reading in March.


Cite this as: BMJ 2015;351:h5990



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