UK Parliament / Open data

Outsourcing and privatisation in the NHS

Commons Debate pack by Alex Bate. It was first published on Wednesday, 23 May 2018. It was last updated on Wednesday, 23 May 2018.

The motion proposed for the opposition day debate on outsourcing and privatisation in the NHS is as follows:

That an humble Address be presented to Her Majesty, that she will be graciously pleased to give directions that the following papers be provided to the Health and Social Care Committee: written submissions received by Ministers since 8 June 2017 on proposals for reform of the Health and Social Care Act 2012, on the creation of accountable care organisations in the NHS, and on the effect of outsourcing and privatisation in the NHS including the creation of wholly-owned subsidiary companies; and minutes of all discussions on those subjects between Ministers, civil servants and special advisers at the Department of Health and Social Care, HM Treasury and the Prime Minister’s Office.

The motion refers to proposals for reform of the Health and Social Care Act 2012. It has recently been reported that reforms to the Act are being considered by the Government, as part of a potential new 10 year funding settlement for the NHS:

BBC News, NHS reforms that could be on the way out, 22 May 2018
Health Service Journal, Government not planning to repeal Lansley legislation, 22 May 2018

The Health and Social Care Act 2012 introduced wide-ranging reforms across the NHS, including the creation of local Clinical Commissioning Groups and the creation of NHS England, giving the NHS operational independence from Government for the first time.

The Department of Health produced a range of fact-sheets about the impact of the Act in 2012, covering areas including clinically-led commissioning, choice and competition, provider regulation, public health and the reconfiguration of services.

The Commons Library briefing paper, The Structure of the NHS in England, also looks at the impact of the 2012 Act. For further reading on the Act, the following resources may be of interest:

The King's Fund, The NHS after the Health and Social Care Act
Full Fact, "The end of the NHS as we know it"? A guide to the Health and Social Care Act, 28 March 2013
The Nuffield Trust, The coalition Government's health and social care reforms: 2010-2015

The issue of outsourcing and privatisation is explored in the April 2018 Commons Library debate pack E-Petition 205106 "Stop the privatisation of NHS services", which covers areas including:

Impact of the Health and Social Care Act 2012
Definitions of privatisation in the health service
Wholly-owned subsidiary companies.

Wholly-owned subsidiary companies are companies created by NHS foundation trusts, usually for the management of services like estates or maintenance, which are fully owned as private companies by the trust. More information can be found in the following resources:

In January 2018, an Early Day Motion on subsidiaries was tabled, referring to their creation as 'backdoor privatisation'.
In March 2018, a Westminster Hall debate was held on NHS Wholly Owned Subsidiary Companies
In April 2018, the Chief Executive of NHS Improvement, Ian Dalton, wrote to the Public Accounts Committee on this issue.

The motion also refers to Accountable Care Organisations (ACOs). An ACO is a model of healthcare provision where a provider, or group of providers, takes responsibility for the healthcare provision of an entire population. The organisation usually receives an annual, capitated budget to deliver contractually agreed health outcomes. More information can be found in the Commons Library briefing paper on Accountable Care Organisations (March 2018). The following resources may also be of interest:

NHS England, NHS England announces consultation on ACO contracts, January 2018
Department of Health and Social Care, Consultation outcome - accountable care models contract: proposed changes to regulation, April 2018
Health Service Journal, NHS England wins judicial review over ACO contract, 15 May 2018

There have also been a number of reports on privatisation and outsourcing in the NHS by healthcare organisations and think tanks, including the following: