Health & Care Act

On July 1st 2022, the Health and Care Act ushered in 42 American-style Integrated Care Systems (ICSs). These independent regional health bodies were initially named Accountable Care Organisations (ACOs) like their American counterparts. The Act puts ICSs on a legal footing, effectively de-nationalises the English NHS and entrenches privatisation within it. This will harm patients and medical staff, while increasing profits for the long list of private companies, including American private health insurance giants, embedded in the NHS.

While Labour MPs voted against the legislation, the Labour leadership group failed to invest time and resources in educating the public on why Labour opposes the Act, or to speak up in favour of renationalising the NHS. Instead, Labour leader Kier Starmer declared his support for ‘partnering with the private sector’ to deliver healthcare, flagging up the split that exists in Labour Party. This is why it’s so  important for us to put pressure on both the main political parties!

Given the huge public support that exists for a universal, publicly-provided NHS, the Conservatives have no democratic mandate to impose American ‘managed care’ – a two-tier system made up of a publicly funded but privately provided tier with profits extracted by denial of care, and an expanded private insurance funded tier – on England. The privatising agenda of the Act was therefore obscured, sowing confusion among MPs, journalists and the public. To counter this, we have gathered together resources from some of the country’s leading experts on the NHS, which expose the serious dangers hidden in this legislation. This research shows that the Act:

  • Reduces access to medical services and emergency services.
  • Enables closures of services, pushing those who can afford to do so into paying for their healthcare.
  • Enables more public money to be diverted from patient care to private corporations and their shareholders.
  • Enables private companies to make decisions on allocating public healthcare budgets.
  • Completes the legal framework underpinning the transition of public healthcare assets into the private sector.
  • Moves us towards the United States model of privatised healthcare.
  • Abolishes the universal care guarantee long enshrined in the NHS.

The first piece of research comes from Professor Allyson Pollock and Peter Roderick from the Population Health Sciences Institute, Newcastle University. It was submitted to the Public Bill Committee in September 2021.

The second piece of research comes from the Health Policy Progress Group. It summarises the findings of a team of experts who studied the Bill on its way to being enshrined in law, and provides some vital historical context.

Health and Care Bill 2021-22

Professor Allyson Pollock and Peter Roderick


The Bill is a ‘hands-off Bill’ which goes in the wrong direction.

It fails to address the serious challenges facing the NHS, public health and social care. We cannot see it making any difference to reducing waiting lists and waiting times for services, to reducing staff shortages, or to providing adequate funding to rebuild and restore capacity in public health services. The ‘integration and innovation’ narrative is tendentious.

It will neither reinstate the Secretary of State’s duty to provide key services throughout England, abolished by the 2012 Health and Social Care Act, nor will it restore and rebuild public services which have been exposed as seriously deficient during the pandemic.

Instead the Bill:

  • replaces the principles of universal and comprehensive coverage throughout England with the limited concept of ‘core responsibility’ for specified groups of people and the conferring of ‘discretions’ on providers,
  • enables further reductions in and closures of services, pushing those who can afford to do so into paying for their health care,
  • will lead to some 40+ integrated care boards (ICBs) which will cover areas that are too large to ensure local and public accountability which has already been degraded over many years,
  • allows more privatisation and leakage of public money to shareholders with insufficient safeguards over how that money is used,
  • will lead to greater variation in provision, access to and levels of services,
  • allows private companies to make decisions on allocating public expenditure through their membership of ICBs,
  • reduces provision and access to medical services and emergency services,
  • further undermines the rights to life and health, and
  • conflicts with the NHS constitution.

We urge MPs to oppose it.


To read the full report by Professor Allyson Pollock and Peter Roderick, click HERE.

Concerns about the Health and Care Bill 2021

Health Policy Progress Group


The Health and Care Bill now in parliament is the culmination of a decades-long series of legislative steps which have repurposed the NHS away from its original Beveridge-model, tax-funded universal comprehensive care delivered by employees of the state.

It creates the legal platform for the final transformation of the NHS by exposure to market forces within a legal framework that advantages large private sector actors.

The result is designed to destroy GP provision and NHS hospital care as we have known it, and will result in less effective, patchier, costlier care in future.



The most strategically important legal changes buried in this legislation must be placed in historical context to be fully understood. In the 1980s, a privatisation blueprint was co-authored by Oliver Letwin and John Redwood — ‘Britain’s Biggest Enterprise’, which has been implemented by the various Acts of Parliament affecting the NHS since then.

The Health and Care Bill 2021 shows clear progression from the 2012 Health and Social Care Act, and no changes of direction away from the completion of the Letwin & Redwood NHS privatisation plan, which has over the last three decades deliberately brought the NHS to this point. It may have been helpful that Mrs Letwin reportedly became director of legal services at the Department of Health during this time.

This is not a Bill that could be amended to make it good, or even to make it barely acceptable: it is a privatisation bill. It needs to be discarded and we should instead seek legal changes which would move us toward restoration of Bevan’s NHS.

Further, it is important not to be confused by the current calls for more public money to pay for the NHS. The NHS has only become so expensive latterly because it is funding not only an unnecessary market administration, and Private Finance Initiative profiteers, but also an ever-increasing range of profit-driven health industry corporations.


To read the full report by the Health Policy Progress Group, click HERE.

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Background photo created by efe_madrid -