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.