Professionals and policymakers give their thoughts on the act's implications and on campaigning for the future of the service
John Ashton: 'I'd like to see a royal commission on public health'
Having lived through seven reorganisations in the 20 years I have been a director of public health, and having been unable to make much progress in public health in Cumbria for the past 18 months due to the distractions caused by yet more structural change, the last thing I want to see is yet another reorganisation. Personally, I now need to recharge my batteries, and dedicate myself to making a difference in Cumbria, by delivering what we can within the law as it now stands.
Any change to the bill now needs to come from evolution, tidying up, and shaping. I would like the opposition to set up a shadow royal commission on public health. We desperately need a legal framework for public health that is fit for the 21st century.
This should not be a party political thing – rather, a royal commission could come up with a proposal for a new public health act, which would be of the enabling kind. It would encourage experimentation, and allow progressive local authorities to develop their own powers; others could then follow what emerged as best practice. Having said that, I am sympathetic to the notion of having health professionals stand for parliament [see Clive Peedell, below].
Andrew Lansley was billed as knowing more about the NHS than anyone else, whereas clearly he knew very little. It is right and proper to have people in parliament who know what they are talking about.
Dr Clive Peedell: 'We need a party to defend the NHS'
Despite the pre-election promises of "no top-down reorganisation" and the overwhelming opposition to the reforms from right across the NHS stakeholder spectrum, the coalition eventually forced through the legislation. Experts in health policy and public, commercial and constitutional law have published evidence in leading peer-reviewed medical journals explaining how this legislation (despite late amendments) will lead to the abolition of the NHS in England. It facilitates the transition from a single taxpayer-funded system to a mixed funding system, with increasing privatisation of the provision and commissioning of healthcare in England.
For this reason, a group of doctors has decided to form a single issue political party to defend the NHS and its founding principles. We hope to stand at least 50 NHS professionals as candidates at the next general election, believing that there is a rising public appetite to vote for independents. We were delighted to see that Lord Ashcroft's recent poll published on Conservative Home put us in third place on 18%, before we have even formed as a party. We would have the added advantage of not being subjected to party whips and would vote in the interests of the public good, not our political and corporate masters. We plan to tactically select seats to take on coaliton MPs who betrayed the NHS.
We are already overwhelmed by the amount of support we are getting from the public and healthcare professionals. If we can keep up the momentum, we strongly believe we can win seats, and the more seats we win, the more influential we can become in making parliament more accountable to the people.
David Owen: 'We were lied to at the general election'
For nine months this NHS bill has dominated my timetable and now there is nothing more that I can do. It will be reversed only if the coalition breaks up, say in 2013, or loses the general election in 2015. I will of course help if Labour needs advice to develop specific amendments to return the NHS in England to an internal market and remove all aspects of an external market. Some of these aspects were developed under Labour in government. Any such action needs to be specific and detailed but not involve total repeal and yet another costly reorganisation from which the NHS has suffered enough. For example, keep the National Commissioning Board and Monitor but strip them of powers to commercialise and marketise healthcare.
Legislation would need to be passed very quickly on coming into power – for example if Labour comes into power prior to a 2015 general election under the Fixed Term Parliament Act. What is needed soon, therefore, is a Save Our NHS Plan for specific emergency action. No generalities. No waffle. But an injunction for "Action this Day". Only such a forensic approach will carry conviction within the NHS, whose staff are punch-drunk and suspicious of any political promises having been lied to at the last general election.
Director of public health (anonymous): 'We need a NHS restoration bill'
The campaign starts now for an NHS restoration bill recreating a socially owned NHS led by health professionals accountable to the people. The current act removes socially accountable organisations from any special place in the NHS and prohibits GPs from preventing privatisation of provision. Once healthcare is defined as a commodity the state buys, not a service it provides, EU competition laws apply more strictly, creating procurement bureaucracies. In the Netherlands competition authorities raided GP premises to stop them favouring local hospitals.
Clinical commissioning should be retained but without the oversight of these market regulators. Further reorganisation is unnecessary but the regulatory framework should be swept away. Our NHS should be run by parliament, the professions and the people, not by market economists, procurement bureaucrats and commercial lawyers.
An NHS restoration bill should not just go back to 2006 but must correct some of the defects in the NHS – extending democracy, establishing a universal occupational health service, and empowering local communities to address health issues.
The campaign against the current act must transform itself naturally into a campaign for a restoration bill – public awareness was late coming, was still building and must not ebb. In clinical commissioning groups and health and wellbeing boards problems created by the act can be exposed, resisted and, where possible, ameliorated.
The Health and Social Care Act 2012 must not remain. The campaign to save the NHS did not end at royal assent.
• This piece is written by a director of public health who, due to restrictions created by the act, does not wish to be named until after the close of poll in the current local government elections
Dr Alex Scott-Samuel: 'This is the health resistance'
The Health and Social Care Act is now law – and the health resistance is up and running. A website is being set up to log accounts of inadequate and poor quality care and charging for NHS services. I have produced a leaflet – The Courage to Refuse – for use in sympathetic GPs' waiting rooms and other NHS settings — which encourages patients to request GP referrals only to publicly provided services. Ideas are also needed re civil disobedience, nonviolent direct action and other legal means of challenging the government's healthcare market. Uncut, Occupy and other resistance groups need rapidly to co-ordinate NHS-related activities.
A privatisation indicators set and baseline data are also required to begin monitoring the impacts of the destruction of our NHS. Hopefully the alliance of medical royal colleges, professional associations, trade unions and political parties whose intervention was largely too late to save the NHS will support this.
Lucy Reynolds: 'The defects of this McNHS reform will emerge'
Those acquainted with the Health and Social Care Act know that it isn't written to improve service delivery, but to provide profit streams for investors, insurers and hospital chains. The responsibility of NHS staff is to protect patients' interests, because Healthwatch England lacks teeth. They can do that by escalating patient concerns through the system, and by keeping publishable records to document soaring costs and deterioration of care within the new system.
The leaked transition risk register gave odds of four to one that "dismantling the current management structures and controls [causes] more failures". It notes that mitigating actions are needed but lacking.
As the defects of this McNHS reform manifest, we should consider the Scottish mutual model developed since 2004, when statistics showed that market-based arrangements cost more. They removed the Westminster-mandated purchaser/provider split and set up 14 regional health boards to administer a collaborative, affordable integrated health system. It was subsequently found that the Scottish mutual NHS has outperformed the partially-marketised English NHS on the index indicator of health service quality, infant mortality and on key efficiency measures including waiting lists and patient satisfaction.
Cheerleaders for "liberating the NHS" insist that the current reforms should proceed. The risk register confirms that the sooner we follow the more efficient path of our northern neighbours, the better for our health and wealth.
Clare Gerada: 'GPs remain committed'
What has to happen now is to focus on stabilising the NHS and addressing the serious problems facing us all – namely reducing budgets, increasing demand and increasing complexity of care. The Royal College of General Practitioners (RCGP) has always argued that it is time for a national debate as to what the NHS should provide, how it should be provided and how we deal with the big issues such as improving end-of-life care, supporting the increasing numbers of frail elderly living alone and reducing the health burdens created by alcohol, obesity and smoking.
General practitioners have always been at the heart of the NHS, and its most trusted representatives. After all, when someone talks about "my doctor" they almost invariably mean their GP.
As the chair of the RCGP, I know that our members have never weakened or faltered in their commitment to the NHS. It is important that as their professional body we continue to have a voice in the future of the health service, particularly when difficult choices have to be made.
Bernice Boss: 'Others should be inspired by our campaign'
This heartbreaking act fragments the health service I've spent my life working in. I support calls for its repeal, and will be upping the political (and if necessary legal) pressure on both outgoing (PCT) and incoming (CCG and CSS) health bosses, to listen to the public wishes, and keep our health services public. Last month in the high court, 76-year-old Michael Lloyd and his lawyers, stopped Gloucestershire PCT transferring nine hospitals and 3,000 nurses and health workers out of the NHS. Large demonstrations and public meetings organised by Stroud Against the Cuts and other anti-cuts groups raised awareness and funds for the challenge. The PCT found it could not lawfully simply hand over NHS services to a "social enterprise" or "community interest company" – essentially an unaccountable, expensive, bureaucratic and vulnerable private company. The consent order also established that, contrary to the developing mythology, commissioners can choose not to outsource, and should consider the perfectly legal option of giving services to another NHS trust without need for a full competitive tender. We hope others will be heartened and inspired by our community campaign.