by Professor Allyson Pollock, professor of public health research and policy at Queen Mary, University of London
The Health and Social Care Bill 2011 represents the biggest threat to public health for 60 years and it is time for the public health community to stand up and say so.
Deliberately conceived as an ‘Abdication and Abolition Bill’, the proposed legislation would sever the duty of the Secretary of State to secure and provide comprehensive healthcare throughout England.
Entitlements to health care are to be abandoned in order that a consumer market can be substituted for a needs-based system and, in David Cameron’s words, the NHS turned into a “fantastic business for Britain”.
As these briefings to the House of Lords show, the Bill will destroy the public health foundations of comprehensive healthcare and the ability to gather information and monitor inequalities.
Geographic administrative units – the hallmarks of the NHS – are to be abolished. Whilst commissioner populations will be made up from GP registrations, GP boundaries are being dissolved. Patient enrolment and disenrollment will lead to unstable denominators and render fair service allocation and planning impossible.
No-one will have ultimate responsibility for ensuring everybody in a geographic area gets access to a GP. Above all, the ability to monitor equity of access within a comprehensive system will be undermined by lack of data and local variations in entitlement.
Public health will be shunted out to local authorities but the resources, functions and services that will go with it are not defined. It is even impossible to tell the populations for which it will be responsible.
Local authorities and clinical commissioning groups will have enormous freedom to decide what they will and won’t provide and the boundaries between chargeable and non-chargeable services will be blurred and subject to local eligibility criteria.
In place of equity will be service and patient selection by commissioners and service providers intent on managing the financial risks of the marketplace. Commissioners will be allowed to outsource their functions to healthcare companies that specialize in these techniques.
The marketisation of healthcare will lead to the denial of care on a scale not seen in England since pre-war days.
At a minimum the Bill must be amended so as to restore all the Secretary of State’s duties and functions and the structures of a national public health service.
Better Health For All 
To give a tangible example… I am very concerned about vaccination. There are clear targets for vaccine uptake, to ensure that PCTs give it the priority it deserves (far better to spend a few pounds on a fence to stop people falling off the cliff than hundreds on ambulances to pick up the pieces of people who’ve fallen; vaccination is extremely good value-for-money compared to most other healthcare interventions).
I know from my work with local authorities that they have many things that they “must do” – and they are not adequately resourced to do all of them. They have therefore had to acquire a thicker skin when it comes to shrugging their shoulders and not doing something they are told they must do.
My concern is that once the responsibility for vaccination moves from PCTs to local authorities, they will consider the benefits of vaccination to be too far in the future to be worth bothering about, given the urgent need for money to spend on other things, and give it a lower priority.