One of the most controversial elements of the despised Health and Social Care Act 2012 was the establishment of NHS England as an “arm’s length body”, or quango, as they used to be known.

The NHS Act 1946 set out the duty of the Minister of Health to provide, or secure the provision of, the services required for a comprehensive health service in England and Wales.

The Conservative-Liberal Government’s 2012 Act changed this fundamentally, to a duty to promote a comprehensive health service. At a stroke, this removed much of the ministerial accountability for the way in which services were to be delivered – “It’s not me guv: blame the doctors in the Clinical Commissioning Groups, or the bureaucrats of NHSE/NHSI/HEE!”

Power grab

The Times of 8th February (“No 10 in NHS power grab”), reported that the Government is developing legislation that would fundamentally reform the 2012 Act, rather than the more limited workarounds that Simon Stevens wanted to enable the formation of Integrated / Accountable Care Organisations.

The Prime Minister apparently wants to make sure that NHSE is “appropriately accountable to the Secretary of State and Parliament” and that ministers have “sufficient levers to direct and influence NHSE”. Bye bye arms’ length!

Calls to stop the NHS being a political football are not new, but a service that has such a profound part to play in the life of almost every person in the country, and which needs so much funding from the public purse, cannot be anything other than a political issue.

The competence and financial commitment of the government of the day should be open to public judgment at the ballot box. What is vital, however, is for the planning of the service to be based on a much longer timescale than the five-year electoral cycle.

This is not just the case with the NHS: a similarly long view needs to be taken in the response to climate change.

Commanded and controlled

Campaigners realise that bodies that were meant to offer opportunities for the public to influence local decisions – NHS Trusts, CCGs and Health and Wellbeing Boards – are nothing of the sort. They are commanded and controlled by NHSE.

That chain of command is currently strengthened by merging CCGs, aiming for one CCG per Integrated Care System.

Accountability for local services becomes increasingly remote and the ever greater involvement of commercial organisations in the planning, administration, and delivery of health services means that Freedom of Information requests can be refused on grounds of “commercial sensitivity”.

Things aren’t great at the moment, but are they about to get worse?

Is the Government intending to take power away from NHSE, but leave accountability with the quangos – so that the Government can pull the strings while avoiding blame when the wheels fall off?

Is there a wish to strengthen the disastrous experiment in offering up the NHS to market forces and commercialisation, and convergence with the US system?

Is this move simply another facet of the turf war which has just led to the resignation of the Chancellor?

It would be lovely to believe that this Government has finally realised the folly of the pro-market policies pursued by successive governments over the past thirty years, resulting in:

  • destabilisation and fragmentation of clinical services that take many years to build up;
  • wilful neglect of the need to train sufficient doctors, nurses and allied health professionals, to deliver universal healthcare in every community in the country;
  • the demoralisation of the existing workforce, by denying them the resources needed to deliver care to the appropriate professional standard;
  • the siphoning off of huge amounts of public money that should be supporting frontline services, into the pockets of middlemen and corporations whose primary aim is to extract the greatest profit possible;
  • patients falling through the gaps resulting from organisations working within the limits of responsibility set out in their contracts.


It would be lovely to believe that this Government has recognised that universal healthcare is a highly cost-effective investment in the people of this country.

It would be lovely to believe that this Government is planning legislation based on the NHS Reinstatement Bill, removing the profit motive from the NHS and harnessing the power of public service, which previously served this country well.

It would be lovely, but …

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